Bill Text: CA SB770 | 2023-2024 | Regular Session | Amended

California Senate Bill 770

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: Health care: unified health care financing.

Spectrum: Partisan Bill (Democrat 9-0)

Status: (Passed) 2023-10-07 - Chaptered by Secretary of State. Chapter 412, Statutes of 2023. [SB770 Detail]

Download: California-2023-SB770-Amended.html

Amended IN Senate March 20, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill

No. 770

Introduced by Senator Wiener
(Coauthors: Senators Menjivar and Smallwood-Cuevas)
(Coauthors: Assembly Members Connolly, Santiago, Schiavo, and Zbur)

February 17, 2023

An act to ~~amend Section 11140 of the Government Code, relating to state government.~~ add Part 4 (commencing with Section 1000) to Division 1 of the Health and Safety Code, relating to health care.

LEGISLATIVE COUNSEL'S DIGEST

SB 770, as amended, Wiener. ~~State boards and commissions.~~ Health care: unified health care financing.

Prior state law established the Healthy California for All Commission for purposes of developing a plan that included options for advancing progress toward achieving a health care delivery system in California that provides coverage and access through a unified health care financing system, including, but not limited to, a single-payer financing system, for all Californians.
This bill would direct the Secretary of the California Health and Human Services Agency to pursue waiver discussions with the federal government with the objective of a unified health care financing system that incorporates specified features and objectives, including, among others, a comprehensive package of medical, behavioral health, pharmaceutical, dental, and vision benefits, and the absence of cost sharing for essential services and treatments. The bill would further require the secretary to establish a Waiver Development Workgroup comprised of members appointed by the Governor, Speaker of the Assembly, and President Pro Tempore of the Senate, as specified. The bill would require the workgroup to include stakeholders representing various specified interests, including consumers, patients, health care professionals, labor unions, government agencies, and philanthropic organizations. The bill would require the secretary to provide quarterly reports to the chairs of the Assembly and Senate Health Committees on the status and outcomes of waiver discussions with the federal governments and the progress of the workgroup. The bill would also require the secretary to submit a complete set of recommendations regarding the elements to be included in a formal waiver application, as specified, by no later than June 1, 2024. The bill would include legislative findings related to the findings of the commission and declare the intent of the Legislature in implementing a unified health care financing system in California.
Existing law states that it is the policy of the State of California that the composition of state boards and commissions shall be broadly reflective of the general public including ethnic minorities and women.
~~This bill would make a nonsubstantive change to those provisions.~~

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. Unified Health Care Financing System
1000.
The Legislature finds and declares all of the following:
(a) The Healthy California for All Commission, established by the Governor and the State Legislature, endorsed a system of unified health care financing that is accessible, affordable, equitable, high quality, and universal.
(b) The commission described the present health care system as fragmented and wasteful, which disproportionately harms low-income Californians and communities of color, and provides the rationale for a new single, government-administered funding system.
(c) The commission found that a unified financing system would create significant opportunities to deliver health care more effectively, efficiently, and equitably.
(d) California will incur an additional five hundred billion dollars ($500,000,000,000) in inflationary medical costs over the next decade unless a unified health care financing system is implemented.
(e) The report by the commission calls for the elimination of corporate profitmaking as the basis of health care decisions.
(f) The magnitude of the change from the status quo in cost savings and positive impact on Californians’ access to health care services that the commission contemplates represents a profound breakthrough in health policy and would establish California as the nation’s leader in pursuing health equity.
(g) The California Health and Human Services Agency has initiated preliminary discussions with the federal Centers for Medicare and Medicaid Services on the terms of a waiver that would provide program approval and full federal financing for a unified health care financing system in California.
(h) Based on these findings, the Legislature endorses the commission’s recommendations for a health care system with unified financing that guarantees all Californians the benefit of a standard, comprehensive package of health care services and supports the agency’s discussions with the federal government regarding the terms of a potential waiver to effectuate the creation of a health care system consistent with this part.
1001.
The Secretary of the California Health and Human Services Agency shall pursue waiver discussions with the federal government with the objective of a health care system that would incorporate the following features and objectives:
(a) A comprehensive package of medical, behavioral health, pharmaceutical, dental, and vision benefits.
(b) A package of long-term care support and services, including measures to slow deterioration and provide palliative care.
(c) A guarantee to services that will not vary by age, employment status, disability status, income, immigration status, or other characteristics.
(d) The elimination, to the greatest extent possible, of the distinctions currently existing among the disparate systems of Medicare, Medi-Cal, employer-sponsored insurance, and individual market coverage.
(e) The elimination of the adverse impacts of insurers attempting to avoid covering the sick or the benefits patients need in favor of a system that has a proactive, mission-driven focus on keeping Californians well.
(f) The absence of cost sharing for essential services and treatments covered under the program.
(g) The establishment of sufficient reserves to guarantee solvency during times of public health emergencies and economic disruptions, supported in part by the elimination of the state’s unfunded benefit liabilities.
(h) A detailed program to ensure a just transition for insurance industry personnel or other individuals whose jobs are disrupted by the creation of a single payer system.
(i) Assurances that no individual will pay more than a specified percentage of their income on a progressive sliding scale for the cost of financing the health system.
(j) Unified financing that delivers health care more effectively, efficiently, and equitably.
(k) Cost-effectiveness by pooling patients together and leveraging their purchasing power to negotiate the best prices from providers.
(l) Greater freedom for patients to choose providers, which will create greater competition, quality improvements, reductions in health disparities, and cost reductions from other system improvements.
(m) Greater investments in public health and efforts to address the social determinants of health through an improved mix of health care and human services.
(n) Improvements in cost, quality, and health care system oversight and integration built on the accomplishments of the Office of Healthcare Affordability and other current initiatives, including the Data Exchange Framework and California Advancing and Innovating Medi-Cal.
(o) A rate-setting process that uses Medicare rates as the starting point for the development of final rates designed to avoid disruptions in the health care system and expand the availability of high quality vital services by sustaining a stable, experienced, and equitably compensated workforce. This process shall include policies and payments to support those providers that serve a disproportionate percent of low-income Californians and other disadvantaged communities.
(p) Promotion of a workforce that is diverse and able to provide culturally and linguistically competent care to all Californians regardless of race, nationality, ethnicity, sexual identity, and socioeconomic status.
(q) Adoption of policies and payments to support those safety net providers that serve a disproportionate percent of low-income Californians and other disadvantaged communities. These providers may need more generous funding than those serving affluent communities in order to effectively address the adverse impacts of health disparities and social determinants of health among their patients.
(r) Prohibition on the kinds of risk-bearing contractual arrangements that could incentivize providers to withhold needed care.
(s) Specific details regarding how care would be coordinated and organized.
(t) Ensure that the methods of payment, delivery, and oversight implemented under the unified health care financing system will continue to allow California the ability to receive the full benefit of federal expenditures and tax credits that currently underwrite the full scope of health services.
1002.
(a) The Secretary of the Health and Human Services Agency shall establish a Waiver Development Workgroup.
(1) The workgroup shall consist of key stakeholders to advise the Governor on topics related to federal negotiations. The workgroup shall include representatives of consumer, patient, and community-based health care service providers, community organizations, health care professionals, labor unions, employers, and health policy experts, as well as representatives of government agencies.
(2) The members of the workgroup shall be appointed by the Governor, the Speaker of the Assembly, and the President Pro Tempore of the Senate as follows:
(A) Nine members shall be appointed by the Governor with a balance of expertise and perspectives, including five members with technical expertise in health care delivery, finance, operations, and public administration, and four members focused on the availability and quality of community health services.
(B) Four members shall be appointed by the Assembly Speaker and four members shall be appointed by the Senate President Pro Tempore. These members shall include representatives of health care professionals, labor unions, employers, and community organizations, as well as people with experience as beneficiaries of Medi-Cal or Medicare, or of being uninsured.
(3) The workgroup should represent a variety of health care professionals and community voices and include representatives from philanthropic organizations focused on health care.
(4) The workgroup shall meet quarterly and shall undertake a program of stakeholder engagement at sites across the state to address issues including, but not limited to, the specifics of the transition to a unified health care financing system from current private and public coverage, adapting existing consumer protections to the new system, applying reforms to move toward systems that reward and prioritize improvements in health outcomes, health care quality, and health care equity, and how to reduce costs and provide consumers the comfort and security they deserve.
(b) (1) The Secretary shall provide quarterly reports to the chairs of the Assembly and Senate Health Committees, detailing the status and outcomes of federal discussions, as well as the progress of the Waiver Development Workgroup.
(2) The requirement for submitting a report imposed under this subdivision is inoperative on January 1, 2028, pursuant to Section 10231.5 of the Government Code.
(c) (1) The Secretary shall report to the Legislature, no later than June 1, 2024, a complete set of recommendations regarding the elements to be included in a formal waiver application, along with all legislative action necessary to proceed with the application and to establish a unified financing system consistent with the outcomes of the agency’s discussions with the federal government. The recommendations shall identify all of the elements among those proposed that the state may implement without a federal waiver, as well as any proposed elements that may require changes in federal statute in addition to a waiver.
(2) The requirement for submitting a report imposed under this subdivision is inoperative on June 1, 2028, pursuant to Section 10231.5 of the Government Code.
(3) A report submitted under this subdivision shall be submitted in compliance with Section 9795 of the Government Code.

SECTION 1.Section 11140 of the Government Code is amended to read:
11140.
~~It is the policy of the state that the composition of state boards and commissions shall be broadly reflective of the general public including ethnic minorities and women.~~