New Universal Access Proposal Introduced in CA Legislature March 26, 2018 Legislative Update 1004 A sweeping package of legislation was introduced in the California Legislature last week that sets a clear and realistic path forward to achieve universal access and improve affordability to health care in California. Sponsored by SEIU CA, Health Access and NextGen America, key components of the legislative package will help increase access to care and expand access to undocumented patients. "The key bills address fundamental challenges with California's current health care system and seek to achieve universal access by improving affordability for all patients, expanding access for undocumented adults and focusing on the behavior of for-profit insurers," said CMA President Theodore M. Mazer, M.D. "CMA has long supported key elements of this legislation, including the expansion of Medi-Cal to income-eligible undocumented adults. CMA fully supports the inclusion of these proposals as a fundamental step towards universal access." While the proposed legislation represents a significant step forward, a truly successful universal access plan cannot be achieved without addressing the health care workforce shortage facing a majority of counties. As the recent University of California, San Francisco report commissioned by the California State Assembly recommended, any successful legislative proposal to achieve universal health care must ensure that California has a strong physician workforce. The bill package contains provisions that CMA supports: State Individual Mandate. The loss of the Affordable Care Act's (ACA) individual mandate could increase premiums by 10 percent as many people, especially the young and healthy, will forgo purchasing health insurance. To ensure a healthy risk pool that provides the most certainty, California needs a mechanism to compel all its citizens to participate in the insurance market to keep costs down. Subsidy Relief for Individuals Purchasing Insurance on the Exchange/Individual Market.Increase subsidy relief for individuals purchasing insurance on the individual market to ensure affordability. Allow Income-Eligible Undocumented Immigrants to Enroll in Medi-Cal. Estimates suggest that 1.8-2 million undocumented immigrants could qualify for Medi-Cal coverage – this would require state-only funds; there would be no federal Medicaid match. CMA also recommends the legislative package to be expanded to include the following: Increase Physician Workforce and Encourage Physicians to Practice in Primary Care. California should increase funds available for loan repayment and increase residency slots, as well as institute policies that encourage physicians to work in primary care and under-served settings. Strengthen State Laws Regarding Oversight of Mergers of Health Insurance Plans. Consolidation leads to higher prices, and California should take a more robust oversight role in this area. Administrative Simplification. Standardize quality measures and institute a single process for provider credentialing that applies to all health plans, hospitals, etc., as well as establish electronic authorization policies for payers. Increase Medi-Cal Reimbursement Rates to Medicare Levels to help increase access for the nearly 14 million Californians currently covered by Medi-Cal.