Bills press for health mandates; foes predict rise in uninsured

Three months after Gov. Arnold Schwarzenegger's "year of health care" ended with a whimper, dashing hopes of universal coverage in California, a series of bills that would increase mandates on insurers and implement market changes are moving through the Legislature.

No longer are there grand designs to reduce the ranks of the nearly 6.7 million Californians who are uninsured all or part of the year. The only thing universal is agreement that more people will lose coverage due to an ailing economy and a state budget deficit now estimated at $9 billion.

"It's a perfect storm," said Dr. Robert Ross, executive director of the California Endowment, a leading health care foundation. "I'm most troubled about what will happen to children, and there's not a lot that can be done for adults."

Given the economic constraints, lawmakers and consumer rights groups are pushing legislation aimed at ensuring that people who have insurance are covered for procedures ranging from gynecological screening for cancers to requiring orthodontic services for cleft palates.

But health plans and business groups contend the mandates – including coverage for maternity services, acupuncture and hearing aids – will drive up insurance costs and increase the number of the uninsured.

During an appearance last week before the Assembly Health Committee, Nick Louizos, a lobbyist for the California Association of Health Plans, cited an independent review of 11 bills that pegged the total cost at $2.7 billion.

The review by the California Health Benefits Review Program, created by the Legislature, concluded more than 85,000 people would lose coverage as a result.

"Due to the high volume of mandate bills introduced this session, we are opposing any bills that would increase premiums because we believe that reduces affordability," said Louizos, who testified against the bill along with representatives of business groups.

Anthony Wright, executive director of Health Access California, a consumer advocacy coalition, contends the cost of most of the bills is nominal.

Wright noted the bill providing screening for gynecological cancers – Assembly Bill 1774 by Assemblywoman Sally Lieber, D-Mountain View – accounts for the lion's share of the costs cited by the health plans (about $2.1 billion).

And Lieber contends the projected cost is inflated because many health plans say they already cover gynecological screenings.

"We're just trying to ensure coverage is provided because too often cancers are detected in late stages," she said.

Sen. Darrell Steinberg, the Sacramento Democrat who will take over next year as Senate leader, said the Legislature can implement market reforms that would not increase the cost of health care.

Steinberg said his Senate Bill 1522 would simplify the process of purchasing insurance by requiring insurers to offer five "benchmark" plans, with easy-to-follow benefits and costs, so consumers could make "apples-to-apples" comparisons from one insurance company to the next.

Steinberg is also carrying the cleft palate bill, Senate Bill 1634. And he's joined with Assemblyman John Laird, D-Santa Cruz, in proposing legislation that would reduce the ranks of the 760,000 uninsured children in the state.

Their Senate Bill 32 and Assembly Bill 1 would expand the state's Healthy Families program to include children in families who earn up to 300 percent of the federal poverty level ($49,880 for a family of three).

"Unfortunately, we don't have a funding source," Steinberg said. "But I think this year we can lay the foundation for expanding coverage in the future."

Meanwhile, the Democrats who control the Legislature are fighting to scale back Schwarzenegger's budget proposal to reduce health care services.

Under the governor's proposed budget, provider rates would be cut by $790 million, significantly reducing access to care for the more than 6 million Californians on Medi–Cal, which serves the poorest people in the state.

Benefits also would be cut by $134 million, including eliminating dental coverage for 3 million people.

The governor's budget also anticipates reducing enrollment in Medi-Cal by 122,000 people by requiring recipients to file paperwork every three months, instead of annually.

Daniel Zingale, a senior advisor to Schwarzenegger, concedes more Californians will be without insurance in the coming year. Cash-strapped businesses, he said, are already reducing job-based coverage.

As a result, Zingale said the governor supports market reforms that he believes will drive down the cost of health care, including greater "transparency" of health care information and pricing.

Schwarzenegger also is intent on ending the practice of "rescissions" in which insurers cancel coverage because the patient left off a pre-existing condition on the application to buy individual health insurance.

Zingale said the ever-optimistic governor believes he will eventually resurrect his universal health care proposal, which died earlier this year under the weight of a nearly $15 billion price tag.

"He's continuing to meet with stakeholders," Zingale said. "Hopefully, something can be done in time for a special election in 2009 or perhaps the 2010 ballot."

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• Call Aurelio Rojas, Bee Capitol Bureau, (916) 326-5545.