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California and Health Reform

California is known for its progressive lawmaking, particularly as an ahead-of-the-game supporter of health care reform. Even while the Supreme Court was teetering on the Affordable Care Act’s constitutionality, the state continued to pave the way for health reform, and planned to do so as a state if the law was rejected on a federal level. California is one of the only states to feel their exchange is ready for public release, and to happily announce their participation in expanding Medi-Cal – on top of the many components of the law the state has already implemented.

The state has followed through with eliminating gender discrimination when assigning rates for individual health plans, now enabling men and women who are the same age to pay the same premium. Enthused by the passing of the law and the re-election, California is prepared to proceed with health reform.


Current Health Reform Laws in California

New consumer protections for insured Californians since the ACA passed in March 2010 have included nationwide changes such as the elimination of rescissions, which gave insurers the right to cancel your coverage if you got sick or made an error on your application. Coverage for young adults who are dependents on their parent’s health plans has been extended to age 26 in both individual and group markets. California insurers also cannot impose a lifetime maximum on your benefits, therefore your coverage will not run out. Annual benefit limits have been phasing out until they are no longer existent in 2014. The current limit is $1 million, and will be $2 million in 2013.

Those who are insured In California also benefit greatly from the implementation of preventive care with no copays or out-of-pocket costs. Providing anyone with insurance access to immunizations, mammograms, wellness visits, colon cancer screenings, contraceptives and more, this portion of the law greatly enhances the fairness of coverage. More than 6.1 million Californians took advantage of at least one new preventive service in 2011 through their private health insurance coverage. About 3 million Medicare beneficiaries received free preventive care in California, as well.

It is also now illegal for children with a pre-existing condition to be declined coverage in California. Anyone up to age 18 who has a qualifying condition is no longer subject to being uninsured because of their health, though insurers can still increase their rates. Adults with pre-existing conditions have another year until they can receive the same treatment, and both can benefit from a lack of rate increases.

The creation of new programs in order to serve a larger number of residents was also an ACA improvement, including PCIP, the nation’s first Health Benefits Exchange, and the Low Income Health program, a federal-state-local partnership made possible by the 1115 Medicaid Waiver.


California Health Reform in 2014

As is evident, California is anticipating January 1, 2014, when the remaining and most important elements of the Affordable Care Act become effective. They have already received funding for and have proudly set up the nation’s first post-reform exchange, the California Health Benefit Exchange, which is required by law to include numerous covered services that typically are not included in private health plans. Benefits include mental health care, maternity coverage, emergency care, and several other categories of mandatory services to offer. This organization will sell private health insurance through the state, and provide basic plans for Californians who receive federal subsidies to purchase coverage.

One of the largest changes to occur is the admission of applicant with pre-existing conditions into the private health insurance market. Existing health insurance companies will be unable to decline anyone for coverage, regardless of their medical history. The end of discriminatory underwriting will take effect, as rates will only increase by a maximum of 10 percent over the normal premium, and exclusions for care to treat their condition will no longer be legal. Additionally, the annual benefit limit will be lifted, and no insurer in California will be able to limit coverage based on how much a policyholder has spent in a year.

The state has also already cleared the path for Medicaid expansion, receiving approval and funding for their plans to offer Medi-Cal to low income residents with higher incomes, as well as childless, non-disabled adults who earn up to 133 percent of Federal Poverty Level. Residents between 19 and 64 with annual income up to $15,000 will be able to obtain coverage through the state’s public health insurance program.





1. Health Access. “The Affordable Care Act in California”. pp. 3, 8-10