Amended  IN  Assembly  April 02, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2517

Introduced by Assembly Member Members Wood and Arambula

February 14, 2018

An act to add and repeal Part 4 (commencing with Section 1000) of Division 1 of the Health and Safety Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 2517, as amended, Wood. Health care coverage.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that took effect January 1, 2014. Among other things, PPACA requires each state, by January 1, 2014, to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers. Existing state law establishes the California Health Benefit Exchange (the Exchange), Exchange, also known as Covered California, within state government for the purpose of facilitating the enrollment of qualified individuals and qualified small employers in qualified health plans, and specifies the powers and duties of the board governing the Exchange. plans.

This bill would express the intent of the Legislature to enact legislation to improve affordability of health coverage offered through Covered California to those who are now eligible for financial assistance in the form of advance premium tax credits.

This bill would establish the Advisory Panel on Health Care Delivery Systems and Universal Coverage in the California Health and Human Services Agency and would require the advisory panel to develop a plan to achieve universal coverage and a unified publicly financed health care system. The bill would require the Secretary of California Health and Human Services to appoint members to the advisory panel, as provided, and would require the advisory panel to convene public meetings at least quarterly.
The bill would require the plan developed by the advisory panel to include a timeline of the benchmarks and steps necessary to implement a universal and unified publicly financed health care system. The bill would require the plan to include, among other things, a multiyear financial model, a consideration of requirements necessary to seek federal waivers or federal statutory changes, and a consideration of the requirements for state constitutional amendments. The bill would require the advisory panel to submit the plan to the health committees of the Senate and the Assembly on or before January 1, 2020, and to submit a followup progress report every 6 months thereafter. The bill would also require the plan to be posted on the agency’s Internet Web site. The bill’s provisions would be repealed on January 1, 2024.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Part 4 (commencing with Section 1000) is added to Division 1 of the Health and Safety Code, to read:

PART 4. The Advisory Panel on Health Care Delivery Systems and Universal Coverage

1000.
 (a) The Legislature finds and declares all of the following:
(1) Health care is a human right and it is in the public interest that all Californians have guaranteed access to health care through a system of unified public financing that improves health outcomes, manages and lowers health care costs for the state and its residents, and reduces health disparities.
(2) With the implementation of the federal Patient Protection and Affordable Care Act (Public Law 111-148) and other state efforts, California has reduced the uninsured share of its population by one-half to less than 7 percent.
(3) As of 2016, nearly three million Californians remained uninsured, 21 percent of Californians remained underinsured, and 11 percent of California adults went without health care because of cost.
(4) The United States spends twice as much per capita as any other industrialized nation, and simultaneously has the lowest ranking and performing health care system based on many metrics, including access to care, equity, efficiency, and healthy lives.
(5) California is experiencing a primary care physician shortage, and the geographic distribution of physicians across California is uneven.
(6) According to the federal Centers for Medicare and Medicaid Services, national health spending is projected to grow 5.5 percent annually, on average, through 2026, representing 19.7 percent of the economy in 2026.
(b) It is the intent of the Legislature to establish universal coverage and a unified publicly financed health care system.
(c) It is further the intent of the Legislature that the health care system ensure that all Californians have timely access to necessary health care, including access that addresses language and geographic barriers.
(d) It is further the intent of the Legislature that to achieve the goal of a universal and unified publicly financed health care system, diverse stakeholders must be brought together to develop a sense of shared purpose and mutual responsibility for a health care system that works well for all Californians.
(e) It is further the intent of the Legislature that to achieve the goal of a universal and unified publicly financed health care system, data must be collected and analyzed to better understand the status quo, to explore how a new system may be monitored and managed, and to examine options for containing or reducing health care costs and improving efficiency in health care delivery.
(f) It is further the intent of the Legislature that to achieve the goal of a universal and unified publicly financed health care system, state budgetary implications must be modeled and financial risks must be assessed and mitigated.
(g) It is further the intent of the Legislature that to achieve the goal of a universal and unified publicly financed health care system, all legal obstacles, including federal permissions and waivers, federal statutory changes, state constitutional issues, and necessary voter approvals, would need to be addressed before any implementation may occur.

1001.
 (a) There is within the California Health and Human Services Agency, the Advisory Panel on Health Care Delivery Systems and Universal Coverage, which is established as an independent body, to develop a plan to achieve universal coverage and a unified publicly financed health care system.
(b) The advisory panel shall convene meetings at least quarterly at locations that are easily accessible to the public in accordance with the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code).
(c) The Secretary of California Health and Human Services shall appoint members to the advisory panel. In making appointments, the secretary shall consider both of the following:
(1) The expertise of each member of the advisory panel so that the advisory panel’s composition reflects a diversity of expertise.
(2) The cultural, ethnic, and geographical diversity of the state so that the advisory panel’s composition reflects the communities of California.
(d) The advisory panel may establish advisory committees that include members of the public with knowledge and experience in health care. A member of an advisory committee need not be a member of the advisory panel.
(e) The advisory panel and each advisory committee shall keep official records of all of their proceedings.

1002.
 (a) The advisory panel shall develop a plan that includes a timeline of the benchmarks and steps necessary to implement a universal and unified publicly financed health care system. The plan shall, at a minimum, include all of the following:
(1) A stakeholder engagement and analytical process by which key design features are developed, including covered benefits, eligibility, service delivery, provider payments, and quality improvement.
(2) The establishment of data collection and reporting systems to support management, evaluation, transparency, and public accountability.
(3) A multiyear financial model that includes state budgetary implications, an assessment of options for raising revenues and managing costs, and identification of the size and potential revenue sources for a prudent reserve.
(4) A consideration of the requirements necessary for the state to seek federal waivers and federal statutory changes, by which funds currently managed by the federal government, but used on behalf of Californians, may be consolidated with other funding sources, including preparation of federal waivers necessary to maximize federal financial participation in a universal and unified publicly financed health care system.
(5) A consideration of the requirements for state constitutional amendments, including an analysis of the impact of the People’s Initiative to Limit Property Taxation, an initiative measure approved by the voters as Proposition 13 at the June 6, 1978, statewide primary election, and the Classroom Instructional Improvement and Accountability Act, an initiative measure approved by the voters as Proposition 98 at the November 8, 1988, statewide general election, on creating a publicly financed health care system.
(6) An initial scope and recommendations to build an information technology system and a financial management system capable of administering a universal and unified publicly financed health care system.
(7) A feasible financing system and an analysis of the need for voter approval of any financing mechanism.
(b) The advisory panel shall submit the plan developed pursuant to subdivision (a) to the health committees of the Senate and the Assembly on or before January 1, 2020, and shall submit a followup progress report to those committees every six months thereafter. The reports shall be submitted in compliance with Section 9795 of the Government Code. The reports shall also be posted on the California Health and Human Services Agency’s Internet Web site.

1003.
 This part shall not be construed to authorize the advisory panel to implement any provision of the plan developed pursuant to Section 1002 until all necessary laws are enacted.

1004.
 This part shall remain in effect only until January 1, 2024, and as of that date is repealed.

SECTION 1.

It is the intent of the Legislature to enact legislation to improve affordability of health coverage offered through Covered California to those who are now eligible for financial assistance in the form of advance premium tax credits.