When Gov. Arnold Schwarzenegger signed a series of health-related measures Sept. 30, California took the lead among states in implementing provisions of the Patient Protection and Affordable Care Act, the national health care reform legislation passed by Congress last March.

Central to the effort are a pair of bills to set up a state health insurance exchange. Assembly Bill 1602, by Assembly Speaker John Perez, D-Los Angeles, establishes the new exchange, while Senate Bill 900, by state Sen. Elaine Alquist, D-Santa Clara, and Senate President Pro Tem Darrell Steinberg, D-Sacramento, establishes that it will be governed by a five-member board appointed by the governor and legislature.

The exchange is a core part of the federal law. In 2014 it will be the “one-stop shop” for individuals and small businesses to get coverage, with programs that can easily be compared, bulk purchasing power like that of large employers, and access to federal subsidies to make coverage affordable.

“California is once again leading the way on health care with the creation of a strong health insurance exchange that leverages the purchasing power of millions of consumers,” U.S. Rep. Pete Stark, D-Calif. and chair of the House Ways and Means Committee subcommittee on health, said in a statement. “This exchange will give everyone a set of clear, more affordable choices for health care, and provide a great example for other states that are creating their own exchanges.”

Anthony Wright, executive director of the Health Access coalition, wrote on the coalition’s website, Oct. 1, “Currently, without an exchange, individual consumers are at the mercy of the big insurers, without any purchasing power, in a complex and confusing marketplace.” Wright said the two bills will help California “be ready on day one to take advantage of billions of dollars in credits and subsidies to help families and small businesses afford coverage.” He pointed out that more than 4 million Californians will be eligible to participate in the exchange, starting in 2014.

Another key bill is AB 2244, to implement the federal ban on denying coverage to children with preexisting conditions, which took effect Sept. 23. Wright pointed out that the state bill limits the amount insurers can charge in such situations much sooner than the federal bill, which doesn’t ban such premium differences until 2014.

SB 1163, by Sen. Mark Leno, D-San Francisco, requires insurers to make information about premium increases public and requires 60-days notice to consumers and the public about proposed premium hikes.

AB 2470, by Assemblyman Hector De La Torre, D-South Gate, counters the widespread practice of insurers’ taking away patients’ health coverage after they become ill, a practice called rescission. It requires independent review in such situations and provides that patients would keep their coverage until the review determines whether the rescission is legal and justified. The bill will protect patients between now and 2014, when federal law will require insurers to accept patients regardless of preexisting conditions.

Two bills – AB 2345, also by De La Torre and SB 1088 by Sen. Curren Price, D-Los Angeles – implement federal law by barring insurers from charging co-pays for some preventive services, and by letting young adults stay on their parents’ group coverage to age 26.

The governor vetoed several bills in the legislature’s health care package, including measures to mandate maternity coverage in all health insurance plans, standardize classifications for health plans, establish mental health parity, limit rate hikes and establish public health insurance options.

Observers say California’s unsuccessful 2007 attempt to pass state health care reform helped prepare the legislature to act quickly on this year’s legislative package. At the same time, far more comprehensive state single-payer bills have passed the legislature twice, only to be vetoed by Schwarzenegger. The latest single-payer bill, SB 810 by Sen. Leno, passed the state Senate this year and awaits a vote in the Assembly.

For ongoing news about California’s implementation of health care reform, see www.health-access.org.

Photo: PW/Marilyn Bechtel