A new class of legislators was sworn in on December 3, welcoming another supermajority of Democrats to the California State Legislature. The Los Angeles Times reports that 60 Democrats — 21 of whom are women — joined the State Assembly, creating the party’s largest caucus in the chamber since 1883. Democrats also gained a supermajority in the State Senate, with 29 Democrats and 11 Republicans. Several health-related bills were introduced before the lawmakers adjourned; they will return January 7, when Governor-Elect Gavin Newsom will take the reins from Governor Jerry Brown.

Assemblymember Joaquin Arambula introduced a bill that would expand Medi-Cal coverage to all of California’s undocumented immigrants over the age of 19. The state already uses state funds to finance Medi-Cal coverage for undocumented immigrants up to age 19, but for undocumented adults coverage is limited to pregnancy and emergency room care. POLITICO’s Angela Hart writes, “Roughly 60% of the remaining three million uninsured Californians are undocumented immigrants who qualify for Medi-Cal but are unable to fully participate in the program because of their immigration status.” Learn more about California’s remaining uninsured in this analysis by the UC Berkeley Center on Labor Research and Education and the UCLA Center for Health Policy Research. (This analysis was recently updated with fresh projections of California’s remaining uninsured.)

Trying Again

Arambula introduced a similar bill earlier this year, but it died in the State Senate. Outgoing senator Ricardo Lara, the original champion of this effort to expand coverage, is also renewing the bill in the senate with an assist from incoming senator Maria Elena Durazo. Sophia Bollag reports in the Sacramento Bee that last session, the Legislative Analyst’s Office estimated the cost of the coverage proposal to be $3 billion per year.

In addition to Arambula’s bill, the POLITICO California Pro newsletter (subscription required) noted the following health-related bills among the 50 bills and two constitutional amendments filed in the senate this week:

• Senator Jim Beall introduced a bill requiring health plans to submit annual reports showing their compliance with “parity” laws that require them to cover mental health care treatment to the same extent they reimburse medical and surgical benefits. Beall filed another mental health bill that would authorize state and local governments to establish at least 100 mental health centers for youth.
• Senator Jerry Hill proposed the first statewide retail ban on flavored tobacco products and introduced a bill to strengthen age verification requirements for sales of tobacco products.
• Senator Connie Levya reintroduced a bill requiring public universities to offer medication abortion in basic student health services. A similar bill was vetoed by Governor Brown in October.

Stay tuned to learn how these bills fare in the new year.

Threats to Coverage Continue at the National Level

The Affordable Care Act (ACA) is under threat once again. As Dylan Scott explains in Vox, the Trump administration has introduced new guidance that would allow states to sell plans that do not meet the federal health law’s requirements for preexisting conditions and benefits, thereby undermining the protections guaranteed under the ACA. Scott writes, “Under the new guidance, states could allow people to use the ACA’s premium subsidies to purchase plans that don’t satisfy the law’s other provisions.”

Kaiser Health News reporter Julie Appleby writes that Seema Verma, administrator of the Centers for Medicare & Medicaid Services, is framing the changes as a way to relieve states of the burden of meeting “virtually impossible” ACA rules. Appleby writes, “The Trump administration wants states to innovate in ways that could produce more lower-cost options, even if those alternatives do not provide the same level of financial or medical coverage as an ACA plan.”

Critics of the new guidance fear that consumers in any states that accept the administration’s offer will find themselves in situations where needed care is not covered or affordable. Younger, healthier people might be incentivized to leave the ACA marketplace for skimpier plans that are cheaper but riddled with fine print and exemptions. This exodus of healthier individuals could “potentially upend the subsidy structure,” said Sabrina Corlette, JD, research professor at Georgetown University’s Health Policy Institute.

However, as Scott notes in Vox, nothing will happen unless states decide to circumvent the ACA this way. “All the Trump administration has actually done is crack open this door,” Scott writes. “States would have to choose to walk through it, and health policy experts I spoke with are skeptical many will.” Given California’s Democratic supermajority — or “gigamajority,” to quote Assembly Speaker Anthony Rendon — and incoming Democratic governor, the Trump administration’s new guidance is unlikely to see the light of day in the Golden State.

What are you watching from the California State Legislature in 2019? Tweet at me with #EssentialCoverage or email me.

Xenia Shih Bion

Xenia Shih Bion is a communications officer at CHCF, where she helps to lead communications around the foundation’s work to create health equity. She is the founding author of the “Essential Coverage” column in The CHCF Blog. Read More

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