ASSEMBLY AND HEALTH SENATE
HEALTH COMMITTEES- HEARING ON
AT THE CALIFORNIA'S HEALTH
INSURANCE MANDATES AN ESSENTIAL
HEALTH BENEFITS SOMEONE WELCOME
EVERYONE HERE TODAY- THIS
HEARING IS TO- TODAY'S RECEIVE
A BRIEF OVERVIEW OF
CALIFORNIA'S HEALTH INSURANCE
MANDATES INCLUDING ESSENTIAL
HEALTH BENEFITS WE WERE INVITED
REGULATORS COVER CALIFORNIA THE
CALIFORNIA HEALTH BENEFITS
REVIEW PROGRAM HEALTH PLANS IN
CONSUMER REPRESENTATIVES. TO
DISCUSS HEALTH INSURANCE
BENEFIT MANDATES ALSO THE-
ANTICIPATE SOME PEOPLE MAY
WHICH MAKE PUBLIC COMMENT- FROM
MANY WHO BELIEVE EXISTING
COVERAGE IS NOT ADEQUATE AND
OTHERS WHO ARE CONCERNED ABOUT
THE IMPACT PREMIUMS FROM DATING
COVERAGE FOR MORE SERVICES. AND
OUR HOPE IS THAT THIS HEARING
WILL LAY THE FOUNDATION FOR
DISCUSSIONS OKRA KERR INCOMING
BUT SO IS THE LAW THE
DELIBERATE. LEGISLATION I GUESS
I SHOULD INDICATE- THAT IN A
RELEASE- THROUGH THAT TO HAVE
FIVE CARE WOULD HERE THAT- AS
OUR MUTUAL COMMITTEE CHAIR WE
THINK IT'S A MOMENT FOR OF.
FLAT. MANY OF THESE ISSUES IN
THE- THREE HAVING THIS
INFORMATIONAL AND ALSO FOR
PUBLIC. WE HAVE A SIGN LIST NOT
SORRY JUST LOOKING RIGHT NOW SO
FOR PUBLIC HAVE COME TO THE
MICROPHONE. ALL RIGHT SO WELL
BUT THAT I'M GOING TO OPEN UP
WITH THE NEW TO REMOTE ON
HEARING ONE OF TEACHER WOULD
TO. A THIS HERE WITH HIS
OPENING. WELCOME THANK YOU.
THANK YOU TENER PAN AND I THINK
THIS IS A REALLY TO. DISK FOR
FULL THANK YOU FOR ALL FOR
BEING HERE WE'RE LOOKING AT
MANY HEALTH CARE ISSUES THIS
YEAR- SPECIALLY HEALTH CARE
AFFORDABILITY. AND HOW WE CAN
CONTAIN HEALTH CARE COSTS. SO
THE MANDATE DISCUSSION KIND OF
FITS WITHIN THE PRIORITIES-
WITH WITHIN THESE PRIMARIES
IT'S HELPFUL TO ROOM BE
REMINDED OF OUR CURRENT
MANDATES. AND HOW WE CHOSE ARE
ESSENTIAL HEALTH BENEFITS.
ESPECIALLY IMPORTANT AS WE SEE
NEW PROPOSALS TO ADD- HEALTH
CARE MANDATES OUTSIDE THE
CURRENT. ESSENTIAL HEALTH
BENEFIT PACKAGE. WE NEED TO
UNDERSTAND THE IMPACT OF ANY
NEW BENEFITS AND THEN
ULTIMATELY THE COST TO THE
STATE SO- I'D LIKE TO I SEE. IN
THIS WAY. WANTS TO SPEAK AROUND
TAKE OVER THE MEETING HERE BUT
MISSED WOULD YOU WOULD YOU
HAVING. THE CARD THANK YOU I'VE-
THAT WERE THIS HEARING. WE SEE
THAT HEALTH CARE AND THE WAY WE
PROVIDED- EVOLVES OVER TIME AND
IT'S GOOD TIME TO REVISIT THIS
AND LOOK AT THESE ISSUES. THANK
YOU AND I JUST WANT TO BEFORE
WE BRING UP OUR FIRST PANEL MAY
REFLECT A LITTLE BIT ON- SOME
WAYS HOW WE GOT WORRIED GUIDE
SO- SO WHEN. CALIFORNIA DECIDED
TO EMBRACE THE ACA- THE FOR
CARE ACT- WE DID- WE WERE
REQUIRED BY FEDERAL LAW TO
IDENTIFY- A PLAN THAT FORM THE
ESSENTIAL HEALTH BENEFITS SO
THE LAW- IN TERMS OF HOW TO
DETERMINE THE TERM THAT. IN THE
PROCESS OF DOING THAT I HAD THE
OPPORTUNITY IS AT THAT TIME I
WAS CHAIR OF THE ASSEMBLY
HEALTH COMMITTEE WORKING WITH-
CENTER HERNANDEZ WAS DURING THE
SENATE HEALTH COMMITTEE- YOU
KNOW- AND OTHER- LEGISLATORS AS
WELL NO WE- WE ACTUALLY SAID
WELL. THERE'S WE'RE TRYING TO
FIGURE THIS OUT- WE REALLY HAVE
TO LOOK AT IT SERVE
COMPREHENSIVELY AND- NO AND THE
AS THE YEARS HAVE GONE BY I
THINK SOME OF THE CHALLENGES IS
THAT- YOU KNOW PEOPLE DO
IDENTIFY GAPS IN COVERAGE DâN
DELPHI THINGS THAT. THAT THAT
HAVE BEEN CHALLENGING FOR
PATIENTS- AS WELL- TO- TO
RECEIVE HELP IN- AND OF COURSE
THEY DO TURN TO THE LEGISLATORS
TO TRY TO HELP OUT- AND
CERTAINLY WE WANT TO TRY TO BE
HELPFUL. AT THE SAME TIME WE
ALSO LOOK AT THE LARGER PACKAGE
SO IF FOR EXAMPLE JUST A YEAR
AND I WANT TO THANK. WITH HIS
LEAD. TO GET THIRTY TWO. BASIC
TYPES HOW DO WE SELL STABLE.
THE AND WE'VE YOU KNOW WE
PASSED A PENALTY FOR A STATE
PANEL TO. IN THE MANDATE AT THE
AC BUT THAT MAY WE'RE NOW
REQUIRING PEOPLE- TO GET
COVERAGE THAN WE HAVE TO
THEREFORE BE VERY CONSCIOUS OF
WHAT THE COST IS AND THAT'S
WHAT WE ALSO. ADOPTED SUBSIDIES
IN FACT I'M PROUD TO SAY COVER
CALIFORNIA RECENTLY SAID THE
ONLY. LARGE INCREASE IN PEOPLE
AND ROLLING IN OUR COVER
CALIFORNIA PLANS THIS YEAR
THANKS TO THE POLICY DECISIONS
WE MADE. THAT ALSO BY THE WAY
LEAD TO A- LESS THAN 1%
INCREASE ON AVERAGE FOR COVERED
CALIFORNIA PLANS. FOR THIS PAST
YEARS WELL AND- SO THAT'S WHAT%
WE WERE ABLE TO ACHIEVE AS WELL
AND SO I THINK THOSE ARE
IMPORTANT ACHIEVEMENTS BUT
THOSE DON'T HAPPEN IN
ISOLATION. AND THAT'S WAY. WELL
WE- WERE ABLE TO DO THOSE
THINGS WE ALSO VERY CONSCIOUS
OF. HE P. I'D SHOP JUST. IS
HAVE SOMETHING THE AC OVER
THESE ANY YEARS AND TRY TO DO
SUCCESSFUL IN PAST. EVEN AGAIN.
SOME PRESSURE YOU KNOW SOME
DECISION MADE IT SO LEVEL WOULD
THREATEN TO DESTABILIZE ARE
ACTUALLY DRIVE UP COSTS AND ON
MARKET TO TAKE THOSE STEPS. AND
WE NEED AND SO THAT THIS
HEARINGS THE TIME OF IT'S BEEN
MANY SINCE SORT OF KIND OF TALK
ABOUT THIS ISSUE MORE
COMPREHENSIVELY. TODAY TO HAVE
THIS CONVERSATION TODAY. AND
AGAIN I REALLY WANT TO SHE OUT
COMING TO TEST IN ALL OF YOU
WHO ARE. TO LISTEN TO THE
DISCUSS. SO WITH THAT. YEAH
OKAY. THANK YOU DOCTOR PAN I.
AGREE MORE ON MANY THE POINTS
YOU YOU WERE AT THE TIME WHEN I
LOT US WAS. IN THE AND INFANCY
IN NOW WE ARE WELL PAST THAT
SOME PRETTY AND- NUMBER FOR
COVER CALIFORNIATHIS YEAR BY
WAY TO FOR. EIGHTY TH. I
BELIEVE IS THE NEW NUMBER WHICH
IS A IS A- STE. FOR FROM PAST
AND HERE WE IN A STATE WHERE
WERE SO ADVANCE. IN THE AREA
WELL STATES CONTINUES SO WE'VE
WERE CLEARLY DOING SOMETHING IN
THE RIGHT DIRECTION. I THINK
IT'S OUR JOB TO MAKE SURE WE
CAN MAKE MAKE IT MAKE SURE THAT
THE MAIN MAIN STABLE
AFFORDABLE. AND DELIVERS ON THE
PROMISE TO CALIFORNIANS SO.
WE'D LIKE TO BRING UP A PANEL
OF THE FIRST PANEL IT'S GONNA
BE. HERE IN BRING UP A BUNCH OF
PEOPLE HERE SO- FORCE WE HAVE A
BUNCH OF PLACES FOR PEOPLE TO
SIT. SO FROM PERSONAL WILL BE A
JUDGE PHILLIPS THE DEPUTY
DIRECTOR OF LEGISLATIVE AFFAIRS
DEPARTMENT MANNISH- MANAGED
HEALTHCARE. BRUCE HANDS THE
SENIOR POLICY. ATTORNEY. HOUSE
IN REFER BRANCH CAL. APARTMENT
IN JAN. FELL OFF FILLS ON. THE
F. OUR AROUND EXCUSE ME. I'M
GLAD IT'S NOT THAT DOES A HAVE
A PATTERSON RIVER IT FOR THIS
JOB. AND THE DEPUTY TO FOR
MANAGED DIVISION AND GEAR IN
COURT WITH THE CALIFORNIA
HEALTH BENEFITS REVIEW PROGRAM.
SO START IN THE OVAL WILL GO
THROUGH THE ORDER ACTUALLY THAT
WE CALLED IT OUT SO PLEASE I
WHENEVER YOU'RE READY. THIS
PHILIPS. THANK YOU SO THANK YOU
SENATOR PAN ASSEMBLY MEMBER
WOULD AND COMMITTEE MEMBERS FOR
INVITING THE DEPARTMENT OF
MANAGED HEALTHCARE HERE TODAY
MY NAME IS JENNY PHILLIPS AND-
I WILL PROVIDE AN OVERVIEW OF
THE BENEFITS HEALTH PLANS MUST
PROVIDE UNDER CALIFORNIA LAW.
WILL ALSO DISCUSS ESSENTIAL
HEALTH BENEFITS. AB WHICH ARE
REQUIRED UNDER BOTH FEDERAL AND
STATE LAW. SO THE DIMINISH THE
REGULATES THE MAJORITY OF
HEALTH COVERAGE IN CALIFORNIA
INCLUDING ABOUT 96% OF
COMMERCIAL AND PUBLIC HEALTH
PLAN ENROLLMENT. THIS INCLUDES-
ALL MANAGED CARE MODELS LIKE
AGING MOST PPO THOSE AND OTHER
COMMERCIAL DESIGNS AS WELL AS
MOST OF THE MEDI CAL MANAGED
CARE PLANS WE REGULATE HEALTH
PLANS BY REVIEWING AND
APPROVING HEALTH PLAN DESIGNS
OR PRODUCTS TYPICALLY CALL
THEM- INSURING FINANCIAL
STABILITY SO MAKING SURE PLANS
ARE PAYING FOR WRITERS-
MONITORING PROVIDER NETWORKS
AND- AUDITING PLAN PROCESSES.
THE DAMAGE THE ALSO ASSIST
CONSUMERS BY RESOLVING
COMPLAINTS WITH HEALTH PLANS
AND ENSURING CONSUMERS ACCESS
TO MEDICALLY NECESSARY HEALTH
CARE SERVICES- WE ENSURE
COMPLIANCE WITH THESE
REQUIREMENTS THROUGH OUR
ENFORCEMENT PROGRAM. WITH THAT
IN MIND- I'LL JUMP IN AND
FOCUSED ON THE TYPE OF BENEFITS
THAT HEALTH PLANS MUST COVER.
SO ALL FULL SERVICE HAVE A
COMMERCIAL HEALTH PLANS
INCLUDING THOSE IN THE
INDIVIDUAL SMALL GROUP AND
LARGE GROUP MARKETS. MUST
PROVIDE ADAM MINIMUM BASIC
HEALTHCARE SERVICES BASIC
HEALTHCARE SERVICES ARE DEFINED
AS PHYSICIAN SERVICES INCLUDING
CONSULTATION AND REFERRALS
HOSPITAL INPATIENT SERVICES AN
AMBULATORY CARE SERVICES.
DIAGNOSTIC LABORATORY AND
DIAGNOSTIC THERAPEUTICAL
RADIOLOGICAL SERVICES HOME
HEALTH PREVENTIVE HEALTH
EMERGENCY CARE SERVICES WHICH
INCLUDE ABLE AS AN ABLE AS
TRANSPORT TO RESIST AS WELL AS
OUT OF AREA COVERAGE. AND
HOSPICE. SO THESE ARE THE CORE
SIDE A BROAD SCOPE BENEFITS
THAT ACTUALLY PREDATE THE
AFFORDABLE CARE ACT AND ARE THE
CORNERSTONE OF MANDATED
COVERAGE UNDER THAT
CALIFORNIA'S KNOCKS KEEN ACT.
IN FACT HEALTH PLANS HAVE BEEN
REQUIRED TO COVER BASIC
HEALTHCARE SERVICES SINCE THE
NINETEEN SEVENTIES- I WOULD
JUST STOP HERE NOTE THAT THE
DEFINITION OF BASS CAN BASIC
HEALTHCARE SERVICES DOESN'T
ACTUALLY INCLUDE A PRESCRIPTION
DRUGS. AND WE'LL TALK A LITTLE
BIT ABOUT THAT MORE LATER
BECAUSE IT IS CONSIDERED AN
ESSENTIAL HEALTH BENEFIT- BUT
YOU MIGHT HAVE NOTICED THAT IT
WASN'T IN THE LAST. TEN SO HOW.
MUCH COVERAGE THESE CAN. OF
BASS HEALTH SERVICES WHEN
MEDICAL NECESSARY SUBJECT TO
ANY APPLICABLE COPAYMENTS
DEDUCTIBLES OTHER LIMITATIONS
THAT ARE PROVED BY THE TEAM
MADE STATE. THE REQUIREMENT TO
COVER HEALTH CARE SERVICE. IS
INTENT BROUGHT. THE B. BASIC
HEALTH CARE SERVICES CATEGORIES
ENCOMPASS ALMOST EVERY STANDARD
MEDICAL SERVICE FOR EXAMPLE THE
CATEGORY OF EMILY TORY CARE
SERVICES INCLUDE OUTPATIENT
CARE SUCH AS DIAGNOSTIC AND
TREATMENT SERVICES. PHYSICAL
THERAPY SPEECH THERAPY
OCCUPATIONAL THERAPY SERVICES
AND OTHER HOSPITAL SERVICES
WHICH CAN REASONABLY BE
PROVIDED ON ANY OF THE TORY
BASIS. BECAUSE THIS CAST SUCH A
WIDE NET. THE SPECIFIC
TREATMENTS REQUIRED WE COVERED
AS BASIC HEALTHCARE SERVICES
HAVE CHANGED OVER TIME AND WILL
CONTINUE TO CHANGE AS
TREATMENTS OF ALL SO DO THE
COVERAGE REQUIREMENTS FOR
HEALTH PLANS. THE PRIMARY
LIMITATION ON A HEALTH PLAN'S
REQUIREMENT TO COVER BASIC
HEALTHCARE SERVICES IS THAT THE
SERVICE MUST BE MEDICALLY
NECESSARY THIS LIMITATION IS
NOT A BRIGHT LINE RULE. SINCE
WHAT IS MEDICALLY NECESSARY FOR
ONE PERSON IS NOT ALWAYS
MEDICALLY NECESSARY FOR THE
NEXT THE KNOX KEEN ACT GOVERNS
THE POLICIES AND PROCEDURES
THAT HEALTH PLANS USED. TO
DEVELOP MEDICAL NECESSITY
COVERAGE DETERMINATIONS AND
ALSO PROVIDES PATIENTS AND
PROVIDERS APPEAL RIGHTS TO
CHALLENGE TO NILES OF COVERAGE
THE KNOX KEEN ASKED ESTABLISHES
A REVIEW PROCESS CALLED
INDEPENDENT MEDICAL REVIEW OR I
AM ARE. AND IN RELEASE CAN YOU
THIS PROCESS AT NO COST TO THEM
TO CHALLENGE A HEALTH PLANS
MEDICAL NECESSITY DENIAL IN
SUCH CASES AN INDEPENDENT
CLINICIAN REVIEWS THE REQUESTED
SERVICE AND THE PATIENT'S FILE.
THEIR MEDICAL RECORDS TO
DETERMINE WHETHER IT'S
MEDICALLY NECESSARY FOR THE
PATIENT. IN THIS WAY THE KNOX
KY ACT IN. HOW PLANS COVER ALL
BASIC HEALTH CARE SERVICES WHEN
THEY ARE MEDICALLY NECESSARY
FOR EACH ENROLLEE. SO THAT'S
BASIC HEALTHCARE SERVICES SO IN
ADDITION TO THOSE BROAD
CATEGORIES THE KNOX KEEN ACT
INCLUDES MANY CONDITION
SPECIFIC ENUMERATED COVERAGE
REQUIREMENTS THAT EVEN PREDATE
THE ACA MOST OF THEM PREDATE
THE ACA. EXAMPLES INCLUDE
SPECIFIC MANDATES RELATED TO
BREAST CANCER CERVICAL CANCER
PROSTATE CANCER SCREENING
COMPREHENSIVE SCREENING AND
PREVENTIVE CARE FOR CHILDREN IS
ALSO MANDATED INCLUDING
IMMUNIZATIONS. REPRODUCTIVE
CARE INCLUDING CONTRACEPTIVE
COVERAGE AND MINIMUM STANDARDS
FOR INPATIENT CARE FOLLOWING
CHILDBIRTH ARE ALSO INCLUDED.
THERE ARE ALSO SEVERAL MANDATES
RELATED TO CHRONIC CONDITIONS
THESE INCLUDE DIABETES CARE
INCLUDING TESTING SUPPLIES AND
MANDATES RELATED TO HIV AND
AIDS AND OSTEOPOROSIS. OTHER
SPECIFIC MANDATES INCLUDE
PROVISIONS ON RECONSTRUCTIVE
SURGERY AND ORTHOTICS. SOME OF
THESE MANDATE ONLY APPLY TO THE
GROUP MARKET WHILE OTHERS APPLY
TO THE INDIVIDUAL THE VERY
BASED ON THE SPECIFIC LANGUAGE
IN THE STATUTE. BUT ANOTHER
MAJOR CATEGORY OF ADDITIONAL
MANDATES- ARE THE MANAGE
RELATED TO MENTAL HEALTH AND
BEHAVIORAL HEALTH CARE
CALIFORNIA'S MENTAL HEALTH
PARITY LAW WAS ENACTED IN
NINETEEN NINETY NINE. AND
REQUIRES COVERAGE FOR THE
DIAGNOSIS AND TREATMENT OF
SEVERE MENTAL ILLNESSES FOREIGN
RELEASE AT ANY AGE AND OF. THE
MOTIONAL DISTURBANCES OF
CHILDREN HEALTH PLANS MUST ALSO
COVER BEHAVIORAL HEALTH
TREATMENT FOR AUTISM AND
PERVASIVE DEVELOPMENTAL
DISORDER. OKAY SO THIS SUMMER
WHERE WE ARE- AT THE TIME OF
THE ENACTMENT OF THE ACA ALL
FULL SERVICE HEALTH PLANS.
REGULATED UNDER THE KNOX KEEN
ACTS. AND STILL ARE ARE
REQUIRED TO COVER ALL MEDICALLY
NECESSARY BASIC HEALTHCARE
SERVICES COMPLY WITH A WIDE
VARIETY OF CONDITIONS SPECIFIC
MANDATES AND COVER MENTAL
HEALTH FOR BOTH ADULTS AND
CHILDREN ON THE SAME TERMS AND
CONDITION. AB RIGHT TO OTHER
MEDICAL CONDITIONS SO ALTHOUGH
CALIFORNIA. ALREADY HAD ALREADY
REQUIRED COVERAGE OF THIS BROAD
RANGE OF HEALTH SERVICES THIS
WAS NOT TRUE NATION WIDE RANGE.
THE ACA CHANGE THAT ON THE
AFFORDABLE CARE ACT REQUIRED
ALL INDIVIDUAL AND SMALL GROUP.
JUST INDIVIDUAL IN SMALL GROUPS
ARE NOT LARGE GROUP- HEALTH
PLANS TO INCLUDEA BASELINE SET
OF BENEFITS CALLED ESSENTIAL
HEALTH BENEFITS FOR EACH BASE
RIGHT. SECTION THIRTEEN OH TWO
OF THE ACA REQUIRES THESE PLANS
COVER THESE FALL AND TEN TEN
CATEGORIES OF THE AGE BEATS SO
YOU HAVE. ABLE TO PATIENTS
SERVICE. EMERGENCY SERVICES
HOSPITALIZATION MATERNITY AND
NEWBORN CARE MENTAL HEALTH AND
SUBSTANCE USE DISORDERS
INCLUDING BEHAVIORAL HEALTH
TREATMENT. PRESCRIPTION DRUGS
THEY'RE BACK REHABILITATIVE AND
ABILITY OF SERVICES AND DEVICES
LABORATORY SERVICES PREVENTIVE
AND WELLNESS SERVICES AND
CHRONIC DISEASE MANAGEMENT AND
PEDIATRIC SERVICES INCLUDING
ORAL AND VISION CARE. AT THE
TIME THE ACA WAS ENACTED.
HEALTH PLANS IN CALIFORNIA WERE
FOR THEM PART ARE COVER MANY
THE AGE BEES BY VIRTUE OF THE
EXISTING COVERAGE REQUIREMENTS
UNDER CALIFORNIA LAW NEVER THE
LESS THE ACA REQUIRED
INDIVIDUAL STATES TO DETERMINE
EXACTLY WHAT BENEFITS WOULD BE
INCLUDED IN EACH OF THE EACH BE
CATEGORIES. AND PUT SOME
CONSTRAINTS ON HOW CITIES COULD
DEFINE THEM CHIEF AMONG THOSE
CONSTRAINTS IS THIS CONCEPT OF
THE BENCHMARK PLAN. STATES WERE
INSTRUCTED TO CHOOSE AMONG
SEVERAL OPTIONS OF EXISTING
GROUP PLANS AVAILABLE AT THE
TIME TO SERVE AS THE DESIGNATED
BENCHMARK PLAN. THE BENCHMARK
PLAN CHOSEN BY THE STATE
DEFINES THE SCOPE OF THE H. B.
COVERAGE. IF THE BENCHMARK PLAN
IS SILENT AS TO THE COVERAGE OF
A CATEGORY B. H. B. THE STATE
MUST SPECIFY. HOW THAT THOSE
SERVICES WOULD BE COVERED THE
KAISER FOUNDATION HEALTH LAN
SMALL GROUP THIRTY HMO PLAN. IS
CALIFORNIA'S BENCHMARK PLAN.
CALIFORNIA'S BENCHMARK PLAN
INCLUDES ALL LEGALLY MANDATED
COVERAGE AS OF DECEMBER THIRTY
FIRST TWENTY ELEVEN INCLUDING
BASIC HEALTHCARE SERVICES. AND
THE VARIOUS SPECIFIC COVERAGE
MANDATES I DISCUSSED EARLIER
ADDITIONALLY THE LAW INCLUDES
PEDIATRIC VISION CARE COVERED
UNDER THE FEDERAL EMPLOYEES
VISION PLAN AND PEDIATRIC
DENTAL AS COVERED UNDER THE
MEDICARE PROGRAM BENEFITS OF
FOR THOSE CATEGORIES. THE EACH
BEES ARE ALSO VERY
COMPREHENSIVE HOWEVER THEY'RE
NOT UNLIMITED AND FALL
GENERALLY WITHIN THE
CONSTRAINTS OF THE BENCHMARK
PLAN. IF THE STATE DESIRES TO
IMPOSE ADDITIONAL BENEFIT
MANDATES IT MUST TO FREE THE
COST OF ANY ADDITIONAL BENEFIT
MANDATE THAT THAT'S ADDED. SO
FAR THIS HAS NOT OCCURRED IN
CASH AND IN CALIFORNIA BECAUSE
WE HAVE NOT ENACTED ANY NEW
BENEFIT MANDATES THAT ACTUALLY
EXCEED THE H. B. SO THAT TAKE
US TO. DAY WITH RESPECT TO THE
BENEFITS THAT TEAMMATES SEE
REGULATED HEALTH PLANS MUST
COVER AND SO JUST TO WRAP UP
ITS- I WAS THE GIVE IT SORT OF
AS BUILDING BLOCKS BUT YOU HAVE
THE BASIC HEALTH CAE SERVICES
AT THE BOTTOM. AS THE
FUNDAMENTAL CORE THEN THERE'S
ALSO A SERIES OF STATUTE
CONDITION SPECIFIC MANDATES AND
THEN YOU HAVE EACH BEES WITH A
pKIND OF PUT OVER HERE BECAUSE
OUR PLANE JUST TO THE
INDIVIDUAL AND SMALL GROUP
MARKETS. AND SO WITH THAT- THAT
CONCLUDES MY PRESENTATION BUT
I'M HAPPY TO TAKE QUESTIONS. I
THINK WE'LL TAKE QUESTIONS
PERHAPS AT THE END OF THE PANEL
SO WE'LL HAVE ALL FOR YOU
PRESENT AND I THINK- WE HAVE
ANY QUESTIONS. GOOD AFTERNOON.
I'M BRUCE SEE I AM THE- SEED.
AT THE CALIFORNIA OF INSURANCE.
AS OF MY COLLEAGUE JENNY HAS
THE ESSENTIAL HEALTH BENEFITS
PACKAGE FOR BOTH DEPARTMENTS IS
SIMILAR BUT THE INSURANCE CODE
HAS SOME DIFFERENCES HICH
REFLECTS ITS EVOLUTION OVER
TIME. PRIOR TO THE ENACTMENT OF
THE AFFORDABLE CARE ACT THE
LEGISLATURE HAD PASSED A
APPROXIMATELY THIRTY SPECIFIC
MANDATED BENEFITS- FIFTEEN
MANDATED OFFICE OF COVERAGE IN
THE GROUP MARKET AND OTHER
MANDATE SUCH AS TO THE
MATERNITY COVERAGE MANDATE FOR
ALL INSURANCE MARKET SEGMENTS
IN TWO THOUSAND ELEVEN. WHEN HE
IN TWENTY TWELVE THE ESSENTIAL
HEALTH BENEFITS BENCHMARK PLAN
WAS FIRST SELECTED BY THE
LEGISLATURE- AS IT WAS A KAISER
SMALL GROUP HMO PLAN. WHICH
EXISTED IN THE CONTEXT OF THE
KNOX KEEN ACT THAT BENCHMARK
PLAN SELECTION BROUGHT THE
CONCEPT OF BASIC HEALTH
SERVICES. FROM THE KNOX KEEN
CODE INTO THE INSURANCE CODE-
FOR INDIVIDUAL AND SMALL GROUP
NON GRANDFATHERED POLICIES SO
SOME OF THE ACA COMPLIANT
POLICIES HOWEVER. OF BASIC
HEALTH CARE SERVICES. DOES NOT
CURRENTLY APPLY IN THE
INSURANCE LARGE GROUP MARKET OR
IN THE- GRANDFATHERED PRE ACA
PLANS- ASSEMBLY MEMBER LIMON
LAST YEAR INTRODUCED- ASSEMBLY
BILL ONE TWO FOUR SIX- WHICH
WOULD HAVE BROUGHT THE- OF. A
BASIC HEALTH CARE SERVICES
RUBRIC INTO THE LARGE GROUP
MARKET- IT WAS HELD IN SUSPENSE
AND THE- SENATE APPROPRIATIONS
COMMITTEE. ONE OF THE THINGS
ARE PANEL WILL BE DISCUSS OUR
OUR OPPORTUNITY. THAT ARE
PERIODICALLY MADE AVAILABLE
THROUGH FEDERAL REGULATION TO
MAKE CHANGES TO A STATES
ESSENTIAL HEALTH BENEFIT
PACKAGE- IN TWENTY FOURTEEN.
FEDERAL RULES PERMIT AT THE
STATE'S TO RECONSIDER THEIR E.
H. BEES FOR TWENTY SEVENTEEN
COVERAGE- AT THAT TIME BY WAY
OF EXAMPLE THE DEPARTMENT OF
INSURANCE RECOMMENDED THAT THE
LEGISLATURE CONSIDER A
DIFFERENT- BENCHMARK PLAN THE
CALPERS KAISER HMO. IN ORDER TO
PROVIDE ENHANCED COVERAGE FOR
CERTAIN AREAS NOT COVERED BY
THE EXISTING- BENCHMARK PLAN-
WORK THE EXISTING SOME GROUP.
PLAN AT LIMóN TO MEDICAL
COVERAGE- IT DID NOT COVER SUCH
ITEMS AS WHEELCHAIRS WHERE AS
THE CAL PLAN CALPERS PLAN WOULD
HAVE COVERED THOSE ITEMS-
ALTERNATELY OF AFTER ANALYSIS
THAT THE- SUCH A CHANGE WOULD
HAVE A PREMIUM IMPACT OF. 1% OR
LESS BECAUSE OF CONCERNS ABOUT
A PREMIUM. IT WAS DECIDED TO
RETAIN THE CURRENT SMALL GROUP
PLAN YOU'LL HEAR FROM OTHER
PRESENTERS THAT WE HAVE THE
OPPORTUNITY NOW TO RECONSIDER-
ARE. HE H. P. SELECTION HOWEVER
THAT RECONSIDERATION IS NOW
CONSTRAINED BY OF FEDERAL RULES
THAT DID NOT. PERTAIN IN TWENTY
FOURTEEN AND SO THE LATITUDE
FOR OUR SELECTION OF A
DIFFERENT EACH BE PLAN MAY BE
MORE LIMITED. AND WITH THAT I'D
BE HAPPY TO DEFER TO MY OTHER
PANELISTS. GOOD AFTERNOON A
SENATOR PAN AND ASSEMBLY MEMBER
WOULD AND COMMITTEE MEMBERS
THANK YOU FOR HAVING ME HERE
TODAY MY NAME IS JAN FALLS
AROUND THEM. AND THEN THE
DEPUTY DIRECTOR OF THE PLAN
MANAGEMENT DIVISION THE COVER
CALIFORNIA SO I WILL BE
PROVIDING A BRIEF OVERVIEW OF
HOW THE STATE BENCH MY PLAN.
HAS HELPED COVER CALIFORNIA SET
BENEFITS IN THE IMPACT THAT IT
HAS ON HEALTH PREMIUMS AS WELL
AS THE IMPLICATIONS OF ADDING
OR CHANGING BENEFITS. AS YOU
HEARD MY COLLEAGUE JUST SAY THE
ACA REQUIRES ARE CONTRACTED
HEALTH PANS WHICH WE REFER TO
AS Q. H. P. ISSUERS. BOTH AN
INDIVIDUAL AND SMALL GROUP
MARKETS TO FIVE THE TEN
ESSENTIAL HEALTH BENEFITS SO
ALTHOUGH I HAVE A CALIFORNIA WE
DO NOT REGULATE DICTATE WHICH
BENEFITS ARE COVERED WE DO HAVE
A STANDARD PLAN SIGNS ALL
HEALTH PLANS THAT CONTRACT WITH
COVERAGE. FOR ANYA MUST OFFER
THE SAME COST SHARING AMOUNTS
FOR CONSUMERS THAT PURCHASE
HEALTH CARE THROUGH US ALSO FOR
THOSE INDIVIDUALS THAT PURCHASE
HEALTH CARE THROW OFF EXCHANGE
MARKET WHICH I'M SURE IN A
LITTLE BIT MORE DETAIL. SO THE
STANDARD DESIGNS HAVE PROVIDED
THE OPPORTUNITY FOR COVER
CALIFORNIA TO PROVIDE
MEANINGFUL SERVICES SUCH AS
PREVENTATIVE CARE WITHOUT COST
SHARING SO THAT THESE ARE
THINGS SUCH AS YOUR ANNUAL
WELLNESS VISITS IMMUNIZATIONS
AND CERTAIN TYPES OF
SCREENINGS. SO OUR COVER
BENEFITS- ARE SIGNIFICANT AS
THEY HAVE SAID A STRUCTURE TO
HELP CONSUMERS SEE CARE AND
ALSO EMPOWERS THEM TO MAKE THE
BEST. FOR THEIR HEALTHCARE
NEEDS WHAT BUT IN ACCESS TO
MULTIPLE PRODUCTS T DIFFERENT
SHARE OPS. TO COVER CALIFORNIA
HAS. BOB WITH I DON'T. THE
BROWN THE SERVER THE- IN THE-
PLANS IN EACH ONE OF THESE
MIDDLE TIER HAVE BEEN. WITH THE
COST LEVELS. FOR EXAMPLE THE
PLAN ME AT THE EXPERIENCE BUT
WHEN CA. SIX SERVICE THEY HAVE
THE HIGHEST OUT OF POCKET COSTS.
AND JUST ON THE RIVER ARE PART
IN PLANT A HIGH PREMIUM BUT IT
MAY HAVE THE- OUT OF POCKET. SO
THIS BENEFITS. ALSO GO OUR HOW
PLANS IN SETTING THEIR- SO
HEALTH PLANS IN THEIR PRE.
BASED PREEMIE. ON MULTIPLE.
SUCH AS- OF SPIES SERVICES. THE
POPULAR DEMO. SUCH AS THE A THE
GENDER AND THE FOR MAY. ON THE
HEALTH WERE OF POP AND- THE
BEER GRAPHICALLY EXT. THERE'S A
LOT OF. BETWEEN NORTHERN AND
SOUTHERN CALIFORNIA REGION'S
AND SO CALORIE CHEN SOUTHERN
CALIFORNIA BEACHES ARE EVEN
MORE PER. THAT TRACK POSITION
AND IS A OF THE GEOGRAPHIC
REGIONS THE NORTH IN AREAS HAVE
VERY LIMITED NUMBER PROVIDE
FIRST. LANCE OPPOSITE TEAM IS
BASED UPON THE PER THAT. AND
WHO THEY CON WITH AND WITH THE-
MIDDLE GROUPS IN HOSPITALS
THROUGHOUT THE STATE. AND IN
THE COURSE STRUCTURE THE- THESE.
WERE SERVICES ARE SUCH A TO THE
DEATH. THE CO PAY AND THE CO
AND- ALL THESE FACTS PLAY. THE
PRE SET ANNUAL FOR HOW PLANS.
SO IF THE STATE TAKES. TO MAN
NEW BY. THAT ARE IN A- TO THE
CURRENT PENSION PLAN. HEALTH
PLAN WE NEED TO KIND AN AFTER
OR NOW. TO ASSESS TYPES. AND
HOW COSTLY THAT ADDITIONAL
SERICES THEY ALSO NEED TO
REJECT HOW MANY PEOPLE THEY
THINK WILL UTILIZE A SERVICE.
AND THEN DETERMINE THE COST
THAT WOULD BE ADDED TO THE
MONTHLY PREMIUMS. IT IS
IMPORTANT TO REMEMBER THAT ANY
INCREASE THE PREMIUM WILL ALSO
APPLY TO INDIVIDUALS THAT ARE
INVOLVED IN WHAT WE CALL AN OFF
EXCHANGE PRODUCTS. SO I'LL TALK
ABOUT THAT IN JUST A LITTLE BIT
SO HEALTH PLANS REQUIREDTO
OFFER THE SAME OR WHAT WE CALL
THE- PRODUCT. TO CONSUMERS WHO
ARE ROLLED OFF THE CHANGE IS SO
THIS IS FOR PEOPLE WHO CHOOSE
NOT TO AND THROUGH COVER
CALIFORNIA. BECAUSE THEY DO NOT
QUALIFY FOR FEDERAL CITY MORE
THAN YOU SOME DATA FOR. TWENTY
TWENTY. THEIR PRODUCT YOU HAVE
THE SAME BEEN DESIGN. THE SAME
PRETTY AND THE HAVE TO SAY
CASHIER. SO ANY CHANGES IS MADE
THAT WAY IMPACT THE PRE FOR THE
COVERAGE FOR OUR ON EXCHANGE
WILL ALSO OCCUR TO THE EXCHANGE
MAYOR AS WELL TO SO DURING TO
AND NINE THE PROCESS 87% OF OUR
COVER CALIFORNIA IN QUALIFY FOR
THE FED VAN PREMIUM CREDIT THAT
OTHERWISE REFERRED TO AS A T.
C. HOWEVER EIGHT SEES CAN ONLY
USED FOR THAT ARE CAN IS HELP.
SO THIS INCLUDES A SIR THAT THE
FULLER THE PENSION PLAN IN ANY
STATE IN EXCESS PRIOR TO
JANUARY TWO THOUSAND AND TWELVE
FOR THE ACA A BENEFIT THAT IS
REQUIRED BY STATE ACTION THAT
TAKES PLACE AFTER JANUARY ONE
THE TWO THOUSAND AND TWELVE
OTHER THAN FOR THE PURPOSES OF
COMPLYING WITH THE FEDERAL
REQUIREMENTS IS CONSIDERED IN
ADDITION TO THE H. B. I WOULD
REQUIRE THE STATE TO MAKE
PAYMENTS TO DEFRAY THE COST OF
ADDITIONAL BENEFITS FOR THE
CONSUMERS SO ALTHOUGH COVER
CALIFORNIA CONSUMERS THAT ARE
ENROLLED ON EXCHANGE MAY HAVE
THIS NEW MANDATE. ACOSTA WE
WOULD NEED TO FURTHER ANALYZE
HOW THIS MAY IMPACT INDIVIDUALS
THAT ARE ENROLLED IN OUR OFFICE
CHANGE PRODUCT AND WHETHER THEY
WOULD NEED TO ABSORB THAT
ADDITIONAL COST THEMSELVES SO
AS WE KNOW AFFORDABILITY IS
CRITICAL FOR ALL CONSUMERS AND
OUR EXPERIENCE TO SHOW THAT THE
CONSUMER ARE PRICE SENSITIVE
AND THERE'S A LOT OF HEALTH
CARE. IN ANY INCREASE TO
DEMANDS WILL AFFECT JUST AND
CHOI. STATES NEED TO BE MY OF
HOW MANDATE YOU BEEN A- IN.
PREMIUMS THE RULES TO HAVE SOME.
IN WHICH ARE WITH STATE PENSION
PLAN. SO WHAT A DEFINED ARE
RAILS MUST ONE OF THREE. TO
CHANGE CURRENT. PLAN THE FIRST
OPTION IS SELECT ANOTHER STATE
H. B. BEEN PLAN THAT WAS YOU
DURING THE TWO. SO PLAY YEAR.
THIS OPTION IS TO SELECT A CAT.
OR MOST CAT. OF THE H. FUHRMAN
SO SPEND PLAN. THE THIRD IS TO
SELECT THE- TO BECOME THE STATE
BENCH MY PLAN. SO STATE'S WERE
TO DECIDE TO. THE BENCH MY PLAN
A NEW SELECT BENEFITS BASED ON
A- AT THE THREE ARE. THAT I
MENTIONED MUST HAVE AN ACTUAL
CERTIFICATION. THAT AFFIRMS
THAT THE STATE'S HE H. B.
BENCHMARK PLANS EQUAL IN SCOPE
OF BENEFITS. PROVIDED UNDER A
TWO EMPLOYER LAN AND ALSO IN
ACTUAR. PORT AFFIRM THAT THE
NEW EACH BENCH MORE. DOES NOT
PROVIDE BENEFITS CENTER SO
GENEROUS THAT IT VIOLATES THE
ACA. SO FOR EW EACH BE
BENCHMARK PLAN TO BE AFFECTED
BY THE TWENTY TWENTY TWO PLAN
YEAR THE STATE MUST NOTIFY
HEALTH AND HUMAN SERVICES OF
THE SELECTION OF A NEW EACH BE
BENCHMARK PLANNED. BY MAY
EIGHTH OF TWENTY TWENTY HOWEVER
HHS HAS ALL RECOMMENDED THAT
STATE MATT THIS INFORMATION
BEAR SO THAT. PROVIDE REVIEW
AND GUIDANCE BEFORE THE MAY
EIGHTH SUBMISSION. P. H. P.
AND- TO INCLUDE ADDITIONAL
SERVICE THERE MAY BE AN AND- TO
PREMIUM. WHICH IN TURN MAY I IN.
THE PREMIUM TECH CREDIT AND THE.
SO IN SOME THE H. B. VENTURE
AND BENEFITS SIZES STANDARDIZED
IS TO COVER CAL CONSUMERS AND
HAS HELPED COVER CAL DESIGN
HEALTH COVERAGE FOR MORE THAN
TWO MILLION CONSUMERS AND
ROLLED ON AND OFF THE EXCHANGE.
THIS WOULD REMAIN MINDFUL THAT
THE ADDITION OF ANY NEW STATE
MANDATES COULD HAVE AN IMPACT
TO THE PREMIUMS FOR WHICH
OFFICE CHANGER RELEASE MAY BE
TAKEN EARLY SENSITIVE TO. THE
AMOUNT OF THE IMPACT VERY
DEPENDING BENEFITS THAT IS IT'S
AN. DATE THE NEW MANDATE. CVH
BE WITH RESULT IN STATE'S TO DO
A- COSTS. UNDER THE FED RULES
TO STICK BE RE TO DO THE- IN
FOR. EVEN IN THE OF THAT THE
STATE LATER INCORPORATED
BENEFITS IN STATE PENSION PLAN.
THERE ANALYSIS SHOULD BE
PERFORMED PRIOR TO THE MANDATE
OF ANY NEW BENEFITS TO ASSESS
THE POTENTIAL COST IMPACT.
THANK YOU FOR COMING OUT TURN.
FIFTEEN GOOD. THANKS FOR HAVING
US HERE TODAY MY NAME IS KEREN
CORBETT I'M THE DIRECTOR OF THE
CALIFORNIA HEALTH BENEFITS
REVIEW PROGRAM KNOWN AS TO
BURKE- TO PURPOSES TABLETS BY
THE LEGISLATURE SEVENTEEN YEARS
AGO YESTERDAY I CELEBRATED MY
TENTH YEAR ANNIVERSARY WHICH
BURKE I DON'T KNOW WHERE TIME
IS GOING. W ALL WERE IN HIGH
SCHOOL CLEARLY WHEN THE-
INTEREST WAS UP THESE. THE MANY
YEARS AGO AT HEALTH INSURANCE
BENEFITS MANDATE BILLS AND
PROVIDE EVIDENCE BASED
ANNOUNCES SELECT YOUR- THE
OBJECTIVE HAS BEEN. TO DECISION
MAKING ON. HELP INSURE TOP. BY
PROVIDING OBJECTIVE
ACADEMICALLY RIGOROUS ANALYSIS
WE PRODUCED OVER A HUNDRED AND
FIFTY ANALYSIS A PROPOSED
LEGISLATION ADDRESSING A WIDE
VARIETY OF BENEFIT COVERAGE
TOPICS. SELECT THE BENEFITS TO
COVER IN A AMONG ESSENTIAL
HEALTH BENEFITS REFLECTS
UNDERLYING TENSIONS THE
PRACTICE OF MEDICINE AS BOTH OF
YOU OF COURSE NOW IS NOT STATIC
IN THE ADMINISTRATION OF HEALTH
BENEFITS IN OVERTIME. IN THIS
OF COURSE BUMPS UP WITH THE
CHALLENGE OF KEEPING HEALTH
INSURANCE AFFORDABLE WHETHER IT
BE AT THE ST PAUL MAKING LEVEL
AND OR VISUAL. WHOSE CONCERT
PERCHED ENSURE. AT ALL TO AT A
POLICY LEVEL WE'RE TRYING TO
BALANCE TO COMPETING GOALS
PROVIDING HEALTH INSURANCE FOR
A WIDE RANGE OF HEALTH NEEDS IN
KEEPING AN OF THE BOWL SO THAT
PEOPLE AND OR PLAN SPONSORS
TEAM THAT. WILL ENSURE CARP.
ESSENTIAL HEALTH BENEFITS ARE
FLOOR AS WE'VE HAVE WITH THIS.
AND ARE RELEVANT BENEFITING
FLOORS INCLUDE HEALTH SERVICE
THIS VERY LONG STANDING OF LAW
AND REGULATION APPLICABLE TO
HEALTH CARE SERVICE PLANS
REGULATED BY DIEM SEE ALSO PUT
APPLICABLE TO SEE THE HAS
INDIVIDUAL GROUP MARKETS.
ADDITIONALLY PREVENTIVE OF
FEDERAL PREVENTIVE SERVICES
MANDATES ARE ALSO AN ADDITIONAL
BENEFIT FLOOR. YOUR BURKE
ASSESSES THE POTENTIAL
INTERPLAY BETWEEN THESE VARIOUS
BENEFIT FLOORS AND STATE AND
FEDERAL MANDATES FOR EACH
ANALYSIS WE UNDERTAKE. AS
YOU'LL FIND IN THAT LARGE TABLE
IN YOUR PACKETS THERE ARE
DOZENS OF EXISTING STATE
MANDATES AND A NUMBER OF
FEDERAL ONCE WE CREATE AND
MAINTAIN THIS RESOURCE FOR
CALIFORNIA AN UPDATED AT LEAST
ANNUALLY. IT IS WORTH
UNDERSCORING THE FACT THAT EACH
BEES DIRECTLY AFFECT THEHEALTH
INSURANCE APPROXIMATELY 10% OF
CALIFORNIANS. EXEMPTS FROM H.
B. REMAINS OUR LARGE GROUP
HEALTH PLAN SELF INSURED A RED
PLANWHICH ARE FEDERALLY
REGULAR. AND ARREST THE
GOVERNOR MULTIPLAYER WELL
ARRANGEMENTS NOT OBJECT STATE
INSURANCE. THE LEGISLATURE HAS
REQUESTED THAT YOUR INCLUDE
WHETHER IS LIKELY TO EXCEED
EACH WITHIN EACH TREE BURKE
REPORT I'D LIKE TO FOCUS ON
THIS DISCUSSION OF MY REMAINING
COUPLE MINUTES. BECAUSE FEDERAL
STATE REGULATIONS ARE CLEAR AS
TO WHO WOULD MAKE THE FINAL
DETERMINATION. CHIPPER QUERIES
BOTH STATE REGULATORS MADE SEE
AN CITY I AND REPORTS THEIR
CONCLUSIONS AND WE APPLY OUR
OWN KNOWLEDGEABLE LAYPERSON
ALTHOUGH I WAS STRESSED NOT
LEAK INTERPRETATION. FIRST DAY
BENEFIT MANDATE TO EXTEND THE
DEFINITION OF THE H. B. AS IN
CALIFORNIA IT IS TRUE BIRDS
UNDERSTANDING THAT THE
FOLLOWING MUST BE TRUE. THE
STATE BENEFIT MANDATE IS NOT
COVERED IN THE KAISER SMALL
GROUP HMO BENCHMARK PLAN THAT
HELPS TO FIND THE CURRENT EACH
BE PACKAGE. THE STATE BENEFIT
AND IT WOULD BY THE PLANS AND
POLICIES SOLD COVERED
CALIFORNIA. THE STATE BENEFIT
MANDATE IS NOT COVERED UNDER
BASIC HEALTHCARE SERVICES AS
REQUIRED BY KNOCKS KEEN. AND
THAT THE STATE BENEFIT MANDATE
IS SPECIFIC TO CARE TREATMENT
AND OR SERVICES MEETING THE
FEDERAL DEFINITION OF A BENEFIT
MANDATE THAT COULD EXCEED THE
H. BEES SHOULD STRESS THE TERMS
AND CONDITIONS OF HEALTH
INSURANCE BENEFITS. E. G.
REQUIRING A CERTAIN KIND OF
PROVIDER GET REIMBURSEMENT FROM
EXISTING SERVICE OR TREATMENT
OR PROCEDURE OR I'VE
REQUIREMENT ON A HEALTH PLAN OR
A PRESCRIPTION DRUG BENEFIT
THESE THINGS DO NOT INTERACT
WITH EACH BE DETERMINATIONS. SO
AN EXAMPLE BOB LAST YEAR OF THE
BILL. FIVE NINETY EIGHT. IT'S
WHICH STRIPPER BUT STE THIS
WOULD REQUIRED SEE REGULATED
PLAN SINCE THE IRISH POWER. TO
PROVIDE COVERAGE HEARING AID
FOR CHIU HERE TO SEVENTY.
LOCALLY FUNDED INCLUDING CAL
AND CAL MAY CARE. THAT ARE
SUBJECT TO KNOX KEEN. CHIPPER
WOULD HAVE H. B. WHY THIS
PURPOSE INSURED BENEFIT NOT IN
CALIFORNIA'S PLAN AS THE
COMMITTEE MAY OUTLINED THE
FEDERAL DEFINITION A STATE
BENEFIT MANDATE THAT CAN EXCEED
EACH BEES IS SPECIFIC TO THE
CARE TREATMENT SERVICE. IT
RECALL ISSUE IS TO OFFER TO ITS
RELEASE. YOUR BIRD AS THAT THE
TOW STATE RESPONSIBILITY IN
THAT FIRST YEAR COULD HAVE BEEN
BETWEEN TWO POINT ONE AND THREE
POINT ONE MILLION. SO ON BEHALF
OF CHIPPER- I APPRECIATE THE
OPPORTUNITY TO BE HERE TODAY
AND TO CONTINUE TO BE A
RESOURCE FOR THE COMEDIAN
OTHERS WERE INTERESTED AND
INVOLVED IN THESE KINDS OF
ISSUES WE HAVE A WIDE VARIETY
OF PRIESTS AND RESOURCE.
AVAILABLE ON OR- FOR ANY TO
ACCESS. TO A COUPLE COUPLE
QUESTIONS- IF THAT'S TO THIS
YEAR. THE D. ON SURE WELL
ACTUALLY I WAS FIRST GO TO BOB
HERTZBERG. AS SOMEONE RAMOS AND.
MAYES FOR JOINING US TODAY AND
SO. QUESTIONS FOR YOU GUYS. ALL
RIGHT WELL CHAIR WITH OKAY MY
POP MY APOLOGIES SO. IT
OBVIOUSLY WE EIGHT WERE UNDER
CHAU AMEND PRESSURE TIMES TO
YOU KNOW AT TO ADD BENEFITS TO
PLANTS. ESERVER IS A KNOW THIS
IS A- IT'S A OPINION AND AN AND
I KNOW THAT'S ALSO BROUGHT WITH
HAZARD ASKING YOU MAKE IT UP
BUT- IN A FROM YOU PERSPECTIVE
WHAT. CURRENT OF THIS HELP IS A
STAKE IS THAT STILL THE TEST OF.
KIND OF OPEN QUESTION.
OBVIOUSLY THERE'S TREMENDOUS
SO- TO CHANGE OR ADD TO THING
SO I'LL I'LL WALK INTO THAT
FIRE- AT LEAST SET FROM THE
FRIENDLY BACK AWAY. EARLY ON
YOU KNOW THERE WAS A THE ACE
AND- THE FORMER CARE ACT
INITIALLY ENVISIONED SORT OF A
DIFFERENT PROCESS ABOUT THE
EVOLUTION OF THE SPECIAL HEALTH
BENEFITS AND THERE WAS A- LONG.
AND ROBUST- EFFORT BY THE
INSTITUTE OF MEDICINE TO ADVISE
SECRETARY OF HHS ABOUT THIS
SORT OF INTERNAL PROCESS OF.
CONSIDERING YOU KNOW BOTH THE
REQUIRE IN THE ACA BUT EVIDENCE
IN TERMS OF THE ONGOING
MAINTENANCE OF WHAT THAT
ESSENTIAL HEALTH BENEFITS LIST
SHOULD BE OVER TIME. NOW I I'M
ACTUALLY CITED SCHUBERT'S
APPROACH SUPPORTING CALIFORNIA
AS ONE APPROACH THAT COULD
INFORM ON GOING- CONSIDERATIONS
AROUND ESSENTIAL BENEFITS. THE
A BOMBER ADMINISTRATION SORT OF
TOOK A DIFFERENT TURN THERE WAS
OBVIOUSLY A LOT OF
CONSTERNATION FROM NUMBER BATES
ABOUT CA AND WE SORT OF A
DIFFERENT DIRECTION I JUST
THOUGHT THAT HISTORY IS SORT OF
WORTH NOTING THAT. IT WAS A DO
IN THE THIS WAS. WEEKLY STATIC.
IN THAT. IT'S ABOUT SO MAYBE
YOU'RE GOING TO ELABORATE ON
THAT WELL I WAS GOING TO SAY
THAT I THINK I MENTIONED IN MY
REMARKS THAT- I THINK WHAT ARE
THE BENEFITS OF BASIC HEALTH
CARE SERVICES USING BROAD
CATEGORIES IS THAT- IT THE
SERVER IS THE CHOIR TO UP BY
PLANTS BECAUSE IT DOES EVEN ALL
OVER TIME AND SO ONE OF THE ONE
OF THE TH AND SORT OF DRAWBACKS
OF BEING VERY PRESCRIPTIVE WITH
RESPECT TO CERTAIN STACK. THAT
I. DIFFICULT ARE COVERED. IN IT
CAN IT CAN SOMETIMES BACKFIRE
BECAUSE AS MEDICINE IS ALWAYS
MOVING FORWARD RIGHT AND SO WE
WANT TO BE ABLE TO HAVE THE
COVERAGE REQUIREMENTS MOVE WITH
THOSE AND FOR THE MOST PLANT
PART THE HEALTH PLANS ARE
GENERALLY OUT WITHOUT. BEING I
THINK. ABOUT IT IT HAS. THE
BROAD CATEGORIES THE DEATH THE-
AND COVERED SERVICE CAN BE VERY
HELPFUL IN THAT WAY. HE
COMPARED TO OTHER STATES-
BECAUSE I THOUGHT AS I THE ONE
OF THE COMMENTS I HEARD WAS
THAT- ONCE IS WE EXPLORE A
CHANGES IN THE ESSENTIAL HEALTH
BENEFITS WE HAVE DAY HEAR
SOMEONE SAY WE HAVE TO LOOK AT
WHAT OTHER STATES WOULD MEAN
AND DRAW FROM THAT OR DID I
SENATE STAND. THE STATE DOES
NOT HAVE TO BUT A STATE CAN AND
LOOK TO. WHAT AND SHE HANDED IT
FOR AN ESSENTIAL HEALTH
BENEFITS PACKAGE FROM ANOTHER
STATE IS NOT REQUIRED IT IS NOT
REQUIRED OKAY OKAY AND THEN I
DID I DID MISS HERE MISS HERE
THAT SO. THE OFF EXCHANGE PLANS
SO OBVIOUS AND THAT'S AND
THAT'S A TWIST THAT I WOULD
VENTURE TO GUESS THAT A LOT OF
MEMBERS HAVEN'T REALLY THOUGHT
ABOUT IS WE START THINKING
ABOUT CHANGES- BECAUSE- WE GOT
TO BE CAREFUL BE PRICEY WITH.
PRICE SENSITIVE FOR THAT THOSE
OFF EXCHANGE. OKAY DATE
TYPICALLY HAVE THE SAME THEY
HAVE THE SAME BENEFITS AS THE
COVER CALIFORNIA PLANS. YES SO
AS LONG AS THEY'RE NON
GRANDFATHERED SO AND SO IN THE
WHICH IS MOSTLY SMALL GROUP
YOU'RE GOING TO HAVE SOME SMALL
GROUPS THAT MIGHT BE
GRANDFATHERED SO DAY DON'T
NECESSARILY HAVE THE
REQUIREMENT TO COVER EACH BEES.
THEY STILL HAVE THE BASIC
HEALTH CARE SERVICES
REQUIREMENT AB AND BUT YES SO
OFF EXCHANGE YOU'RE GOING TO
SEE IN THE INDIVIDUAL AND SMALL
GROUP MARKET YOU'LL HAVE BEEN
REPAIRED PRODUCTS AND THEY
HAVE. EXACTLY THE SAME BETTER
THE EXACT SAME COP. AND THE OU
WILL BE TERM TURNOUT BENEFIT
DESIGNS AT THE- MORE SO ON THE
SMALL GROUP MARKET AT HALF
COVERED. IN NOTHING BUT COST
SHARE STRUCTURE. WE DIFFER FROM
WHAT. STATE AND THE PERSON
THINK OF COURSE. EXT AS FIRST
OFFICE CHANGED THIS. IS ROUGHLY.
WELL IT'S KIND OF HARD DISK
BECAUSE I IT WILL REALLY DEPEND
ON AND ROLL MEN'S AND THERE
MIGHT BE THERE'S OBVIOUSLY MORE
PRODUCT DESIGNS OFFERED OFF
EXCHANGE BECAUSE YOU HAVE THIS
ALTERNATE BENEFIT DESIGN YOU
HAVE MERE PLUS ALTERNATE OFF
CHANGE DO YOU HAVE. MORE MORE
QUESTIONS PUT OFFICE GAINES BUT
THE IN ROMAN FOR THE INDIVIDUAL
MARKET IS MUCH HIGHER ON THE
EXCHANGE OFF EXCHANGE OKAY
SMALL GROUP I THINK IS STILL
SLIGHTLY MORE OFF EXCHANGE OKAY
HIGHER MOMENT YEAH. THANK YOU
SO MUCH FOR YOUR PRESENTATION
SO I WANT ACTUALLY DOVE IN A
LITTLE MORE DEEPLY INTO THE
ISSUE OF- THAT YOU RAISE THAT
IF YOU HAVE A- YOU KNOW A
MANDATE. THAT IT CAN BACKFIRE-
THE SO. AND SO I'M JUST
THINKING ABOUT SOME OF THE
MANDATES THAT WE'VE PASSED BOTH
PRE AND POST A CLL KNOWS ME
POST CA- BUT- SO WILL ACTUALLY
MONTHS I'M A PEDIATRICIAN- WE-
I WORKED WITH MY PREDECESSOR
THAT TEMAS AND ASSEMBLY- STAR
SIGN BURKE- WE MANDATED
COVERAGE FOR. AUTISM SERVICES
RIGHT- TO HEALTH PLANS IN THE
REASON THAT INVOLVED WAS
BECAUSE- ESSENTIALLY- NO IT
FAMILIES WHO NEED HELP AND THEY
SAID WELL YOU KNOW WHAT HE GETS
THROUGH THE SCHOOL. I WOULD
SHOULD OFTEN YES AND WE
FAMILIES WERE STUCK WITH
SCHOOLS ONE THOUGH TO HEALTH
CARE THING AND THE- YOUR SAID
IT'S A SCHOOL THING ARE. THE
SO- AND SO BECAUSE ID A THE
SCHOOL HAS TO TAKE CARE OF IT
SO WE DON'T WANT TO TAKE CARE
OF IT AND- I GUESS THE QUESTION
I HAVE THEN IS THAT- SO WELL
FIRST OF ALL CAN YOU GIVE ME AN
EXAMPLE. IT WAS PASSED SEVERAL
MANDATES THE SAMPLE HOW ANY
SPECIFIC DEAL WITH JUST ONE OF
THE MANDATES WHERE THIS MIGHT
IT BACKFIRED- WHERE- A SPECIFIC
END DATE BECAUSE TUESDAY FIX
THEN OUT TO. BLESS YOU KNOW OF
PEOPLE NOW PATIENTS HAVING AN
ABILITY AT THE SERVICES THAT
THEY NEED SO YOU BROUGHT THAT
UP AS AN ISSUE I'M NOT SAYING I
DISAGREE WITH THAT NECESSARILY
BUT- IT'S I THINK IT MIGHT BE
HELPFUL THEY ACTUALLY HAVE A-
FORCED TO. PICK ONE AND GIVE US
AN EXAMPLE HOW THIS MIGHT
HAPPEN. WELL I THINK- I DON'T
KNOW I'M NOT SO I THINK IT'S AN
ISSUE CAME UP. TWO YEARS BACK
HAVING TO DO WITH D.
MAMMOGRAPHY AND WHETHER OR NOT
THAT WAS COVERED. BECAUSE
MAMMOGRAMS WERE COVERED- BUT
DID THREE D. MAMMOGRAPHY SO I
THINK REALLY THE- WHAT IS I
DON'T KNOW THAT IT SO MUCH
BACKFIRED AS MUCH AS HAVING THE
REQUIREMENT TO COVER BASIC
HEALTH CARE SERVICES WAS. CAN
SOMETIMES BE RELIED ON BECAUSE
OF THE BROAD SCOPE BECAUSE
MAYBE THAT THE MANDATE IS
SOMEWHAT- NEED. IN THE WAY THAT
IT'S HER MIGHT NOT COVER
ADVANCEMENT SO. IT WOULDN'T
NECESSARILY MAYBE WE- END UP
WITH SOMETHING NOT BEING
COVERED SO MUCH AS THAT FACT
THAT BECAUSE WE HAVE THE
COVERAGE REQUIREMENT OF BASIC
HEALTH CARE SERVICES. THAT
LARGER CATEGORY SORT OF AND
SERVES AS A BACKSTOPS TO MAKE
SURE THAT WE WOULD WANT
SOMETHING THAT AS SITES MOVE
FORWARD IN IS MEDICALLY
NECESSARY FOR THAT PATIENT THAT
THAT WOULD BE COVERED. I CAN'T
THINK OF ANY SPECIFIC IS GET UP
OFF THE TOP OF MY HEAD OR
SOMETHING CHRISLEY WANTING
CAUGHT. SO I MEAN THAT THAT
EXAMPLE FOR EXAMPLES ACTUALLY
HE'S COVERED PERSPECTIVE
KNOWLEDGE YEAH A TECHNOLOGY
THAT REALLY NAY THAT MAY BE YOU
THIS. LEE AT THE OVER NINE MAY
I. THERE'S OTHER TECHNIQUES
STAFF NOW A SUBSEQUENT SIX THAT
THAT'S WHAT I WAS THAT'S YEAH
ALL RIGHT SO AND I KNOW OTHER I
THAT THAT DON'T THINK IT
HAPPENED HERE CAL. FOR PEER TO
TIME DOES SOME HOPE THAT TOTAL
BONE MARROW TRANSPLANTS WOULD
BE A POTENTIAL TREATMENT FOR
BREAST CANCER AND SO DOES A LOT
OF TERROR IN THE COMMUNITY TO
HAVE THE PROPER PROCEDURE TO
TURN IT DOWN AS EXPERIMENTAL TO
REQUIRE THAT. OVER TIME IT'S
COVERED IT WAS UP TO GO IF IT
MEANT. VALUE HAPPENED. THE WAY
INSTEAD IN CERTAIN. THAT THAT
WAS COVERED SO I DIRECT A
SOMETHING'S WHEN YOU SPECIFY IT
TO A PARTICULAR FORM OF
TECHNOLOGY VERSUS A- THAT THAT.
THERE'S A CHALLENGE THERE BUT-
BUT I GUESS SO FOR EXAMPLE
GOING BACK TO THE AST EXAMPLE.
AND IT'S COMES DOWN TO WELL
OKAY SEE TALKED ABOUT WHAT WE
HAVE WE HAVE BROAD CATEGORIES
RIGT AND I GET THINGS ARE
DYNAMIC. THIS THE TERMINATION
THEN DOES IT FIT INTO THAT
BROAD CATEGORY OR NOT RIGHT SO
LET'S JUST TAKE OUR A ES DE.
DOESN'T BECOME. AS EIGHTY
EXAMPLE- YEAH DATE IF SOMEONE
GOES AND SAYS WELL MY CHILD HAS
A DEVELOPMENTAL CONDITION AND
NEEDS TREATMENT AND WENT AND-
SO BUT IS SO IN WENT THROUGH
YOUR EMAIL DISCREETLY AND
WHAT'S THE VIEW PROCESS WHICH
WHICH I KNOW WILL YOU TRY TO
MAKE IT SIMPLE BUT FRANKLY IF
YOU'RE TRYING TO BE MET. THE
HOOPS EVEN WE TRY TO MAKE. THE
AND BARRIERS HOW DO YOU THE
CASE IN QUESTION IS YOU SAID
YOU HAVE A PHYSICIAN WHO MAY
HEALTH MAKES THESE
DETERMINATIONS FOR THESE
APPEALS HOW WHAT GUILIN'S YOU
PROVIDE THAT TO THE SIDE YOU
KNOW IS IT. YOU KNOW WITHIN THE
BROAD CATEGORY OR NOT. FOR THE
TERMS OF THE MEDICAL NECESSITY
PIECE OKAY OKAY OKAY SO I THINK
I UNDERSTAND ADDRESS KING SO- I
THINK WITH RESPECT TO THE MAT
THE SUBSIDY DETERMINATION
THAT'S DONE BY INDEPENDENT
CLINICIAN OKAY. I DON'T KNOW
THAT WE'RE GIVING GUIDELINES TO
PHYSICIANS ABOUT HOW THEY
SHOULD DETERMINE MEDICAL
NECESSITY ARE NOT THAT THE
JUDGEMENT OF THAT SO THERE'S NO
GUIDELINES RIGHT AYE AYE YEAH I
CAN'T THINK OF ANYTHING- THEN.
DOWN TO THE AST THING PRIOR TO
ACTUALLY PASSING THE LAW THEN
HOW WAS THAT DECISION THEN HOW
IS THAT. BUT CAME TO THE A. B.
C. AND SAID WELL. YOU KNOW
MIGHT BE SO HOW ABOUT A HOUSE
WE DECIDED WITHIN THE BROAD
CATEGORY THAT ASD TREATMENTS-
WE'RE SENSUALLY NOT CONSIDERED
TO BE COVERED SHOULD BE COVERED
BY HEALTH CARE SO I MEAN YOU
CAN ARE YOU WHEN YOU HAVE A
BACK CATEGORY THAT COULD I MEAN
IT'S AN INTERPRETATION ISSUE
THAT. SO WHAT POINT THE
DECISION FALL TOWARD. AT WHICH
THEN NECESSITATED I GUESS WE
CAN ARGUE WHETHER NECESSITY BUT
ESSENTIALLY RESULTED IN A BILL
AND MANDATE TO NOW COVER IT
BECAUSE THE DECISION ALWAYS
SEEM TO BE THAT NO IT WASN'T.
BECAUSE THAT'S ONLY WHAT PLANS
CONSTANTLY TOLD THE PATIENTS
OKAY THAT OKAY SO THOUSAND FEET
SO BASICALLY WE HAVE BROAD
CATEGORIES AND I TRY TO FOR YOU
TO HAVE A SPECIFIC STATUTE LIKE
THE ONE THAT WE HAVE IN
CALIFORNIA TO. BE H. T. YEAH
THAT. TRYING TO GIVE BECAUSE-
AGAIN YOU THAT AS AN EXAMPLE BY
WHY GET BILLS. GAIL DIFFERENT
REASONS FOR DIFFERENT THINGS
BUT I MEAN THAT THAT'S AN
EXAMPLE IT'S NOT A TECHNOLOGY
ETCETERA BUT IT IS. AN AREA
WHERE PEOPLE SAID WELL LOOK YOU
KNOW WE THINK. PEOPLE ARE
GETTING ACCESS TO THE SERVICES
THE HEALTH PLANS CONSTANTLY
TELL US THAT. WE'RE NOT GOING
TO PROVIDE COVERAGE FOR IT IT'S
YOU KNOW AND- OFTENTIMES
EXCUSE. GO GET IT FROM THE
SCHOOL. BY WHICH WE PAY FOR
VITAL BILL. AND SO THAT'S WHY
THE VENT THAT COMMUNITY CAME TO
US AND WE WANT INSURANCE
MANDATE EVERY TIME TURN AROUND
AND SELL. THE THEN IS THAT PART
OF IT WHY DID THEY END UP.
TURNING TO LEGISLATURE IS
BECAUSE- UNDER THE LAW BROAD
CATEGORIES THAT EXISTED THEN.
RIGHT BECAUSE WE HAD THIS BROAD
CATEGORIES. SOMEHOW IT
DETERMINATION WAS MADE BY
SOMEONE. AT THE IDEA OF THE
PLANS THEMSELVES CERTAINLY
DECIDE OLD THAT HAITIANS BUT
ALSO I GUESS. THE REGULATOR
YEUTTER SAID WELL WE KIND OF GO
ALONG WITH THE PLANS BECAUSE
THEY WEREN'T YOUR GOING AROUND
OVER TELLING TRANSCEND AND I
KNOW THAT'S WRONG SO HOW DO WE
DECIDED THAT WAS NOT. BE
INCLUDED IN. THIS IN THIS. HER
DEATH. OF BASIC HEALTH SERVICES
SO I. THAT FOR EACH SITUATION
IT MIGHT DIFFER I THINK IN THE
EXAMPLE THAT YOU'RE GIVEN.
THERE'S PROBABLY A NUMBER SINCE
I THINK HISTORICAL CONTEXT IT
MAY BE PART OF IT THAT. THERE
WAS A THERE WAS A THOUGHT AT
THE TIME- THAT THIS WAS
SOMETHING THAT SCHOOLS SHOULD
BE COVERING AND- AND CLEARLY
THE THINKING ON THIS AND
COVERAGE OF MENTAL HEALTH AND
BEHAVIORAL HEALTH. THE P. H. TO
LOOK PAST HAS. FALL RIGHT AND I.
AND STATE MENTAL HEALTH. AND
FEDERAL MENTAL HEALTH PARITY
THERE HAS BEEN AN INCREASE
FOCUS- ON COVERAGE OF THESE
THINGS SO I THINK OF THAT.
THERE WAS. IF IT HAD NOT BEEN
THOUGHT TO BE HEALTH CARE
COVERAGE MAYBE TWENTY TO THIRTY
YEARSAGO AND SO SOMETIMES
THESE THINGS EVOLVE ESPECIALLY
IN THE AREA O MENTAL HEALTH
AND SO I THINK THAT AS I
UNDERSTAND IT AT THAT TIME THE
LEGISLATURE OFFICE. TO ANSWER
THE- AND DEFENDED SAY THIS IS A
HEALTH CARE SO AND IT WILL A
VERY. RANGE OF SERVICES THAT
DIDN'T MAYBE AS NEATLY FALL
INTO SOME OF THE CAT. THAT ARE
USED TO DESCRIBE BASIC
HEALTHCARE SERVICES I WAS SO
LIKE YOU KNOW IT IT. WHETHER OR
NOT IT'S REALLY AT THE
CONSERVATIVE IT'S BEING
PROVIDED BY YOU KNOW A PARA
PROFESSIONAL IN THE HOME SO I
THINK IT GOT MAYBE IT WAS IN
THE AREA THAT IT WAS SOMEONE IN
MARTIN'S AT THE TIME I AM AND
WHAT NOT AS CLEAR. AS LIKE YOU
KNOW FIXING A BOWL EARLY RIGHT
AND SO- SO I DON'T HAVE AN
EXACT ANSWER FOR YOU AS TO YOU
KNOW WHY THERE WAS A SPECIFIC
REASON WHY THAT SPECIFIC
PROVISION WAS- WAS PASSED BUT I
THINK THAT- I THINK THAT
SOMETIMES. THE THINKING AND-
THE EVOLVING OF WHAT SHOULD BE
COVERED- HAPPENS AND THEN
THERE'S CATIONS WHERE THE
LEGISLATURE STEPS IN AND SAYS.
YOU KNOW THIS IS DEFINITELY
SOMETHING THAT HEALTH PLAN
SHOULD BE COVERED AND THAT'S
BAD EXAMPLE OKAY. I APPRECIATE
YOUR ANSWER AND I DON'T WANT
YOU TO FEEL LIKE I'M PICKING ON
YOU SPECIFICALLY BUT SINCE
YOU'RE TO A TOPIC BECAUSE IT
BECAUSE I THINK THIS REFLECTS
ON THE TENT SO INTENTIONS
BECAUSE AS YOU EXPRESS IN YOUR
ANSWER. AND THAT. IS THAT WELL
WHEN WE WERE LOOKING AT THIS
ISSUE AT THAT TIME YOU KNOW AND
THERE IS AGAIN TREMENDOUS
PRESSURE. FROM PEOPLE ABOUT
WELL YOU KNOW WE WANT TO GET
ACCESS THE SERVICES WE THINK IT
SHOULD BE FROM. PLANS THAT YOU
SAID WHAT WE KIND OF LOOK
HISTORICALLY THAT SOMETHING WE
NORMALLY COVERED RIGHT. BUT
SAME TIME WE'VE ALSO TALKED
ABOUT WELL. MANDATE CNO WE ALSO
WILL FALL OFF RIGHT TO NOT BE
INVOLVED. OF ALL. MORE SO MORE
MAYBE INVOLVING. AND SO NOW THE
TENSION AYE. THE OUT TRYING TO
FIGURE OUT HOW HE RESOLVES THIS
RIGHT SO. WE HAVE ESSENTIAL
HEALTH BENEFITS YOU KNOW ACA
WOULD LEAD THE STATE LAW ALL
RIGHT WE SELECTED OURSELVES
ABOUT IT AND JUST AND JUST TO
BE SURE I GOT IT RIGHT- MISSED
FILES ARE NO OKAY SO IT HAS TO
BE IN THE STATE BENCHMARK PLAN
AT THE TIME OF. JERRY FIRST
TWENTY TWELVE RIGHT SO IT'S NOT
LIKE THE BIT THE BENCHMARK PLAN
CHANGE THERE. THE OUTSIDE TO
ADD SOMETHING SUBSEQUENT TO
THAT THAT STILL DOESN'T COUNT
RATE BECAUSE THEY HAD TO BE AT
THE TIME OF THAT YEAR AND I
CORRECT. RIGHT THE BENEFIT HAD
TO BE IN PLACE BY DECEMBER
THIRTY FIRST TWO THOUSAND
ELEVEN FOURTEEN NOT EXCEED THE
GENEROSITY IS THE STATE
BENCHMARK PLAN YET RIGHT SO
EVEN IF KAISER WENT BACK AND
SAID WE DECIDE ADDED DIFFERENT
COVERAGE THINGS. ON THEIR OWN
TO THE BENCHMARK PLAN THAT
WOULD NOT THAT THAT THAT THAT
DOESN'T APPLY TO THE BENCHMARK
IS FIX THAT. DECEMBER THIRTY
FIRST TWENTY ELEVEN I GUESS
RIGHT. SO I GUESS THE QUESTION
IS THAT NOW WE GOT STRUGGLE
WITH. HISTORY WE LACK THE
PARTICULAR DATE DOWN. AND
THINGS ARE EVOLVING STILL
TECHNOLOGY EVOLVES EVEN SOCIETY
HELP OFFICE RIGHT AND SO WHEN
BIG THINGS THAT CONTINUES TO BE
TALKED ABOUT HIS MENTAL HEALTH
PARITY IN WHAT IS THAT EXACTLY
SUPPOSED TO MEAN AND I THINK
THEY'RE MADE. I THINK THERE'S
SOME MORE EVEN LEGISLATION
ABOUT. SO FROM YOUR PERSPECTIVE
AND I REALIZE WERE SIR TIED
LITTLE BIT TO THE LAWS. IN A
BID TO LOSS TO AND WHAT THEY'RE
FOR THE FEDERAL GOVERNMENT'S BE
WILLING TO PAY FOR WHICH THEN
BECOMES WHAT'S THE STATE
WILLING TO PAY FOR. THE FEDS
ARE PAYING FOR- ARE YOU SEE IS
NAVIGATING THE FACT THAT WE
ALSO HAVE WE'RE WE'RE TRYING TO
FIGURE OUT HOW TO OF ALL OF
THEM BECAUSE- THIS IT IS WHAT.
EXPECTATIONS AND TING HE HAS
INVOLVED IN THE- MEDICINE AND
RELATED AND HEALTH CARE HAS
EVOLVED. AT HOW HOW DO WE TRY
TO RESOLVE THIS ISSUE OF. WELL
BUT YET AT THE SAME TIME WERE
SORT OF LOCKED IN LEGISLATIVELY
AND ACTUALLY SO I GUESS THE
OTHER INTERESTING QUESTION IS
RELATED TO THAT. WOULD BE IS
THAT. SO THE BENCHMARK PLAN
HOUSE SPECIFIC IS THIS- BECAUSE
WE A BROAD REQUIREMENTS SO I
MEAN IT'S EXACTLY LIKE THE
BENCHMARK PLAN WOULD HAVE OR
NOT HAVE COVERED THAT IN ON
DECEMBER THIRTY FIRST TWENTY. A
LOT OF AND IS THE IT'S WHAT
EVERYONE'S GONNA LOOK BACK TO
AND SAY WELL THAT'S- SAID THAT
IT'S THAT INTERPRETATION EVEN
IF SOMEONE SAYS IN THE FUTURE
WE INTERPRET A LITTLE
DIFFERENTLY YES IT'S WHATEVER
WAS IN PLACE F. WITH A STATE
BENCH MY PLANET OFFERED. BY
DECEMBER TWO THOUSAND ELEVEN
AND ANY STATE. MANDATED THAT
WAS IN ADDITION TO WHAT WAS IN
THAT BENCHMARK PLAN. THAT WAS
ALREADY IN PLACE SO CALIFORNIA
HAS MORE. I WOULD SAY THE-
OTHER TYPES OF SERVICES THAT
ARE ALREADY INCLUDED IN THE
BENCHMARK PLAN. THAT MAYBE SOME
OTHER STATES WITH- BUT IS THE
FACT THAT IT WAS THE CUT OFF
DATE OF DECEMBER THIRTY FIRST
THOMAS NAY LEVIN SO. IF THERE'S
NEW STATE MANDATED BENEFITS
THAT'S WHEN IT'S TAKEN ME TO.
THE CAR AND WE WOULD HAVE TO
TAKE A LOOK AT. SO IN OTHER
OPTIONS OBVIOUSLY. THE FEDERAL
PROVIDE THAT MORE. VILLAGE.
SOMETHING COULD BARELY INTO BUT
BEING VERY MY OF THE OBVIOUSLY
ANY IN TO SERVICE WELL USUAL
INCREASE THE PREMIUMS RIGHT AND
SO THAT WILL THAT WILL HAVE
IMPACT TO OUR CONSUMERS AS WELL
TO- AS FAR AS THIS FEDERAL
SUBSIDIES WILL PROBABLY GO UP
AS WELL AS THE STATE SUBSIDIES
BUT FOR SURE IT WILL IMPACT
POTENTIALLY ARE OFF EXCHANGE
MEMBERS WHICH WE HAVE OVER FOUR
HUNDRED AND TWENTY. THOUSAND
INDIVIDUALS THAT ARE MORE THAN
THE OFF EXCHANGE MARKET RIGHT
NOW THAT POTENTIALLY WOULD NEED
TO FURTHER INVESTIGATE WHETHER
OR NOT THEY WOULD ACTUALLY
GETTING THE YOU KNOW. FOR THE
IT WILL INCREASE THE PREMIUM
FOR THEM WITHOUT ANY ASSISTANCE
FROM THE FEDERAL GOVERNMENT. TO
SEND WITH REGARD TO YOUR
SPECIFICALLY. THE BENCH PLAN
THAT WE CURRENTLY HAVE HAS SOME
SPECIFIC LISTS IN IT FOR
EXAMPLE THE DURABLE MEDICAL
EQUIPMENT THAT PROVIDES REYES
SPECIFICALLY LISTED. AND THAT
CONSTRAINS WHAT THE SCOPE OF
THE CENTRAL HEALTH BENEFIT FOR
THAT IS. FOR EVERYONE. OKAY SO
I MEAN I THINK THE I THINK
WE'LL GO SOME OF THE TENSION
ALSO IS THAT. I YES IF YOU.
ADDED BENEFIT MOST LIKELY THE
BAND THEY SERVE ASSET BUT
USUALLY THEY THAT. EIGHT
INCREASED. THE PLAN AT THIS
SAME TIME. THE REASON YOU BUY A
PLAN IN THE FIRST PLACE IS THAT
IT NEEDS TO BE THERE WHEN YOU
NEED IT RIGHT AND HAPPY OF THE
PENNY HOW WE WANT TO FIND THAT
BUT- IN A SUPPORT WE STRUCK YOU
KNOW THAT CERTAINLY I STRUGGLED
WITH WITH THE WITH THE A SOME
MULLIN SPILL OVER THE HEARING
AIDS RIGHT WHICH- TO. SUPPORT
BECAUSE BECAUSE GET YELLED BUT
THE NATURE OF THE BENEFIT WILL
IS ONE IN WHICH I THOUGHT THAT
WAS IS THAT AND REASONABLE
EXPECTATION EXPECT THE HEALTH
AND THE COVER RIGHT I MEAN
HEARING IS PRETTY. NOW BEYOND
THAT HERE'S THE HAS A PROFOUND
IMPACT OUR LATIN ABILITY HERE-
YOU KNOW- I CAN HAVE A PROFOUND
IMPACT ON YOUR ABILITY TO. TO
FUNCTION IN AND MY FAMILY SOME
PEOPLE WHO'VE WHO FEEL HAVE HAD
THAT CONDITION- LIFE AND IT'S
YOU KNOW BEEN EDUCATE AND TRAIN
MAY BE ABLE THAT BUT NOW IT'S
STILL HELLO HEARING LOSSES. AND
SO YOU KNOW WHAT POINT IN A
DIFFERENT WAY ON GENERALLY IT
IS AT THE ACT AS THOUGH RIGHT I
MEAN IT'S NOT. THE POWER BUT
STILL WE ARE HOW HOW HOW HOW DO
WE DO WITH THE A GAPS AND THEN
UP THOUGH IF THERE MAY BE NEED
GAPS OVER TO. WRITE SO THE WE
GO ON TO. THE LIKELIHOOD THAT.
WITH TECHNOLOGY MOVING AT AT
AND SO FORTH- THAT YES MAYBE
FOR YOUR YOUR VAST MAJORITY P.
WE GOT. EVERYTHING COVERED BUT
IF THE GAPS ARE LARGER AND
LARGER I MEAN IF THE PRESSURE
WE FEEL THAT THE PRESS THAT WE
WITH WHAT. WHY NOT COME WITH
MANDATE BILL RATE AS SOMEONE'S
IN WRITING. AND THERE TO FIGURE
OUT HOW TO ADDRESS THAT YEAH.
FEDERAL RULES OUT. SCRIBE BUT
TODAY DO NOT SO MUCH PROVIDE. A
WITH. TO THE- AS PROVIDE.
PERILS TO THIS. YOU COME UP
WITH. A WITH WEEKS WHICH IS
DESCRIBED TO PASS ONE IS TO
CHOOSE A DIFFERENT ESSENTIAL
HEALTH BENEFIT BENCHMARK PLAN.
BUT THE FEDERAL RULES THAT
PERMIT THAT. IN THIS CYCLE- THE
PLAN SELECTION WOULD HAVE TO BE
COMMUNICATED TO THE FEDERAL
GOVERNMENT. BY MAY EIGHTH OF
THIS YEAR JUST VERY SHORT TIME
PERIOD. AND THEN THE SELECTED
PLAN WOULD HAVE TO BE COMPLY
WITH WHAT WAS CALLED THE
GENEROSITY REQUIREMENT IN THAT
IT CANNOT BE MORE GENEROUS IN
TERMS OF ACTUARIAL VALUE THE
PERCENTAGE OF. VALUE NEVER TO
THE POT XIN THAT IT COVERS-
CANNOT BE MORE GENEROUS THAN A
PANEL OF COMPARATIVE PLANS SO
BASICALLY IF YOU. KNOW IF YOU
HAVE A CHEVY NOW YOU. ABLE TO
GET THE CASH. BECAUSE THIS
GENEROSA OR- IF ON THE OTHER
HAND YOU WISH TO PURSUE A- UP.
TO DEVELOPING A NEW STATE
MANDATE FOR SOMETHING SPECIFIC-
JUST RECENTLY IN A PROPOSED
FEDERAL RULE ISSUED THE NOTICE
OF BENEFIT PAYMENT PARAMETERS
FOR TWENTY TWENTY ONE- THE
FEDERAL GOVERNMENT IS
PROPOSING. HAS NOT YET MADE
FINAL THE STATE REPORTING
REQUIREMENTS FOR THE MANDATE
SAID IT HAS AND DEVELOPED IN
THE FUTURE. OVER THE PAST YEAR
OF THE AFFORDABLE CARE ACT THE
STATE'S HAVE ESSENTIALLY BEEN
ABLE TO SELF POLICE AND SELF
EVALUATE WHERE THEY'RE A NEW
MANDATE IS SUCH THAT IT
REQUIRES AT THE STATE. DEFRAY
THE COSTS. NOW WE'RE GOING TO
BE REQUIRED IF THIS RULE IS
MADE FINAL. TO REPORT ANNUALLY
TO THE FEDERAL GOVERNMENT WATER
MANDATES ARE WHAT ARE
EVALUATION IS AND- THE PROPOSED
RULE IS REPLETE WITH THE
INTENTION OF THE FEDERAL
GOVERNMENT TO PROVIDE INCREASED
OVERSIGHT. OF THE- AND THE
CHARACTERIZATION PROCESS SO I
CAN SHARE WITH YOU THAT
NATIONALLY AMONGST THE
INSURANCE COMMISSIONERS THERE'S
GREATCONCERN. THAT THE STATE'S
DETERMINATION THAT A NEW
MANDATE DOES NOT REQUIRED TO
FOR A BILL MAY BE CHALLENGED
NOW BY THIS BUT THE FEDERAL
GOVERNMENT THROUGH THIS
REQUIREMENT SO TWO PATHS TO
PERILS. DAD I MEAN AND
CERTAINLY UNDERSTAND THAT NO
WELL WE SEE THIS FREQUENTLY IS
THAT WHAT I WANT TO GET THE
CSTS. IT'S CENTER- BUT I THINK
ONE OF THINGS THAT WE JUST WANT
THINK ABOUT IS THAT HOW HOW ARE
YOU GOING TO DO THIS EVOLUTION
OVER TIME BUILDING I DO JUST
WANT TO QUICKLY CORRECT MYSELF-
IS ACTUALLY EIGHTY FIVE NINETY
PLAY IS SIMILAR BLOOM. AND THAT
MULLIN ALTHOUGH I AND I WANT
RECOGNIZE SOMETHING MULLIN FOR
HIS HIS WORK BECAUSE HE ALSO
HAS DONE TREMENDOUS WORK AROUND
HEARING LOSS AS WELL BUT IT IS
SO BLOOM AND I NEED TO SURE HE
GETS THE CREDIT FOR DOING BILL
THAT HE AUTHORED. AROUND SO IT.
ON THE RIGHT. MY FEET. PARKS
TERMS THAT BILL BUT HEY I'M JED.
THINK OF. AND I. YOU REGULATE.
YOU KNOW YOU HAVE IMPLEMENT
THESE THE LAWS THAT HE- BOTH
THOSE PASSED BY US AS WELL AS
TRYING TO FIGURE OUT NAVIGATE
THE FEDERAL LAWS THAT WE ARE
TRYING TO. DO AS WELL TO STOP.
THE WOOD WE WILL CONTINUE TO
HAVE YOU KNOW- PRESSURE FROM
PEOPLE WHO WILL POINT OUT WITH
THE WITH MANY OF THEM WITH GOOD
REASON- THEY ALSO THE THAT-
THERE'S A GAP IN THAT PEOPLE
ARE SUFFERING AND SO HOW DO WE-
HOW DO WE- BALANCE. IT OUT WHAT
WOULD. WHAT TO AND MAYBE SOME
BE TELLING THEM LIKE WILL YOU
NEED TO HELP US LOBBY THE
FEDERAL GOVERNMENT TO TREAT
GIVE US SOME FLUID NELSON
MECHANISM. TO TRY TO DECIDE AS
TIME GOES ON YOU KNOW HOW WE
DID A FIGHT GAPS HOW DO WE
ADDRESS THIS IN A WAY- THAT-
THAT IS SURE IS THAT OLD GET.
COVERAGE A NEED BUT BALANCE IS
OFTEN I DO RECOGNIZE THAT YOU
KNOW WE CAN. IS THAT GOING.
WITH OF THAT EVERYTHING ON THAT
WILL AT CAL. BUT MAYBE THE
CHEVY IS MISSING SOMETHING.
LIKE YA SIDE VIEW MIRROR MAYBE
WE SHOULD THINK ABOUT SIDE YOU
MAY. HATE IT ALL OF AB DOESN'T
BILL ENOUGH THAT AB L. MADE CAR
WILL STILL DRIVE WITHOUT IT BUT
IT'S A LITTLE SAFER. SO FORTH
NOT SOME PSYCHO WE AYE CADILLAC
ARRAYED IN THROUGH A REAR
SPOILER THAT WE REALLY DON'T HE
DRAPES SO. AND IT COURSE THAT'S
ALL THERE'S JUDGMENT ABOVE AND
ACTUALLY WHAT KNOW HOW WHAT
WHAT WHAT BUT- I IT'S- TRIED IT
NO I THINK. WE WANT. TO THINK A
LITTLE BIT ABOUT. ABOUT THAT I
KNOW CHIU VERY TIME IN IN THE
BILL COME OUT. TO HELP US OUT
WITH. THIS WELL. THE OTHER
KOREAN IN A CHIPPER ONLY FOR
DOING AT BILL I MEAN. DE SEIR
INTO HELP US TRY TO MAYBE
ADDRESS THIS ON A LARGER ISSUE-
IN TERMS OF- I MEAN. I GUESS
ONE INTERESTING QUESTION WOULD
BE IS THAT WE YOU KNOW WE'VE
GOTTEN ESTIMATES PER MANDATE
AND I'M A PAST AND SOME HAVEN'T.
ONE TO FIND THE CUMULATIVE
IMPACT BECAUSE IT YOU KNOW EACH
ONE SEEMS LIKE- IT'S ONLY YOU
KNOW IT'S A DOLLAR A YEAR IT'S
FIFTY CENTS A YEAR IT'S THAT
ARE BUT THEN WE START. AT
ADDING THEM UP AS WELL AS
THERE. ARE SOME SENSE OF
CUMULATIVE IMPACT AS WELL AS
YOUR BIRDS LOOK THAT- WE HAVE
AND I MEAN YOU KNOW WHEN WE DID
THE TO BURKE WORKED WITH MIL
MEN IN THE ASSESSMENT OF THE
VARIOUS BENCHMARK OPTIONS BACK
IN TWO THOUSAND. EIGHTEEN AND-
BRUCE ABOUT YOU KNOW THE STATE
BUDGET TO STICK WITH THE
EXISTING KAISER HMO PLAN BUT
YOU KNOW WE DID LOOK AT OKAY
WELL WHAT ARE THESE OTHER TESTS
OUTSIDE OF THAT AND I MEAN IN A
SOAP. CERTAINLY LOOKING
BACKWARDS DIFFICULT TO THEN
FIGURE OUT WILL WHAT IS
COUNTERFACTUAL WHAT WOULD HAVE
HAPPENED. IN REGULAR MEDICINE
AND PLANS WITH A COVERED ANYWAY
OR WHAT WAS DUE TO THE TO THE
MANDATE SO. A LOT OF THESE A
RETROSPECTIVE ANALYSES ARE
REALLY DIFFICULT AND GIVE YOU A
RANGE THAT KIND OF MAKES YOU
OKAY THAT VERIFIES COMMONSENSE.
BUT IT'S NOT AN EXACT SCIENCE
ON THAT'S MY HESITATION ONE.
POLICY WANT ME LOVE THAT IDEA
THAT WOULD BE MY IDEA OF A
VACATION- THE ACCURATE. KING TO
TRY TO GIVE THAT IS A CLEAR
ROADMAP TO THE FUTURE ISN'T
THAT. ACCURATE OKAY BUT
CERTAINLY I THINK THERE IS A
PLACE OF BEING ABLE TO PROJECT
YOU KNOW HOW MUCH WOULD SOME OF
THE ITEMS THAT ARE NOT
CURRENTLY PART OF THE BENCHMARK
LIKE INFERTILITY OR
CHIROPRACTIC PEDIATRIC
CARRONADES CERTAINLY DOING I'LL
SIT ON THAT YOU KNOW PREFERABLY
WITH MAYBE MORE THAN SIXTY DAYS
BUT- YOU KNOW SOMETHING THAT WE
COULD SUPPORT. YEAH I MEAN AS
FAR IS THAT THE- WELL MAYBE
DIFFICULT THERE'S ALSO MAYBE
SOME VALUE SAYING WHAT WE
PROJECTED THIS IN THIS WHAT
REALLY HAPPENED AND THIS IS
WHAT WE'RE WORK YOU KNOW THAT
THE SIMI THAT. THAT THE MANDATE
HAD YELLED. AND THE PLACE I
REALIZE. YOU KNOW WE'RE WE'RE
NOT TRYING TO ADD TO ANY NEW
ONES RIGHT NOW. BUT OKAY. ALL
RIGHT. RIGHT QUESTIONS AND IF I
GUESS IS PLEASE ANY KNOW BEAR
MY- A LOT OF- A LOT OF THE
TENSIONS. HOW IN THE SINKING SO
AS PRACTICE OF. BECAUSE A LOT
OF. WE HAVE A COUPLE PRACTICE
CHANGE R OTHER YOU KNOW TAKING
ON AND PROVIDING CERTAIN
SERVICES SOMETIMES AT. LOWER
COST OR PARA PROFESSIONALS ARE
ALLIED HEALTH PROFESSIONALS SO
AS IS THE POLLUTION OCCURS
COVERAGE FOR THOSE WHO DON'T.
TO RUB UP AGAINST EACH FEES SO
THERE IS. AS WE SAID BUT I
THINK OF THESE TONIC PLATE. OF
HEALTH CARE. IS ALLOWANCE FOR
THIS EVOLUTION OCCUR THAT DON'T
BUMP UP WITH THE- YEAH I MEAN
THAT WHEN. THAT PERHAPS SAID
BIGGIES. IS THAT- WITH THE
DEVELOPMENT OF BETTER
TECHNIQUES FOR EXAMPLE CATHER'S
ASIAN CARDIAC CATHETERIZATION.
MUCH TO THIS MAY I THINK OF THE
CARDIOTHORACIC SURGEONS REMOVED
FROM BY PASSES TO KAT YELLED
VARIOUS CATHETER TECHNIQUES FOR
STENSON OTHER TYPES OF THINGS-
AND THAT ALL HAPPENED UNDER THE
UMBRELLA OF. THE EXISTING-
BASIC HEALTH BENEFITS RIGHT BUT
THOSE WERE THAT WAS IT THAT'S A
PRETTY BIG SHIFT. AND INCLUDING
CUT COSTS AND SO FORTH SO. AND
I'M SURE THERE'S MANY OTHERS WE
CAN POINT TO APPRECIATE THAT
OBSERVATION. OUR EIGHT. RIGHT
WELL THAT I WANT YOU THANK ALL
FOR YOUR PRESENTATIONS THIS IS
BEEN VERY HELPFUL IN
UNDERSTANDING THE SCOPE OF WHAT
HAPPENED IS WE IF THERE ARE
MANDATE- CHANGES- AND ALSO WHAT
ARE SOME THINGS THAT- THAT THAT
WE SHOULD BE AWARE OF AND I
APPRECIATE. YOUR YOUR THOUGHTS
AND YOUR- WAS THEM THAT AND
KNOWLEDGE ABOUT- WHAT THE WHAT
YOU FACES A REGULATORS AS WELL
AS OUR VALUE EIGHT PERCENT. AND
WILL YOU HAVE TO ACTUALLY MAKE
IT WORK. FOR THE CALIFORNIA
APPRECIATIVE OF THAT IS SO THEY
YOU VERY MUCH FOR YOUR- FROM
HERE TODAY THANK YOU. ALL RIGHT.
YEAH OKAY WELL NEXT UP IS- THE
PERSPECTIVE FROM OUR HEALTH
INSURANCE CARRIERS AND CONSUMER
PERSPECTIVE SO HEARD FROM THE
REGULATORS NOW LET'S HEAR FROM
THE- PEOPLE ON THE FRONT LINES.
THE PLANS TO ACTUALLY HAVE TO.
SELL THE COVERAGE IN
IMPLEMENTED AND THE CONSUMERS
WHO ARE THE ONES WHO HAVE TO
LIVE WITH IT. OKAY AND PAY THE
PREMIUMS. THANK YOU THANK YOU
SO OF MAYBE JUST A QUICKLY DO
INTRODUCTIONS HERE FIRST AND
THEN WE'LL GO AHEAD THE START
WITH THAT MR LOUISA SO ACTUALLY
WHAT WE HAVE AND INCLUDES A
VICE PRESIDENT OF WHAT'S THE
AFFAIRS OF THE CALIFORNIA
ASSOCIATION HEALTH PLANS DIANA
DOUGLAS BOXING LEGISLATIVE
ADVOCATE FROM HEALTH ACCESS
CALIFORNIA AND A JONES WERE
BLOOM- CHAIR OF THE CALIFORNIA
CHRONIC CARE COALITION AND VICE
CHAIR OF THE CALIFORNIA HEALTH
COLLABORATIVE WELCOME ALL-
MISTER LEWIS THANK YOU. THANK
YOU MISTER CHAIRMAN MISTER
CHAIR- THANKS FOR THE
OPPORTUNITY TO- DISCUSS OUR
VIEWS RELATING TO THE IMPACT OF
STATE BENEFIT MANDATES ON THE
AFFORDABILITY OF HEALTH
COVERAGE AND- AGAIN MY NAME IS
NICK LOUISE US ON THE VICE
PRESIDENT LEGISLATORS PER
CAPITA CALIFORNIA ASSOCIATION
PLANS A- LITTLE BIT OF A
DIFFERENT APPROACH ABOUT TO
TALK STATE MANY. CAN PROCESS BY
WHICH. TO FIVE OUT. YOU KNOW
MOVING. THE BUT KNOW AS AS DOES
DOES YOUR AS A TRADE
ASSOCIATION THE REPRESENTS
FORTY A KNOCK LICENSE HEALTHTHAT DELIVER HELL CARE TO SIX
K. ON INCLUDING THE ELEVEN
MILLION BENEFICIARIES THAT
RECEIVE COVERAGE OF THE MEDICAL
MANAGED CARE PROGRAM- HEALTH
PLANS ARE DEDICATED TO ENSURING
THAT EVERYONE HAS ACCESS TO
HIGH QUALITY AND AFFORDABLE
HEALTH COVERAGE. AS YOU WANT
CALIFORNIA INSURANCE MARKET IS
CHANGE PRETTY DRAMATICALLY-
OVER THE LAST SEVERAL YEARS AND
REMEMBER PLANS HAVE BEEN CLOSE
PARTNERS FOR THE STATE TO
IMPLEMENT VARIOUS KEY MARKET
REFORM. BY SEVERAL MEASURES I
CAN LEADS THE WAY WITH
ACCESSIBLE AND AFFORDABLE
HEALTH CARE. CALIFORNIA
CONTINUES TO CLOSE THE
UNINSURED GAP AND- WE LOOK FOR
TO MAKING MORE STRIDES THIS
YEAR HOME ON THAT ISSUE-
CALIFORNIANS IN THE INDIVIDUAL
MARKET PAY LESS FOR HEALTH
INSURANCE- ON AVERAGE- THAN THE
AVERAGE AMERICAN IN ACCORDANCE
COVERAGE. FOR NEEDS POOL OF
CUSTOMERS OR ITS RISK POOL- HAS
CONSISTENTLY BEEN HEALTHIER
THAN THE NATIONAL AVERAGE AS
WELL. AND THE REASON FOR THIS
SUCCESS IS THAT CALIFORNIA'S
LEGISLATION ADMINISTRATION-
HAVE ME DECISION SOMETIME
DIFFICULT DECISIONS ON THAT
HAVE LED TO MARKET STABILITY-
EXAMPLES OF THIS- INCLUDE THE
EARLY EARLY IN RELATIVELY
AGGRESSIVE ADOPTION OF THE
AFFORDABLE CARE ACT- IN
CALIFORNIA. I'M IN ONE CRIME A
RECENT EXAMPLE- IZZY ENACTMENT
OF A STATE BASED ON INDIVIDUAL
COVERAGE REQUIREMENT OR THE
INDIVIDUAL MANDATE IN LAST
YEAR'S BUDGET. AND THIS
REQUIREMENT COUPLED WITH STATES
CITIES. IS ALREADY RESULTING IN
SOME OF DEVELOPMENTS. MOST
NOTABLY THE PRODUCTS SO IT
COVERED CALIFORNIA TWENTY
TWENTY ARE EXPERIENCING AN
AVERAGE PREMIUM INCREASE OF A
LITTLE LESS THAN 1% AND I THINK
THAT'S A PRETTY NOTEWORTHY
ACHIEVEMENT- IN JUST YESTERDAY
AS AS A SUMMER WOULD MENTION TO
COVER CALIFORNIA ANNOUNCED ITS
HIGHEST ENROLLMENT NUMBERS
SINCE TWENTY SIXTEEN. AND A 40%
INCREASE- OVER LAST YEAR'S
FIGURES SO THAT'S GOOD NEWS AS
WELL ON ANOTHER KEY REASON FOR
CALIFORNIA WELL TO MARKET
STABILITY- WHICH A LOOSE LITTLE
BIT LATER IS THAT OUR STATE IS
DECIDEDLY IN HISTORICALLY
MANAGED IN ITS MARKET
ORIENTATION- WITH THE GOAL
DELIVERY RIGHT- THERE AT THE
RIGHT TIME TO THE RIGHT PEOPLE
IN USING EVIDENCE ADDRESS IT
I'M TO. POLICIES SO WE BOUGHT
THE STATE FOX TOUGH TO SEE ON
LEAD TO THE BOLTS THAT CAPITAL
SIR CAN TO SO. ALL THESE IS
BLAZING MARKETS AND THE- POLICY
AT LEAST AGREE FOR THE NOW
REGRETTABLY YOU KNOW FOR OUR
FIRST ONE ON COVERAGE MANDATE.
RUN IN THE OPPOSITE DIRECTION
AFFORDABILITY ON IN IN THEIR
TOTALITY WE FEAR WILL UNDERMINE
A MANY OF THESE SUCCESSES THAT
WE HAVE ACHIEVED. ON CAP
GENERALLY A THIS IS ALL MANDATE
BILLS BECAUSE THEY DRIVE UP
HEALTH CARE COSTS FOR
INDIVIDUALS FAMILIES. ON
EMPLOYERS- SOME MANDATES
INCREASE THE COST OF CARE
INCREMENTALLY. OTHER MANDATE
BILLS INCREASE THE COST
EXPONENTIALLY- EITHER WAY OUR
CONCERN HAS BEEN THE CUMULATIVE
IMPACT MANDATES ON THE
AFFORDABILITY OF. LAST YEAR CAL
LEDGE CAN. FROM ABOUT NINE OR
TEN NEW BENEFIT MANDATES BILLS
THAT AS PROPOSED WOULD HAVE
DRIVEN UP DRIVEN UP THE COST OF
HEALTHCARE PREMIUMS BY MORE
THAN EIGHT HUNDRED AND THIRTY
THREE MILLION DOLLARS THAT'S
CLOSE TO A BILLION DOLLAR A
PREMIUM IMPACT- AS A RESULT OF-
THE PACKAGE OF MANDY BILLS LAST
YEAR INTESTACY CONTRADICTORY.
ANNUALLY PASS THIS MANY BILLS
WILL SUBSTANTIALLY INCREASE
PREMIUMS WENT LAWMAKERS HEALTH
PLANS AND OTHERS ARE TRYING TO.
ACHIEVE AFFORDABILITY- I DO
WANT TO EMPHASIZE- THAT- YOU
KNOW HEALTH PLANS DO NOT OPPOSE
THE UNDERLYING SERVICES. ON
THAT ARE BEING PROPOSED IN MAN
BILLS AND YOU KNOW- WE
ACKNOWLEDGE THAT THESE ARE
SOMETIMES VERY SENSITIVE- IN
SYMPATHETIC ISSUES I MEAN YOU
KNOW WE'RE ALL MADE OUT OF THE
SAME STUFF SO IT'S- IT'S HARD
SOMETIMES GET UP IN OPPOSE
THESE BILLS. BUT YOU KNOW WE
STRONGLY BELIEVE POINTING OUT
THE NEGATIVE AFFORDABILITY
IMPACT- WE FEEL IS FUNDAMENTAL
TO THE PROCESS- MANDY BILLS ARE
GONNA I'D LIKE TO MAKE IS THAT
MANY BILLS OF KIND OF EVOLVED
OVER THE LAST SEVERAL YEARS- IN
ADDITION TO THE BILLS THAT ARE
ST. COVERAGE MANDATE
REQUIREMENTS OFFER BENEFITS-
MANY MANY BILLS THESE DAYS ARE
NECESSARILY REQUIRE COVERAGE
FOR EXISTING BENEFITS BUT
CHANGE THE WAY THAT THEY ARE
COVERED- AND SO IN OUR VIEW
MOST OF THESE BILLS- YOU KNOW
WE'LL WOULD UNRAVEL THE CHECKS
AND BALANCES OF OUR MANAGED
CARE SYSTEM. INCREASE VOLUME
BUT NOT NECESSARILY THE QUALITY
OF SERVICES. OF THE IDEA BEHIND
MANY OF THE BILL'S
INTENTIONALLY OR
UNINTENTIONALLY IS THAT MORE.
AND MORE SERVICES IN DRUGS INTO
HIS SHOULD BE PUMPED OUT WAS
ZERO CONSIDERATION OF
AFFORDABILITY. OF THE
UNDERLYING COSTS OF THE
SERVICES OR WHETHER THEY ARE
EVEN RECOMMENDED- BY THE
EVIDENCE. AND NOT SURPRISINGLY
VIS BUT SOMETIMES- SUPPORTED-
FOR THE PETITION THERE'S OF
CARE PREMIUM TALLER AND VARIOUS
DRUG MANDATE THAT YOU IN THE
PAST IN IN. THIS YEAR. I'M MIND
AND APART IS JUST POINTING.
HILL STREET A POINT ABOUT YOU
KNOW THE- ON. YOU KNOW IT AB
BASEMENT ANGELA THE RIGHT AT
THE RIGHT TIME V. COMMITTEES
UNDER PRIOR LEADER. ON CAMPUS
ACTUALLY ONE HEARD IN. A COUPLE
OF. THAT WOULD HAVE REMOVED
HEALTH PLAN UTILIZATION
PROTOCOLS ON PAIN MEDICATION.
IN OTHER WORDS IF THE DOCTOR
PRESCRIBED A PAIN PILL IT WOULD
AUTOMATICALLY COVERED BY THE
HEALTH PLAN- AND SO YOU KNOW.
ABOUT THE PROPOSED POLICY
THROUGH THE HISTORY. EPIDEMIC
CAN YOU. THAT I IN YOU KNOW THE
DOESN'T REALLY LIKE A GOOD IDEA
AND RETRO AND SO NEED TO TAKE A
LONG PURSE NOT ONLY A NEW
COVERAGE MANDATES BUT MAN
EXISTING COVERAGE INTO THE WAY
THINGS ARE CO. HELLO TERM WRIST
WE- YOU'VE- WOULD HELPFUL THAT
DEPARTMENT. SO IN ADDITION TO
COST AMONG THE KEY
CONSIDERATIONS- IN OUR ANALYSIS
OF MANDY BILLS INCLUDES THE
FOLLOWING. YOU KNOW IT DOES A
BILL IRRESPONSIBLY REMOVE
MEDICAL MANAGEMENT PROTOCOLS ON
DRUGS AND OTHER SERVICES. THE
BILL INCLUDE A POLICY CHANGE
THREATENS THE MANAGED CARE
MODEL OR EXPOSE HEALTH PLANS TO
LIABILITY. DOES THE BILL
ERRONEOUSLY APPLIED
RETROSPECTIVELY. THE BILL THE
CAR MY POINT IN TIME. THAT ARE
NOT BASED ON INDEPENDENT REVIEW
EVIDENCE BASED MEDICINE BUT
THAT SITE SPECIFIC
ORGANIZATIONS BY NAME. AT
INHIBIT THE INABILITY OF PLANTS
TO ADAPT TO INNOVATION OR NEW
INFORMATION AS AS DISCUSSED
PRIOR IN THIS HEARING. SHIFTING
GEARS A LITTLE WILSON WAS POINT
OUT THE HEALTH PLANS IN THE
INDIVIDUAL MARKET AND SMALL
GROUP MARKET DID NOT SET THE-
EACH BEATTY'S WHICH YOU KNOW
YOU KNOW WE DISCUSSED EARLIER-
YOU KNOW. LATER IN THE EVENING.
BENCHMARK PLANNING C. H. BEES-
IN YOU AGAIN YOU'VE HEARD FROM
OTHERS ABOUT THAT PROCESS IT
WAS A LOGICAL PROCESS. THAT
INCLUDED RIGOROUS ANALYSIS.
COMPARISONS IN TRADE OFFS-
BETWEEN THE NEED FOR BENEFITS
AND AFFORDABILITY. ON IN THE A
VERY COMPREHENSIVE SET OF
BENEFITS WAS WAS SELECTED FOR
CALIFORNIANS IN THOSE MARKETS-
AND- YOU. SIMPLY IT STANDS FOR
REASON HOWEVER THAT EVERYTHING-
CAN BE LOOTED. OUT AND IN THAT
PROCESS. AND YOU THE FOR ALL
YOU'RE DOING ONE OF THE BENEFIT
MANDATES ON HIS RELATED CONCEPT
IN THAT COULD EXPOSE STATE
GENERAL. TO FIT. HE REPLACED
GATED AYE I MADE A MINISTRY DID
MINISTRATION STIPULATE THAT THE
FOR GOVERNMENT WILL NOT PAY FOR
THE COVERAGE SO. TO SUPPORT
BENEFIT. MANDATES THAT EXCEED
THE H. B. AS IN THE STATE WILL
HAVE TO DEFRAY THAT COSTS WHICH
THE EXPERTS PRIOR TO ME
EXPLAINED IN BETTER DETAIL BUT
THESE RULES MIGHT BE GETTING
TIGHTER THERE ARE PROPOSED
FEDERAL RULES TABLE THAT WOULD
REQUIRE. TO HAND WILL BE
IDENTIFIED. BEEN SAID EXCEED
THE H. P. OR PROVIDE
JUSTIFICATION FOR STATE
MANDATED BENEFITS STATE
BELIEVES DOES NOT EXCEED THE
ESSENTIAL HEALTH BENEFITS. AND
SO STATE DID IN ITS STATES
DON'T COMPLY WITH THIS A
PROPOSED RULE THE FEDERAL
GOVERNMENT WILL THROUGH THE
LOOK MAKE THAT DETERMINATION IS
SO. MANY MORE HE- PROPOSITION
THE STATE A POTENTIAL. IN THE
COMING MONTHS YEARS. I'D LIKE
TO CLOSE JUST A WITH SOME
SUGGESTIONS ON MORE- YOU KNOW
WHAT WE FEEL IS MORE LOGICAL
AND COMPREHENSIVE APPROACH TO
HOW THE LEGISLATURE MIGHT
CONSIDER MANDATE BILLS MOVING
FORWARD- FIRST I DO WANT TO
THANK YOU FOR THE ATTENTION
THAT YOU'RE GIVING THIS ISSUE
WE THINK IT'S IMPORTANT. AND WE
APPLAUD THE CHAIRS FOR
DELIVERING YOU KNOW THE MESSAGE
TO MEMBERS THAT YOU KNOW THESE
BILLS ARE ALWAYS A GOOD IDEA
SO- WE THANK YOU FOR THAT THE
WORK THAT DAY TRIPPER IS ALSO
VERY COOL. AND WE APPRECIATE
MANY BILLS ARE OFTEN GIVEN A
SPEC HEARING DATE ASIDE. ACT OF
THE LEGISLATURE. SO BUT OUR
RECOMMENDATIONS ON YOU KNOW
PROCEDURAL PROCESS OF MANDATE
BILLS INCLUDE THE FOLLOWING.
NUMBER ONE- WE DO RECOMMEND
THAT- THE STATE CONSIDER RE
OPENING THE ESSENTIAL HEALTH
BENEFITS QUESTION AND
CONVENTION PLAN CONSIDERATION.
ON AND SELECTING A NEW PLAN OR
AT LEAST LOOK INTO THAT- THIS
OFFICE IS KIND OF SCARY
RECOMMENDATION- AS PLANS MAY
NOT SUPPORT THE FINAL SELECTION
FROM AFFORDABILITY OR ACCESS
PERSPECTIVE- BUT IT'S AT LEAST
A COMPREHENSIVE PROCESS AN
ANALYTICAL THAT FORCES US TO
CONSIDER THE TRADE OFFS
INVOLVED- IN QUITE FRANKLY
ANYTHING. JEKYLL IS DOUBLE THE
SPENDING HOURS AND HOURS IN
COMMITTEE MEETING WHAT MAN BILL.
UP I'M. NUMBER TWO WE WERE
RECOMMEND FROM LEGISLATURE
PROCESS PUTTING MNDY BILLS ON
A TO YOUR BILL CYCLE- AND YOU
KNOW ALL EXPLAIN THE REASONING
FOR THIS- WILL NUMBER ONE IT'S
BEEN DONE FROM BEFORE THERE'S
PRESS AND FOR THAT- IN THE WE
FEEL THAT IT'S BEEN. AN
OFFICIAL TO THE POLICY MAKING
PROCESS- INTO HAS SEVERAL
ADVANTAGES. IT WILL ALLOW
TROOPER MORE TIME HE WAS WORK
ON THE CHIU BOURBON NOW SEES
ARE OFTENTIMES DELIVERED RIGHT
BEFORE AN INS. DECK THIS IS
THROUGH THE BILLS HAVE BEEN
HURTING COMMITTEE- AND THIS RUG
RUSH PROCESS- IS FOR TALK TO
ALL PARTIES ALT WE SO THINK
GIVING HER MORE TIME ALLOWS
STATE. TO AT THE END OUT AND
PROVIDE BACKING IT IS NOT AN-
FOR. THE ISSUE PARTS. SEASON
SITUATIONS. THE ARE THE PRE YOU
PORCHER WE HAVE A- HE IS WAY
FOR BERMAN COULD HAVE BEEN COST
ABOUT WHAT IS CURRENTLY CO WHAT
EXCEEDS ESSENTIAL BENEFITS WHAT
THE MEDI LITERATURE SAYS ABOUT
A PART ISSUE OR WHAT THIS BILL
LEE IS AND ITS IMPACT. A TWO
YEAR CYCLES THERE'S A
COMMITTEES THE OPTION OF
REQUIRING TO BURKE TO ESTIMATE
THE CUMULATIVE IMPACT. OF ALL
THE MANDATE THAT HAVE BEEN
INNER TO USE WHICH IS A
SOMETHING I WAS APPROACHED
EARLIER- WE TRY TO DO A
CUMULATIVE IMPACT BY ADDING ALL
THEPREMIUM INCREASES ESTIMATED
BY TIMBER. BUT WE KNOW THAT THE
SIMPLE MATH MATH MATH IT IS
UNSCIENTIFIC- AND SO THERE
COULD BE A LITTLE BIT MORE
RIGOR AROUND THAT DOES. REQUIRE
TIME- YOU KNOW OTHER IDEAS WE
HAD WAS YOU KNOW REQUIRING THE
PLANS TO REPORT THE PREMIUM
IMPACTS OF ANNIE'S RESISTING.
WE DON'T USUALLY REPORT
CARMEN'S ON A BUT IN. COULD BE
IN. CONJUNCTION WITH THE OTHER
CITY TIONS. WE'LL BE THERE ANY
NEW MATT EXCEEDS THE ESSENTIAL
BENEFITS SHOULD HAVE A
CORRESPONDING LINE ITEM
APPROPRIATE IN. IN THE BUDGET
TO. COVER THE TRAIL
REQUIREMENTS. SO AND AGAIN YOU
KNOW. TO TELL YOU TO YOU KNOW
CONTINUE THE I. ARE YOU
INCLUDING MANAGE IN A SPECIAL
OF BUSINESS YOU KNOW DURING YOU
KNOW IDENTIFIED HEARINGS- THE
IS. SOMEWHAT TEDIOUS I GUESS
BUT ALSO KIND OF EMPHASIZES THE
TOTALITY OF THESE- PREMIUM
IMPACTS SO CLOSING AND YOU KNOW
WE FEEL THAT WHEN WE
COLLECTIVELY FOCUS ON MARKET
STABILIZATION AND ON THE
UNDERLYING DRIVERS OF HEALTH
CARE COSTS WE GET GOOD OUTCOMES.
AND IT'S AND FROM OUR
PERSPECTIVE DO NOT FIT THAT
AGENDA. AND THERE ARE OTHER
LOGICAL WAYS OF DEALING WITH
THE ISSUE THAT WE HOPE THAT YOU
KNOW YOU'LL CONSIDER MOVING
FORWARD. THANK YOU. THE SURPLUS.
GOOD AFTERNOON SENATOR PAN
ASSEMBLY MEMBER BOARD THANK YOU
FOR INVITING ME TO BE A PART OF
TODAY'S HEARING AND DIANA
DOUGLAS POLICY ADVOCATE WITH
HEALTH ACCESS CALIFORNIA THE
STATE WIDE CONSUMER ADVOCACY
COALITION FOR OVER THIRTY YEARS
HEALTH ACCESS TO TOP QUALITY
AFFORDABLE CARE FOR ALL
CALIFORNIANS QUALITY BENEFITS
MEANS THE GUARANTEE THAT
CUSTOMERS GET THE CARE THEY
NEED WHEN THEY NEED IT. SINCE
NINETEEN SEVENTY FIVE EARLIER
THAN I CAN ACT AS REQUIRED
COVERAGE OF BASIC HEALTH CARE
SERVICES INCLUDING DOCTOR
VISITS HOSPITALIZATIONS IMAGING
LABORATORY IN OTHER SIX
SERVICES HOWEVER PRIOR TO THE
FORMAL CARE ACT INSURANCE UNDER
THE A CALIFORNIA DEPARTMENT OF
INSURANCE OVERSIGHT WERE A
LIMITED BENEFIT. INCLUDING
THOSE THAT MAY ONLY OF COVERED
IF YOU DIE. AS ONLY A FEW DAYS
OF HOSPITALIZATION OR ONLY
GENERIC PRESCRIPTION DRUGS.
WITH THE PASSAGE OF THE
AFFORDABLE CARE ACT IN ITS
REQUIREMENT THAT SMALL GROUP
AND INDIVIDUAL MARKET PLANS
COVER TEN ESSENTIAL HEALTH
BENEFITS. WE GAINED MUCH NEEDED
ADDITIONAL PROTECTION FOR
CALIFORNIANS UNFORTUNATELY
THOSE WITH LARGER GROUP
COVERAGE REGULATED UNDER
INSURANCE CODE STILL LACK MANY
OF THOSE PROTECTIONS. IN FACT
THE ACA ITSELF WAS ABLE TO PASS
IN LARGE PART DUE TO THE
OVERWHELMING PUBLIC OUTCRY OVER
JUNK HEALTH INSURANCE PLANS
THAT LACKS MANY KEY OFFICE.
LEADING UP TO THE LANDMARK
LEGISLATION WERE PROLIFERATION
OF CONSUMER STORIES
HIGHLIGHTING THE REAL HUMAN
COST. OF GROSSLY IN AT AN OPEN
MID. USING COVERAGE. WHAT FORTY
CONSUMER SUSAN BREAK ABOUT WHAT
SHE THOUGHT WAS CATASTROPHIC
COVERAGE. SHE ONLY FOUND OUT
AFTER SHE WAS DIAGNOSED WITH
BREAST CANCER THAT IN FACT MANY
OF HER TREATMENT OPTIONS MOST
OF OUR TREATMENTS WERE NOT
COVERED. THE OUTPATIENT
LUMPECTOMY THE CHEMO THE DRUG
SHE NEEDED. THE RADIATION WERE
NOT COVERED UNDER THE PLAN SHE
HAD PURCHASED THE EASY
THANKFULLY PUT AN END TO THOSE
SORT OF SUB STANDARD PLANS THAT
LEFT PATIENTS IN A LARGER
WORSE- IN A IN A POST A CA
WORLD THE LEGISLATURE SHOULD
CONTINUE TO REEVALUATE BENEFIT
MANDATES BY TAKING INTO ACCOUNT
THE EVOLVING CIENCE AND
PRACTICE OF HEALTH CARE. AS
BENEFIT MANDATES OUR VALUE
ADDED IS ALSO NECESSARY TO
BALANCE THE GOALS OF
AFFORDABILITY. AND PUBLIC
HEALTH ALONG WITH THE NEED TO
PROVIDE ACCESS TO CARE AND
FINANCIAL SECURITY FOR PATIENTS
THAT COMES WITH A COMPREHENSIVE
COVERAGE- HEALTH ACCESS AS A
CONSUMER ADVOCACY COALITION WHO
FOUGHT FOCUS IS NOT ONLY A
QUALITY OF CARE BUT ALSO.
AFFORDABILITY AND IN MANY
INSTANCES WE TAKE THE LEAD ON
ADVOCATING FOR CONSUMER
AFFORDABILITY- IT WE RECOGNIZE
THE NEED TO BALANCE. THE
AFFORDABILITY WITH THE GOALS OF
PUBLIC HEALTH AND COVERED
BENEFITS. OUR ORGANIZATION DOES
NOT SUPPORT EVERY BENEFIT
MANDATE THAT THAT COMES ALONG
AND WE VIEW SOME. ITH THE
SKEPTICISM AB PARTICULARLY I
WOULD NOTE THAT WAS SPONSORED
BY- IT MAYBE A SPECIFIC DRUG OR
DEVICE MANUFACTURER FOR THAT
HAVE A- SORT. OF FOCUS IN THIS
REGARD. I'M AT THE SAME TIME WE
THAT PROPOSE MANDATES RESULT IN
VERY MINOR ADDITIONAL COST AS
FAR AS PREMIUMS GO SOMETIMES
PENNIES ON THE PREMIUM AND
GIVEN THAT THE USED TO BE
LIMITED BUT THE COST SPREAD
ACROSS ALL ENROLLEES THAT'S THE
POINT OF INSURANCE OF ANY OF
THESE MANDATES THAT WE TALK
ABOUT WELL THEY WOULD INCREASE
COSTS IT'S VERY RELATIVE TO.
THE GAMES THAT GOT FOR PATIENTS.
WITH ASIAN TIMBER FROM THE
BEGIN AND EVER ITS ROLE IN
DETAILING THE IMPACT OF THESE
MANDATES- NOT ONLY THE COST BUT
ALSO THE BENEFITS THAT WE SEE
THEM. TO THE CONSUMERS THAT ARE
OUT THERE AND TO THE PUBLIC
HEALTH IN A BROADER SENSE-
AFFORDABILITY IS ALSO CRUCIAL
GOAL SO CONSUMERS NEED TO BE
ABLE TO AFFORD COVERAGE IN THE
FIRST PLACE- WITH ANY PREMIUMS
THAT ARE MANAGEABLE AND ALSO
COST SHARING THE FORM OF COPAYS
AND DEDUCTIBLES. THAT AREN'T SO
BURDENSOME THEY WILL PROVIDE
FOLKS SEEKING OUT THE COVERAGE
THAT THEY NEED FOR THE CARE
THEY NEED- BUT DENYING THE
TERROR OR RESEARCHING WHAT WE
CONSIDER TO BE MEDICALLY
NECESSARY CARE. THAT IN OUR
OPINION AN APPROPRIATE MEANS OF
KEEPING COSTS DOWN WE'RE
PLEASED THAT CALIFORNIA'S
TAKING MANY OTHER APPS TO
ADDRESS AFFORDABILITY-
PRTICULARLY RECENTLY BY
PROVIDING CHANNELS. AND COVER
ALL OF. AND ALSO TAKING SMART
POLLUTION GET ON MY- UP CARE SO
PER THE NEW. A OFFICE OF HER
HEALTH CARE FOR WE BUT WE
BELIEVE THAT A LOT OF THE
APPROACHES HAVE A BETTER
ABILITY TO GET TO WHAT'S
UNDERLYING THAT THE RISING
COSTS. WE DO NOT WANT TO GO
BACK TO THE PRE AC LANDSCAPE OF
FEWER IF ANY ESSENTIAL HEALTH
BENEFITS WERE LOWER COST CAME
AT THE EXPENSE OF PEOPLE'S
LIVES DIGNITY AND FINANCIAL
STABILITY CALIFORNIANS SHOULD
EXPECT ESSENTIAL BENEFITS TO BE
COVERED AS A BASELINE AND
NOTABLY FOR THOSE TWO EVOLVED
SIGNIFICANTLY OVER THE YEARS AS
WE HEARD EARLIER AS TECHNOLOGY
CHANGES AS OUR EXPECTATIONS AND
MORE IS CHANGE. THESE THESE
BASELINE BENEFIT. AN EVOLVING
IN THE NINETEEN EIGHTIES SUCH
BASICS AS CHILDHOOD
IMMUNIZATIONS LIFESAVING PAP
SMEARS AND MAMMOGRAMS WERE NOT
COVERED. WE'RE NOT REQUIRED TO
BE COVERED. IN THE NINETEEN
SEVENTIES PRESCRIPTION DRUGS
WERE ACTUALLY CONSIDERED
OPTIONAL BENEFIT SO YOU SEE IN
THESE OF ALL OVER TIME. AND
WOULD EXPECT THEM TO CONTINUE
TO DO SO. WITHOUT DEBATING THE
MERITS OF SPECIFIC PROPOSALS
FOR PARTICULAR BENEFITS
CONSUMER ADVOCATES STRONGLY
SUPPORT OF ALL BEING ESSENTIAL
BENEFIT REQUIREMENTS THAT TAKE
INTO ACCOUNT THE CHANGING
SACKED SCIENCE AND PRACTICE OF
MEDICALLY NECESSARY CARE. AND
ALSO THE NEED TO KEEP PREMIUMS
AND COST SHARING AFFORDABLE ALL
WORKING ULTIMATELY ENSURE
PATIENTS HAVE ACCESS CARE AND
FINANCIAL SECURITY THAT THEY
EXPECT FROM HEALTH CARE
COVERAGE THANK YOU. WELCOME.
GOOD AFTERNOON. MY NAME IS JOE
MORE BLUNT AND I'M A REGISTERED
NURSE AND I AM HERE
REPRESENTING THE CALIFORNIA
CHRONIC CARE COLLABORATIVE OF
WHICH I AM THE CHAIR OF THE
BOARD AND ALSO THE CHRONIC ARE
THEY I'M SORRY CALIFORNIA
HEALTH COLLABORATIVE WHICH I'M
ALSO VICE CHAIR OF THAT BOARD.
SENATOR PAN AS THE MEN WOULD I
WOULD VERY MUCH AND MEMBERS OF
THE COMMITTEE LIKE TO THANK YOU
FOR THIS OPPORTUNITY FOR OUR
ORGANIZATIONS TO PARTICIPATE IN
THIS DISCUSSION. THE CALIFORNIA
CHRONIC CARE COALITION IS AN
ALLIANCE OF NONPROFIT. AND
PROVIDER ORGANIZATIONS UNITED
TO IMPROVE THE HEALTH OF
CALIFORNIANS OUR MISSION IS TO
IMPROVE THE HEALTH CARE SYSTEM
SO THEY'RE ALL CALIFORNIANS
WITH THE CONDITIONS CAN ACCESS
APPROPRIATE QUALITY. HEALTH
CARE. WE ENCOURAGE PREVENTION
WE ENCOURAGE EFFECTIVE
DIAGNOSIS AND MANAGEMENT OF
CHRONIC DISEASES WITHIN THE
CALIFORNIA HEALTHCARE POLICIES.
A CENTRAL BENEFITS OF HAD A
DIRECT IMPACT FOR CALIFORNIA
PATIENT ACCESS. TO QUALITY CARE
AND THE LIVES OF MILLIONS
CALIFORNIANS INCLUDING THE WITH
CHRONIC IS. IT'S ACCESS TO
AFFORDABLE ADEQUATE COVERAGE
THAT ENABLES HEALTH CARE ACCESS
IS CRITICALLY IMPORTANT FOR
PEOPLE WITH. AN AT RISK FOR
COMPLEX CHRONIC DISEASES WHEN
PEOPLE ARE NOT ABLE TO AFFORD
THE TOOLS. IN THE NECESSARY TO
MANAGE THEIR CHRONIC CONDITIONS
THESE TEND TO SCALE BACK THEY
WILL FOREGO CARE. THEY WILL
SKIP MEDICINES THEY'LL CUT
THEIR PILLS IN HALF YOU'VE
HEARD ALL OF THESE STORIES
BEFORE I KNOW THESE OFTEN LEAD
COMPLICATED AND EMERGENCY ROOM
VISITS WHICH TEND TO BE
EXPENSIVE IF YOU'RE TALKING
ABOUT THE COST OF CARE. AND
THESE HOSPITAL ADMISSIONS CAN
VERY OFTEN BE. I WAS HIS NURSE
SPECIALIST FOR SEVEN YEARS AND
I'VE SEEN FIRST HAND WHAT
HAPPENS WHEN PEOPLE CANNOT
AFFORD THE MEDICATION THE BASIC
EQUIPMENT FOR THAT ONE DISEASE
LET ALONE. THE COMPLICATIONS
THAT COME WITH IT. THE
CALIFORNIA CHRONIC CARE
COALITION AND ITS ADVOCATES
HAVE WORKED WITH OTHER
STAKEHOLDERS FOR THE PAST TWO
DECADES TO IN THESE ACCESS TO
AFFORDABLE QUALITY HEALTH CARE.
MUCH OF OUR PUBLIC POLICY WORK
FOCUS ON LEGISLATION THAT
SUCCESSFULLY IN SOME CASES
ADDED MANDATES AND CREATED
LEGISLATION FOR THE APARTMENT
OF INSURANCE WE WERE
INSTRUMENTAL IN DEVELOPING THE
TO. MANAGED HEALTH. HAITIAN
ADVOCATES. MANDATE WE FOUGHT
FOR TO PROTECT CONSUMERS WHOSE
HEALTH PLAN DENIED THEM ACCESS
TO CARE THEY WERE CONSIDERED
ONLY AFTER PEOPLE PRESENTED
WITH TWO MILES FOR THE SPECIAL
CARE EITHER CAUSING HARM
UNNECESSARY DELAYS AND
TREATMENT CONDITION WORSEN OR
AGAIN X. TO THE EMERGENCY.
CALIFORNIA. COLLUDED AN
ESSENTIAL HEALTH BENEFITS OF
CALIFORNIA DOES NOT DROP THESE
EXISTING BENEFITS DUE TO
BUDGETARY PRESSURES ESSENTIAL
HAVE YOUR BENEFITS FOLLOW THE
KNOX KEEN ACT CONSIDERATE
PROTECTION. PROVIDERS PLANS.
THROUGH THE LEGISLATIVE INTENT
OF THE KNOX KEEN ACT IT IS THE
INTENT AND PURPOSE OF THE
LEGISLATURE TO PROMOTE DELIVERY
AND CAUGHT HEALTH AND MEDICAL
CARE TO THE PEOPLE OF THE STATE
OF CALIFORNIA THE CASE FOR YOU
I CARE COULD LOSE COLD. FOR
PATIENTS TAX MY DATE WORKABLE
HEALTHCARE THROUGHOUT THE CARE
CAN YOU TAKE. IN OUR RESEARCH
INDEPENDENT NICOLE PORT WHICH
WE RELEASED IN TWO THOUSAND AND
EIGHTEEN. WE ANALYZE FROM THE
DEPARTMENT OF MANAGED HEALTH
CARE WEBSITE AN INCREASING
NUMBER OF DENIALS WHICH WAS
ALARMING TO US. WERE FOR THE
NOVELS FOR KEEP POPPING.
PROCEDURES MEDICATIONS
REIMBURSEMENT WE WANTED TO KNOW
WHAT WAS BEHIND ALL OF THESE TO
NILES OUR DATA EXPLORED A
SAMPLE AND YOU HAVE A COPY OF
THE REPORT. ARE FINDING ANY
PEOPLE WITH CHRONIC DISEASES
AND CONDITIONS ARE DENIED
pREQUEST WHICH RIVER- FOR
EFFECTIVE TREATMENT AND
MANAGEMENT OF THEIR CONDITIONS
WE WANT TO FIND THE RIGHT NOW.
ONE PEOPLE WERE DENIED AND THE
REASON FOR THE DENIALS. WE
INVESTIGATED TRENDS OF ISSUES
RELATED TO THE INTERRUPTION OF
ACCESS TO TIMELY HEALTHCARE.
EFFECT IT WOULD HAVE ON A PER
SINCE. TWO NEW THE CARE. IF ALL
OF THE MANDATE LEGISLATION THAT
WE HAVE. IS A FACT OF WIND THEN
WE ASKED WERE OVER 61% OF THE
INDEPENDENT MEDICAL REVIEWS
SUBSEQUENTLY OVERTURNED BY THE
DEPARTMENT OF MANAGED
HEALTHCARE. AND FOUND THAT WAS
AN ALARMING SITUATION STATISTIC
THE CHRONIC HERE COALITION IS
INVOLVED WITH MANY SHAREHOLDER
WORK GROUPS COMMITTED TO
FINDING ANSWERS. THAT ARE NOT
NECESSARILY DEPENDENT UPON
MANDATES OR LEGISLATION WE ARE
READY AND WILLING TO BE A PART
OF THE SOLUTION MAKING
HEALTHCARE WORK FOR EVERY IS A
TOP PRIORITY. WE WOULD BE MORE
THAN HAPPY TO BE A RESOURCE FOR
THIS COMMITTEE. AND WE WOULD
LIKE TO SEE MORE INVOLVEMENT
WITH THE PATIENT AT THE TABLE
AND IN THESE DISCUSSIONS I
THANK YOU FOR THIS OPPORTUNITY.
THANK YOU QUESTION. FIRST OFF
THANK YOU FOR THE IN THE
INFORMATION FOR AN ANSWER IT IS
DIVERSE AND VALUABLE- FROM
DIFFERENT PERSPECTIVES- I'M AND
I'M CURIOUS CURIOUS MISTER
RESOURCE YOU YOU MENTIONED THAT
TO AND MAYBE AT SOME POINT WE
GOT BACK. THEN THE DISCUSSION-
THAT IS THAT IS I'M NOT SURE WE
COULD GET EVERYTHING BACK IN
THE CAN IF WE DO THAT BUT BUT
I'M- BUT I BUT I APPRECIATE
THAT BECAUSE AS- WE SEE
PRESSURES. DEVELOPING WITHIN
HAVE THE END WITH THE
LEGISLATURE- I THEY KIND OF
THESE BE THE QUESTION IS SHOULD
THE SHOULD WE BE DOING THAT ON
A MORE REGULAR BASIS- BUT TO
SORT OF KEEP THE PRESSURE OFF
OF SOME OF THE CHALLENGES THAT
WE FACE HAS THIS IS COME ALONG.
THE A REALLY LOADED. WELL YEAH
I MEAN I KNEW WHEN I SUGGESTED
THAT I WOULD GET A HARD
QUESTION SO- THAT I DON'T HAVE
THE ANSWER TO. YOU KNOW I'D
THAT I'D- I THINK A PERIODIC
REVIEWS IS NOT OUT OF THE
QUESTION YOUR POSITION ON THAT
BUT- YOU KNOW I THINK IT'S TO
BE I YOU KNOW THE CONCEPTS THAT
WE BROUGHT UP EARLIER AROUND.
IN AS A KID AND CHANGES IN THE
HEALTH CARE SPACE- YOU KNOW YOU
WOULD WANT A PRODUCT TO BE IN
PLACE FOR A CERTAIN NUMBER OF
YEARS IN ORDER TO. CONSISTENT
ON IN TO SEE- YOU KNOW HOW IT'S
IMPACTING THE OVERALL COST OF
CARE- AND- YOU KNOW DIDN'T DO
SOME MEASUREMENTS AND THINGS OF
THAT NATURE- IT'S NOT SOMETHING
WE HAD CONSIDERED I THINK WE
WERE POOR OFFERING IT AND IS A
IN THE MORNING BUDGET CALLED.
THEN WHEN THE WAR OFF BILLION
YOU KNOW UNTIL IT IS EVERY YEAR.
WHAT IS I WAS I WOULD SAY JUST
IN IN GENERAL IT'S IT IS A
CHALLENGE I THINK AS- IT WITH
INSURANCE IN GENERAL- PEOPLE
HAVE AN EXPECTATION THAT. THAT
THEIR NEEDS ARE GOING TO BE
COMPLETELY COVERED- ME SEE FOR
EXAMPLE- WHILE IT'S NOT THIS
ISN'T. THIS ISN'T A INSURANCE
COMMITTEE BRING- I THINK OF
WILDFIRES IN THE FACT THAT A
LOT OF PEOPLE THOUGHT THEY HAD
COVERAGE FOR CERTAIN THINGS IN
DID NOT. BUT THEY WERE RICH.
AND CENTER WERE NOT. THIS I.
TWENTY AROUND HEALTH CARE WHEN
PEOPLE HAVE NEEDS- THAT THAT
THERE SHOULD BE IT SHOULD BE
COVERAGE FOR THAT AND I THINK
WHEN THEY FIND THAT THERE ARE
COVERAGE THAT'S THAT'S- THAT'S-
THAT'S WHERE. THAT'S WHERE THE-
AND SO. PROCESS LOOK AT THE
PANEL OFF TO BE ADEQUATE AT
RESPOND TO BE NEED AND A CHECK
WORLD IS SOMETHING WE WOULD YOU
KNOW I WOULD BE OPEN TO I DON'T
KNOW WHAT THAT ULTIMATELY LOOKS
LIKE BUT- IT IT IS CHALLENGING
THROUGHOUT INSURANCE WHETHER
YOU KNOW HE CAN. INSURANCE HOME
BUT WHATEVER OUR I THINK PEOPLE
PATIENT WHAT IT SHOULD BE FOR
WHAT THEY'RE PAYING IS NOT
ALWAYS WHAT IT IT REALLY PANS
OUT TO BE A TALKING TO CEMENT
IN ABOUT THE FACT WASN'T TOO
MANY. DROP BY. COVERED WITH
WITH MEDICARE AND SO ON SO
THESE ARE THESE ARE THESE ARE
CHALLENGING ISSUS SO THANK YOU.
THIS THE ANNOYED THAT THANK
YOU- FOR EVERYONE THE PANEL FOR
YOUR PRESENTATIONS SITES WILL
BE CLEAR YOU SAID THE
SUGGESTION THAT WE LOOK AT THE
IS SOMETHING THAT YOUR STORY OF
PERSONALLY OR THAT. I CAP
DECISION. I MEAN WE WOULD. I
WOULD SAY THAT IT'S A PER A
BOWL- APPROACH TO AND-
CONSIDERING WHAT SHOULD BE
COVERED IN THE STATE OF
CALIFORNIA THAN THE CURRENT
METHOD OF JUST THROWING
MANDATES INTO THE HOPPER- INTO
YOU KNOW. QUITE FRANKLY YOU
KNOW THE- IT'S A IT'S A TIME
CONSUMING ISSUE YOU KNOW FOR
BOTH THE COMMITTEES AND FOR US
I MEAN WE ARE MORE- YOU KNOW
EXISTENTIALISM BROAD IN A
BROADER YOU KNOW- HEALTH CARE
RELATED ISSUES THAT WOULD
RATHER BE DISCUSSING AND SO.
YOU KNOW WHEN THERE'S A PROCESS
AVAILABLE TO THE STATE IT'S IT
YOU KNOW WHAT WE'RE SAYING IS A
BIT. ANALYTICAL LOGICAL. RUN
RECESSION THAT CONSIDERS A
TRADE OFFS IS PREFERABLE TO THE
PRESIDENT THAN THE EXISTING
PROCESS SO- JUST YOU KNOW FRAME
MY RECOMMENDATION YOU KNOW IN
THOSE TERMS. AND A PRECIADO
THAT IN A AND STANDARD TAT I
MEAN I THINK THE THING IS HOW
DO WE HOW WE LOOK AT THIS IS
ENTIRE SYSTEM. BECAUSE WHEN YOU
LOOK AT ONE. MALL I GUESS. ONE
THING. YOU GET THE JOB. OF IT'S
GOING TO BE LIKE FIVE CENTS OR
SOMETHING OR YOU KNOW FIFTY
CENTS OR AND DO YOU THINK WELL
THAT'S NOT. THE SELLER TO BIG
DO YOU WANT. SEC AND- LOOK.
WHAT IT IT'S AN ODDBALL ONE
WITH. WHOLE THING. THE ABOUT
OKAY WELL THIS IS GOING TO TAKE.
IF TAKE THE PLAN A COVERS ALL
STUFF THAT'S GOING TO CAUSE
THIS MUCH WE PICK THE PLAN. SO
AND IS THE IS THAT WHAT PEOPLE
ONE TO RATE THAT. AND SO FORTH
WHAT THE BACK AND- IT'S MORE
SUS. SYSTEMIC CONVERSATION AND
I GUESS. I ASSUME THAT THE
OTHER PIECE OF IT WOULD BE IS
THAT. IF WE WERE DOING THIS WE
WOULD ALSO THEN PEOPLE LIKE
WILL ACTUALLY DO YOU BRING ALL
YOUR STUFF OUT THE- CARD.
PATIENT WE'RE NOT GONNA BE.
TAUGHT ABOUT. VISUAL OFFS WE'RE
GONNA DISCUSS ANY THIS IS. NOT
IN UNCOMMON NINE IN INSURANCE I
MISS ON THE EDUCATION COMMITTEE
PEOPLE WANT. THINGS IN THE
CURRICULA RIGHTON. DO WE DO
THIS TOGETHER ARE. EACH
INDIVIDUAL ONE HAS ITS OWN
MERITS BUT YOU KNOW THEN WE
START PILING ON AND THE
TEACHERS ARE LIKE OKAY WHAT'S
IN OUR TEXT BOOKS WHAT WHAT WE
HAVE TO COVERED IS AT ALL
CONNECT TOGETHER AND SO FORTH
AND- SO FORTH SO. NOT A COMMON
THEME IN GOVERNMENT I.
GOVERNANCE BUT LET ME KNOW ON
THAT FIRST THE SAME QUESTION
PERHAPS SAID IT IS A LITTLE
LOOK BACK HISTORICALLY- BUT AYE
OPPOSED TO REGULATORS YOU KNOW
AN AREA THAT'S NEAR DEAR TO MY
HEART. THE ISSUE ROUND AUTISM
COVERAGE IS NOW LAW RIGHT AND
SO FORTH BUT- BUT CLEARLY DOES
IT THE NATION BEFORE- THAT AT
LEAST PLAN SAID PRETTY MUCH
SAID WE'RE NOT YEAH WE LIST
FALLS INTO THE BROAD. IT CETERA.
HOW TO DEAL WITH THE THINGS
MOVING FOR INTO THE FUTURE
WHERE WE THIS TEN OUT. OKAY
WELL KNOW PEOPLE FEEL IT'S A
DEVELOPMENTAL CONDITION THEIR
ORDER OUT DIED SUPPOSED TO SOME
SERVICES WOULD BE L. COULD BE
CONSIDERED TO BE COVERED
THROUGH IDA THROUGH THE
EDUCATION SYSTEM BUT SAME TIME
PEOPLE FEEL. I MEAN THE
TREATMENT SHOULDN'T JUST BE AT
SCHOOLS SO- MAYBE REFLECT A
LITTLE BIT ON- TRAFFIC WITH THE
YOU WERE BACK THERE FOR SOME OF
THESE DATA YEAH THIS DISCUSSION
NINE DOES I YOU KNOW I DIDN'T
STAFF THAT BUILD RIGHT I
REMEMBER SOME OF THE DEBATE
AND- YEAH I WAS A LITTLE MORE
COMPLICATED MEAN VIEW THE OTHER
PARTY THAT WAS INVOLVES
REGIONAL CENTERS. RIGHT YOU
KNOW INTERNAL PERSPECTIVE THEY
WERE LEGALLY OBLIGATED PROVIDE
SOME OF THE SERVER OUT OF A BE
PLAN MAY. SO PART OF UP. VIEW
THAT AS A- THEFT FROM THE
REGIONAL CENTER TO PREMIUM
HERE'S- AND WE CAN THINK
PROPRIA I AM BEAT BUT AS A MAY
IT'S A HEALTH PLAN MANDATE
WE'RE WHAT WE CAN TO COMPLY
WITH THAT THEY. THANK YOU
THERE. WE LOOK IN FRONT THAT.
PROCESS THAT. IT AND A SERVICE
LIKE. WELL IT'S A- OF SOME OF
THE ANY. FOR PEOPLE SAID. I
EXPECTED BY HELP. TO PAY FOR IT
AND IT'S NOT AND SO WHERE. WAS
THE LINE REALLY SUPPOSED TO BE
LIKE WE DON'T COVER ANY OF IT
GO DEVELOPMENTAL CENTERS IN THE
SCHOOL OR WAS IT THAT. YOU KNOW
DO WE DRAW OTHER THAN ACTUALLY
FORCE WE WHAT THE RESULTS WERE
IN THE END BUT YEAH. YEAH I
MEAN I THINK I WELL THIS WITH
THAT YOU KNOW. THIS IT REALLY
TOUGH NUT TO CRACK- THOUSAND
THAT WE HAD TO CRACK BEFORE
YEAH IT WAS INDIAN YOU KNOW I
THINK YOU KNOW WHERE THE-
LEGISLATURE EVENTUALLY LANDED
WAS AT A NEED TO STEP IN AND
DECIDE THE QUESTION AND SO- YOU
KNOW COULD THERE'D BEEN- YOU
KNOW SOME WORK DONE BEFORE
HAND. KIND OF YOU KNOW ALLEN
THOSE ISSUES SO DIDN'T GET TO
LEGISLATION YOU KNOW I'M NOT
SURE I AGAIN I WASN'T A PART OF
OUR RIGHT. THOSE DISCUSSIONS-
BUT YOU. MANY OF THEIR COVERAGE
POLICIES AT THE PLANS HAVE ARE
ARE BASED ON WHAT'S OUT THERE
IN THE MEDICAL LITERATURE SO.
IF IT'S COMMENDED BY. YOUR
REVIEW MEDICAL GUIDANCE NIGHT
THAT THAT HAS A STRONG. ON
WHETHER A PLANNED THING SAID
IT'S APPROPRIATE TO BE COVERED
OR NOT. IF SOMETHING'S
CONSIDERED EXPERIMENTAL. THEN
IT MIGHT NOT BE VIEWED AS
SOMETHING THAT WOULD BE A GOOD
INVESTMENT OF PREMIUM DOLLARS
SO I THINK YOU KNOW- I DON'T
THIS FULLY ANSWERS YOUR
QUESTIONS BUT BUT BUT BUT YOU
KNOW. TO YOU CENTERS IN
EVOLUTION THE MEDICAL COMMUNITY
ABOUT WHAT'S IT WHAT'S WAS
MEDICALLY NECESSARY AND THINGS
OF THAT NATURE THOSE THINGS
LIKE SEEPING INTO- BE A
CONSIDERATION OF HOW. PLANS
DEVELOP THEIR- THEIR COVERAGE
POLICIES SO- I THINK AT THE
TIME YOU KNOW IN JUST A GOING
BACK THAT EXAMPLE SOME OF THE-
SOME OF THE SERVICES RETURNING
TO EXPERIMENT. BUT YOU KNOW
LEGALLY TV OUT. OF IT PARTY.
OKAY YEAH I THINK I'LL JUST
LEAVE IT AT THAT. AND ANY
COMMENTS FROM. OUR REPRESENTS
HERE TO SAY ESPECIALLY IN A TO
GO BACK TO THE EXAMPLE OF-
AUTISM AWESOME SPECTER DISORDER
AND INCLUDING THAT IT WHEN
WE'RE TALKING ABOUT. A LOT OF
THOSE YOU SAID INTO THE HOUSE
AND IN. IT GOING TO THE AND IT
IS CONSUMER ADVOCATES WE
BELIEVE IN THE ABILITY OF THE
PROCESS TO HELP US DETERMINE
WHICH OF THESE. SHOULD
ULTIMATELY BECOME A BENEFIT
MANDATES- THE AND IT YOU KNOW I
APPRECIATE SOME OF THE
DISCUSSION AROUND TAKE A LOOK
AT THE BIGGER. I ALSO WANT TO
SAY THAT- THE MANY PROPOSAL IT.
A. R. DELAYED WILL HAVE A
SIGNIFICANT IMPACT FOR THE
FOLKS THAT ARE LOOKING FOR THE
SO. WITH AUTISM IF THAT'S IT IF
IT'S DELAYED FOR A YEAR OR TWO
THAT HAS A SIGNIFICANT IMPACT
ON THOSE CHILDREN WHERE- IT YOU
KNOW IT'S VERY DIFFICULT TO GO
BACK IN TIME AND THEN. IN MAKE
UP FOR THE BOSS IS THAT WERE
NOT COVERED. I'M SO WHAT WE
HAVE EIGHT OF SOME DISCUSSION.
BEATING TO TAKE A LOOK AT THE
CUMULATIVE EFFECTS AND SO
FORTH. ULTIMATELY WE HAVE.
WRONG IN THIS SAYS THE AS- THE
PROCESS WORKS NOT ONLY BENEFIT
MANDATES BUT LET. ALL AT. THAT
WE CAN GET IT IS. AND WE OUT.
OF THE BILLS THAT PART. ON
THESE OF THE CONTINUITY OF CARE
AND THE CHRONIC DISEASE. IT'S A
IT'S A LONG TERM INVESTMENT AND
IT ISN'T SOMETHING THAT IS
GOING TO BE FIXED BY ONE DOCTOR
VISIT OR WHEN. I A OUR VISIT
AND I THINK WE OFTENTIMES LOSE
TRACK OF THE FACT THAT THESE
PEOPLE ARE LIVING WITH THIS
DISEASE FOR THE REST OF YOUR
LIFE AND THAT AS MEDICINE
CHANGES DISEASE CHECK. IN TIME
WE'RE NEEDING THINGS I HAVE OF
WHAT. OF MEDICINE PROVIDE OR IT
TO THE BUT WE CAN'T GET IT AND
THAT HAS BEEN A BIG BIG PROBLEM
IN THE CHRONIC CARE WORLD. IS
THAT WE JUST CAN'T ACCESS TO.
THE THINGS THAT WE NEED BASIC
THINGS. SO I WITH A LIFE THAT
ALWAYS BE CONSIDERED. THANK THE
OTHER THING AT ANY AND THIS THE
PREFERABLY IN MY MIND IS THAT
WE GIVE THE INCENTIVES TO PULL
THE DEVELOP WEATHERS THE
BENEFIT DESIGNS ARE THE
COVERAGES. TO TAKE CARE OF THE
SEASONS OF TRYING TO
LEGISLATORS SO FOR EXAMPLE. FOR
CHRONIC AND- RIGHT WE CREATE
COPAYS I MEAN IT CAME FROM THE
RAND STUDY TO HAVE PEOPLE THINK
TWICE ABOUT IT BUT FOR EXAMPLE
WE KNOW THAT PITNEY BOWES IT'D
EXPERIMENT ACTUALLY ZEROED OUT-
PAID FOR STORY. IS FOR PEOPLE
LAST MONTH DOES AFTER ALL.
THERE'S NOT AND WHY WOULD YOU
WANT THE SCOURGE FROM USING
THAT RIGHT BECAUSE THAT
ACTUALLY KEEPS THEM FROM
EXACERBATE AS MOTION LEADS TO
BE IN THE YARD HOSPITALS SO
FORTH AND- THAT ACTUALLY SHOWN
IT. SAVES MONEY ACTUALLY TO DO
THAT THAT THE YEAH YES THE-
UTILIZATION OF THE STORYTELLERS
WENT UP. THAT WASN'T SO BAD
THING BECAUSE THE ER VISITS AND
THE HOUSE POLLUTION AND THESE
ARE ALL. PEOPLE BY THE WAY SO
THEY'RE LOOKING AT THEIR OWN
EMPLOYEES SO THESE ARE NOT
PEOPLE WHO ARE NOT UNEMPLOYED.
THEY THEY MADE MONEY THEY COULD
MAKE. WELL THEY'LL I CAN USE.
THIS DOES EXACTLY EACH PERSON
BUT- NOW THEY HAD INCOME TO PAY
THE COPAY BUT IT BUT THE COPAY
AND THE PERSON THE COPAYS MAKE
PEOPLE THINK TWICE SO.
CERTAINLY SOME MEDICATIONS
MAKES SENSE OTHER MEDICATIONS I
AM ARGUE THAT. AND SO YOU KNOW
WE DON'T LEGISLATE AS A CARD.
SAYING NECESSARILY BUT- WE WANT
INCENTIVIZE. PEOPLE THINK MAYBE
SMARTER IF IT DOES FIND AT. IN
PEOPLE WHO HAVE CONDITION GET
ACT. TO AREAS IN FRONT OF THEM
THAT MIGHT. BECAUSE THE TO THE
LESS LIKELY TO SENSES BUT WE
ALSO KNOW THAT THE OVERALL
INCENTIVE IS YOU DON'T WANT TO
BE THE PLAN THAT'S KNOWN AS THE
BEST YOU KNOW THE ONE THAT
TREATS PEOPLE AND DISEASE THE
BEST ARE AS A BASS IT'S
RELATIVE THING BUT- YOU KNOW
WHERE AND I'M TRYING TO SEE.
I'M GOING TO THAT. THAT'S NOT
NECESSARILY GOOD FOR THE
PLANET. LARA AND FROM AN ACTUAL
STAND SO HOW HOW DO WE HOW WHAT
DO YOU KNOW. WHAT WILL YOU DO
ABOUT THAT SO. AND IT'S FOR
YEAH WE DON'T ALLEGE.
PARTICULAR DESIGN BECAUSE I'M
NOT SURE WE CAN COME UP WITH A
BETTER ONE THAN. BUT HOW
INCENTIVIZE PEOPLE TO DEVELOP
THESE KIND MORE. INNOVATIVE THE
BENEFIT DESIGNS. RIGHT SO I
KNOW THIS IS A LITTLE BEYOND
JUST. INSURANCE MANDATES BUT-
YEAH I MEAN YOU KNOW WITH WITH
RESPECT TO CARD CONDITIONS OF
THE MEDICATIONS THAT ARE USED
THEIR OBVIOUSLY AS YOU KNOW
AND- MANY IF NOT. THE VAST
MAJORITY ARE SMART SPECIALTY
MEDS THAT YOU KNOW- REPRESENT A
SMALL PERCENTAGE OF THE
PRESCRIPTIONS BUT A GIGANTIC
PERCENTAGE OF THE COST- IN SO
THAT HAS AN IMPACT. ON THE YOU
KNOW- STRUCTURE IN PRICING- SO
YOU KNOW IF I. SOME PLAN ARE ON
THEIR OWN INNOVATING IN THAT
DEPARTMENT AND THERE ARE
CERTAIN DRUGS- WHERE. THE PLAN
ON ITS OWN HAS BEEN ABLE TO
LOWER THE COST TO PAY- TO DO A
VERY AFFORDABLE LEVELS. YOU
KNOW AND I APPRECIATE YOUR
COMMENTS AND WE PROBABLY SHOULD
LEGISLATE THOSE THINGS BECAUSE
YOU KNOW WHEN YOU DO
LEGISLATIVELY YOU'RE BASICALLY
UNDERCUTTING THE HEALTH PLAN-
BIG TIME BECAUSE- THEY'RE ABLE
TO. LOWER THOSE COSTS FOR
TUMORS BECAUSE- ON- THEY'RE
ABLE TO GET A GREAT PRICE. FROM
THE DRUG MANUFACTURER THE
DEVICE MANUFACTURE. LEGISLATE
THAT. YOU BASICALLY RICH
COMPLETELY REMOVING LEVERAGE ON
THE PART OF THE PAYER TO GET
THOSE GREAT DEALS. ON MENS. SO
PLANS ARE A FEW THE NOW YET IS
A CASE BY CASE. BUT THERE WHAT
THEY CAN. IN EXPERT. WITH IN
THE CONFINES OF YOU KNOW THE
ACTUAL RARE REAL VALUE BENEFIT
DESIGN RESTRICTIONS- OF THE A.
C. A. AND A LOT OF THE
EXPERIMENTATION THAT
DEPARTMENT'S GOING ON IN THE
LARGE GROUP MARKET WHERE THEY
YOU KNOW THEY'RE THEY'RE LESS
RULES REGULATIONS ABOUT THAT-
YOU KNOW I DON'T HAVE A LOT OF
THOSE EXAMPLES IN FRONT OF ME
BUT YOU KNOW I HEAR IT-
ANECDOTALLY FROM OUR MEMBERS
SO. ON YOU KNOW IT'S ON.
SCIENCE AND KNOW THEY DO WHAT
THEY CAN YOU KNOW WHILE. WITH
WITHIN THE CONFINES THAT
THEY'RE ALLOWED. SO BUT- YOU
WILL HAVE TO ENGAGE IN A
DISCUSSION- YOU KNOW IF YOU
HAVE ANYTHING SPECIFIC THAT
YOU'D LIKE US TO. TO TAKE A
LOOK AT. THE. WELL THANK YOU SO
MUCH FOR YOUR PRESENTATIONS
REALLY APPRECIATE YOU BEING
HERE. EIGHT AS A NO DOUBT OKAY
SO NEXT IS A PUBLIC COMMENT SO
WITH A ONE A- SO PLEASE COME UP
TO THE FACT MICROPHONE THERE.
YOUR NAME YOUR ORGANIZATION AND
I DON'T SEE ANYONE COMING UP
VIA- THERE'S A NAME
ORGANIZATION AND- ZERO A LONG
LINE I ASK YOU CAN KEEP YOUR
REMARKS TO TWO MINUTES OR LESS-
BUT- AND IF YOU HAVE ANYTHING
YOU WANT TO HAND OVER TO THE
SERGEANTS OR SOME IT'S ME
PLEASE DO SO AS WELL BUT THANK
YOU WELCOME. A GOOD AFTERNOON
MY NAME IS PRESTON YOUNG FROM
THE CALIFORNIA CHAMBER OF
COMMERCE THE CONVERSATIONS
AFTERNOON HAS ALREADY BEEN
ROBUST AND PRODUCTIVE SO I
DON'T EVEN WANT YOUR TWO
MINUTES ALL I TRY TO TAKE ABOUT
THIRTY SECONDS. THE BUSINESS
CAN BE SPECIFICALLY MEMBERS OF
THE CAL CHAMBER OF COMMERCE
THEY ARE- SENSITIVE TO
INSURANCE MANDATES ME SIR
USUALLY BORN OF GOOD TENSIONS
HEARING AIDS MEDIC EVER BE. GAP
IN THE CITY. AND IT'S AS YOU.
WITH THE SYSTEMIC. COUNTER
EVERY THERE IS. AND THAT'S THE
OF SO WHEN PREMIUMS ARE
INCREASING INCREASES THE COST
OF DOING BUSINESS IN THE STATE
OF CALIFORNIA WHICH DIRECTLY
IMPACTS EMPLOYERS AND YOU SEE
YEAR AFTER YEAR WITH PREMIUMS
INCREASING DOUBLE PERCENTAGE
POINTS MAYBE 14% LAST YEAR AND
I THINK THIRTEEN POINT 2% THE
YEAR BEFORE SO- MANDATES THEY
ARE SENSITIVE TOPIC BUT- THE
CHAMBER IS IN A POSITION. GRAY
WILL POST OFFICE ALL MANDATES
THAT COME ACROSS THE DESK IN
THE REASON WHY IS IT INCREASES
THE COST OF DOING BUSINESS SO-
I THINK TODAY'S CONVERSATION
WAS FANTASTIC I THINK. THE
OFFICE OF HEALTH CARE
AFFORDABILITY BEING INSTITUTED
ALL IS ALSO A SIGN OF THINGS
HEADING IN THE RIGHT DIRECTION.
THAT BEING SAID THE CHAMBER
WOULD LIKE TO BE A PART OF
CONVERSATION MOVING FORWARD
SOUND THANK YOU FOR HAVING
THIS. CONVERSATIONS AFTERNOON.
THANK YOU SEEN NO OTHER PUBLIC
COMMENT THE CHIU WITH SPEECH
YOU WILL HAVE A SOME CLOSING
THANK YOU TO EVERYONE- FOR
THEIR- PRESENTATIONS THIS
AFTERNOON- THIS IS A AS WE SAID
FROM THE BEGINNING THIS IS A
TIMELY ISSUE AS WE START
LOOKING AT THE- THE GOVERNOR'S
PROPOSAL. FOR AN OFFICE OF
HEALTH CARE AFFORDABILITY THE
CHALLENGES THAT THAT- PEOPLE
FACE- WITH RISING PREMIUMS
ALTHOUGH THIS YEAR'S IS A
PLEASANT SURPRISE SEE- THE
CHANGE- THE LOW COST LOW RISE.
AND I APPRECIATE THE
PERSPECTIVES OF HOW WE MIGHT
LOOK AT- MANDATES IN THE
FUTURE- AND- AND BUT I ALSO-
WILL RE RE EMPHASIZE THE
CHALLENGES THAT WE FACE AS
LEGISLATORS FROM PRESSURES FROM
FROM FROM OUR- OUR CONSTITUENTS
AND- AND IT'S ALWAYS A BIT OF A
BALANCING ACT HOW WE HOW WE GO
FORWARD. BUT VERY TIMELY
DISCUSSION AND- THANK YOU SO
MUCH FOR YOUR INPUT TODAY. I
THANK YOU TO HER WOODS- I TWO
WANT TO THANK ALL OF OUR
PRESENTERS AND ALL OF YOU WHO
ARE HAVE BEEN- WATCHING EITHER
IN THE AUDIENCE OR- WATCHING
OUR FOR A SEAT HERE- THIS IS AN
ISSUE THAT I THINK THAT THAT IN
BOTH OF US AS CHAIR SINCE. FELT
THAT WE NEED TO- TO REVISIT-
BECAUSE WE REALLY HAVEN'T HAD
THIS KIND OF DISCUSSION ABOUT
THIS FOR MANY YEARS. SINCE WE
ESTABLISHED THE WORK ON A CM
PLANTATION AND ESTABLISH THE
ESSENTIAL HEALTH BENEFITS I
THINK- APPRECIATE. REALLY THAT
THE TESTIMONY AND I THINK THAT.
BE IT IS A- THAT WE HAVE
CONFERENCE PLAN. THAT WHO THE
AC WE TRY TO RID THE JUNK PLANS
AND YOU'LL CALL JUNK PLAN
BECAUSE THE FOR IS THAT PEOPLE
THOUGHT THEY GOT HEALTH CARE
COVERAGE AND WHEN THE TIME
CAME- IT FAILED THEM AND THAT
IS ONE OF THE THINGS I THINK
DEFINITELY DID DRIVE- PASSAGE
OF THE ACA- AND SO YOU KNOW YOU
HAVE THE PROMISE OF IT VERY
INEXPENSIVE PLANNED THEN WHEN
YOU. FINALLY GOT SICK OR YOU
GET INJURED IT TURNS BUT IT
WASN'T THERE. AND SO YOU KNOW
WE DID WANT TO BE SURE WE HAVE
STANDARDS AND THAT THEY WERE
COMPREHENSIVE PLANS. NOW WHAT
THIS COMPREHENSIVE. WORKED VERY
HARD TO BE SURE WE HAVE AND I
THINK WE DO HAVE VERY
COMPREHENSIVE COVERAGE- THROUGH
OUR- THE PLAN WE SELECTED. YOU
KNOW THERE ARE SOME GAPS AND
THEN OF COURSE THINGS HAVE.
ALSO EVOLVED OVER TIME SO- THAT
WAS NO BACK AND WE'LL TALK
ABOUT IT BENCHMARK PLAN THAT
WAS ESTABLISHED ESSENTIALLY
BASED ON SAID BENEFITS AND-
WELL THAT- AND DECEMBER THIRTY
FIRST OF TWENTY ELEVEN SO IT'S
NOW TWENTY TWENTY. NINE YEARS
LATER AND I ALSO DO AND- I
APPRECIATE THAT SO YOU KNOW WE
HAVE CONSTITUENTS WHO COME TO
US WHO WANT. MANDATES OUR- TO
THEY THAT PEOPLE UP EXPERIENCES
AND- IS A VERY IMPORTANT BASS
OF FREE TO SAY THAT WOULD LOOK
AT THE MORE SUS THAT. AND AT
AND THAT WE SHOULD THINK OF.
WICKS RE VISIT. YOU KNOW OUR
PACKAGE. IT IN SOME WAY JUST.
BECAUSE I THINK WITH THE DOING
THAT ON THAT I THINK. WE SEE
PERHAPS PEOPLE FIRST OF ALL
DON'T. REALLY UPSET WE HAVE BUT
ALSO MAY LOSE A LOW CONFIDENCE
AND AS WELL I THINK THAT. WE TO
BE SURE WE CAN THE PUBLIC ABOUT
WHAT IS IT THAT PROVIDE. WHAT
YA THE END AND I'LL REAL. THE
BETTER OF WOULD PROVIDE AGAIN
WE HAVE A CAR. WE DO HAVE GAPS
BUT I THINK THAT PROCESS MAY
ALSO HELP US DO THAT AND I'M
NOT SAYING WITH A START THAT
THIS YEAR. BUT I THINK
SOMETHING US THE ABOUT AND LOOK
AT IT LOOK FOR TO ENGAGING- THE
MEMBERS ARE COMMITTEE ABOUT.
HOW WE MIGHT GO ABOUT DOING
THAT- AND ALSO I THINK THAT.
THESE WERE IS WE- LOOK AT THESE
THINGS- THAT- YOU KNOW WE HAVE
TO- BE SURE THAT- WHAT KIND OF
ALSO- STRUCTURES DO WE NEED TO
PUT IN PLACE TO EVEN WITHIN.
OUR CURRENT DEFINITIONS TO BE
SURE THAT. DINNER THAT
DEFINITIONS THE PEOPLE WHO CAN
GET A TO THE CARE THEY NEED AND
SO WE HAVE THESE BROAD
CATEGORIES APPRECIATE THAT
PRESENTATION OF THE INMATES
SEE. SO HOW DOES THAT FINALLY
GET INTERPRETED IN THE BOTTOM
LINE WHEN IT COMES DOWN TO WELL
THIS PATIENT FEELS LIKE THEY
NEED ACCESS AND THEY GET THE
NIGHT AND HOUSE THAT. YOU
PLAYED OUT HOW THAT PLAYS OUT
IN A WAY THAT ALLOWS PEOPLE TO
GET THE CARE THEY NEED IF IT'S
APPROPRIATE IN A TIMELY MANNER
BECAUSE WE KNOW THE BLAZING
CARE I MEAN. BUT THERE'S A
CHILD WHO'S NOW DEVELOPMENTALLY
A CERTAIN TRAJECTORY OF PERSON
CRYING DISEASE TO WITHOUT RISK
FOR INCREASE EXACERBATIONS OVER
THAT PERIOD OF TIME AS WERE
WAITING- HOW HOW WE MAKE. THE
SYSTEM WORK BETTER AS WELL SO
WITH THAT IDEA AND I THINK THIS
IS A IMPORTANT CONVERSATION
THAT- WE HAVE TODAY THAT WE'VE
HAD THAT WE NEED TO CONTINUE TO
HAVE. ON THE BASIS AND- MY LOOK
FOR TO WORKING WITH YOU CHAIR
WOODS AND WORKING OUT. WE MET.
YONDER HEARING MY WANT TO GET
THE. SOME OF THESE ISSUES IN A
WAY THAT I CAN GET ARE CALLED
SO THAT WE CAN DO IT IN A MORE.
SAYS WAY VERSES HE PERHAPS A
CONDITION OF THE- OF THE YEAR.
WEIGHT SO WITH THAT ANY OTHER.
COMMENTS NUMBER. OKAY WITH THAT
AND WHAT THEY AGAIN IF FOR
BEING HERE THIS CAN. THE THIS I
JOIN IN FOR HERE OF THE SIM AND
SENATE COMMITTEE ON CAL. HEALTH
INSURANCE MANDATES AND CENTRAL
HEALTH IT'S YOU WERE TURNED.