Existing law governs the delivery of health care services to persons in the state through private and public means. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

This bill would declare the intent of the Legislature to enact legislation that would create a blue ribbon commission that would study how the state can move toward ensuring health coverage for all Californians. create the 9-member Health Care for All Commission in the State Department of Health Care Services, for the purpose of investigating and making recommendations on improving health care access and affordability for all Californians. The bill would require the Governor, the Senate Rules Committee, and the Speaker of the Assembly to each appoint 3 members of the commission, and require the commission to elect its chair from among its members. The bill would require the commission to meet quarterly between January 1, 2018, and January 1, 2020, and during that time period investigate issues related to improving health care access and affordability for all Californians. The bill would, following the investigation, require the commission to provide a report and recommendations regarding its findings to the Legislature. The bill would require the State Department of Health Care Services to provide general support and staff assistance to the commission.

Existing law governs the delivery of health care services to persons in the state through private and public means. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions.

This bill would declare the intent of the Legislature to enact legislation that would create a blue ribbon commission that would study how the state can move toward ensuring health coverage for all Californians.

Date of Hearing: May 3, 2017

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 1643

Author:(Bonta) – As Amended Ver:March 28, 2017

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill establishes the Health Care for All Commission (Commission) in the Department of Health Care Services (DHCS) to investigate issues related to improving health care access and affordability for all Californians. Specifically, this bill:

1. Requires the Commission to meet quarterly from January 1, 2018 to January 1, 2020, and investigate issues related to improving health care access and affordability for all Californians. Requires the Commission to report its findings to the Legislature and make recommendations for improving health care access and affordability by July 1, 2020.
2. Requires DHCS to provide general support and staff assistance to the Commission.
3. Sunsets on January 1, 2021.

FISCAL EFFECT:

Unknown, significant GF cost pressure, likely in the hundreds of thousands to low millions of dollars annually for two years, for staff and contract costs to DHCS to support the Commission, as well as minor costs to reimburse commissioner expenses. For comparative purposes, the California Health Benefits Review Program (CHBRP), which supports a narrower mission than the Commission envisioned by this bill, has an annual budget of $2 million.

COMMENTS:

1. Purpose. According to the author, this bill allows California to continue to investigate and analyze different proposals related to improving health care access and affordability.  This bill will convene a group of experts that will explore options. 
2. Background Currently, a number of commissions and advisory committees exist, including the Little Hoover Commission, the DHCS Stakeholder Advisory Committee, Medi-Cal Managed Care Advisory Committee, as well as others. In recent years, the California Health and Human Services Agency convened a Let's Get Healthy California task force to improve health in the state, as well as a technical advisory group to support California's ultimately unsuccessful grant proposal to the federal government for a State Innovation Model grant. There is currently no broad, statewide commission charged specifically with examining options for improving health care access and affordability across the entire health care system. Other states have empowered commissions to study issues or to take significant action on health care costs. In Maryland, a commission sets hospital rates and in Massachusetts, a commission sets a statewide cost growth benchmark.
3. Prior Legislation. AB 2345 (Ridley-Thomas), of the 2015-2016 Legislative Session, would have created the Commission on Health Care Cost Review to study and analyze public policies relating to health care costs and access to health care coverage. AB 2345 was held on this committee's Suspense.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 19, 2017

ASSEMBLY COMMITTEE ON GOVERNMENTAL ORGANIZATION

Adam Gray, Chair

ABPCA Bill Id:AB 1643 (

Author:Bonta) – As Amended Ver:March 28, 2017

SUBJECT: Health Care for All Commission

SUMMARY: Establishes the Health Care for All Commission (Commission) in the Department of Health Care Services (DHCS) to investigate issues related to improving health care access and affordability for all Californians. Specifically, this bill:

1. Requires the Commission to consist of nine members, who have expertise or work experience in the health care field.
2. Requires the Governor, the Senate Rules Committee, and the Speaker of the Assembly to each appoint three members to the Commission by February 1, 2018, and requires the Commission to elect a chair from among its members. Permits each Commissioner to serve until January 1, 2021.
3. Permits a Commissioner to be reimbursed his or her actual and necessary expenses incurred in connection with the performance of his or her duties as a member of the Commission, however, prohibits a member of the Commission from compensation.
4. Allows a Commissioner to be removed for cause by majority vote of the members of the Commission and requires the Chair to appoint a replacement.
5. Requires the Commission to meet quarterly from January 1, 2018 to January 1, 2020, and investigate issues related to improving health care access and affordability for all Californians. Requires the Commission to report its findings to the Legislature and make recommendations for improving health care access and affordability by July 1, 2020.
6. Requires DHCS to provide general support and staff assistance to the Commission.
7. Requires the commission shall comply with the Bagley-Keene Open Meeting Act (Bagley-Keene Act).
8. Sunsets the provisions of this bill on January 1, 2021.

EXISTING LAW:

1. Establishes the Bagley-Keene Act which requires state entities to conduct their meetings open to the public. These requirements include, but are not limited to:
   1. Providing notice of a meeting to any person who requests notice in writing. Requires the notice to be given and be made available on the Internet at least 10 days in advance of the meeting. Requires the notice to include the name, address, and telephone number of any person who can provide further information prior to the meeting;
   2. The notice to include an agenda including a brief description of the items of business to be transacted or discussed in either open or closed session, as specified;
   3. Upon request, a person be provided notice for all meetings of a state body or for a specific meeting or meetings; and,
   4. The notice to be made available in appropriate alternative formats that comply with the Americans with Disabilities Act of 1990 (42 U.S.C. Sec. 12132) and the relevant related federal rules and regulations, as specified.
2. The Bagley-Keene Act defines “state body” to mean each of the following:
   • • • 1. Every state board, or commission, or similar multimember body of the state that is created by statute or required by law to conduct official meetings and every commission created by executive order.
         2. A board, commission, committee, or similar multimember body that exercises any authority of a state body delegated to it by that state body.
         3. An advisory board, advisory commission, advisory committee, advisory subcommittee, or similar multimember advisory body of a state body, if created by formal action of the state body or of any member of the state body. Advisory bodies created to consist of fewer than three individuals are not a state body, except that standing committees of a state body, irrespective of their composition, which have a continuing subject matter jurisdiction, or a meeting schedule fixed by resolution, policies, bylaws, or formal action of a state body are state bodies for the purposes of this chapter.

(d) A board, commission, committee, or similar multimember body on which a member of a body that is a state body pursuant to this section serves in his or her official capacity as a representative of that state body and that is supported, in whole or in part, by funds provided by the state body, whether the multimember body is organized and operated by the state body or by a private corporation.

FISCAL EFFECT: Unknown

COMMENTS:

Purpose of the Bill: According to the author, “AB 1643 allows California to continue to investigate and analyze different proposals related to improving health care access and affordability. This bill will convene a group of experts that will help explore our options on an issue that impacts all Californians.”

Background: In signing the ACA’s comprehensive health reform legislation, President Obama adopted a dual mandate for the ACA: it needed not only to expand coverage but also to contain costs (despite the additional utilization associated with the increased coverage), and improve quality. In his August 2016 review and recommendations that could improve the health care system, the President found that the ACA has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. The President also indicated that policymakers should build on progress made by the ACA by continuing to implement state exchanges and delivery system reform, increasing federal financial assistance for state exchange enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs.

The ACA additionally established the Prevention and Public Health Fund (Fund) to provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality. To date, the Fund has invested in a broad range of evidence-based activities including community and clinical prevention initiatives; research, surveillance, and tracking; public health infrastructure; immunizations and screenings; tobacco prevention; and, expanding public health workforce and training.

Bagley-Keene Act: When the Legislature enacted the Bagley-Keene Act of 1967, it essentially said that when a body sits down to develop its consensus, there needs to be a seat at the table reserved for the public. In doing so, the Legislature has provided the public with the ability to monitor and be part of the decision-making process. The Act explicitly mandates open meetings for California State agencies, boards, and commissions. It facilitates transparency of government activities and protects the rights of citizens to participate in state government deliberations. Therefore, absent a specific reason to keep the public out of meetings, the public is allowed to monitor and participate in the decision-making process. Similarly, the Ralph M. Brown Act of 1953 protects citizen's rights to open meetings at the local and county government levels.

Existing law defines an advisory board, commission, committee, and subcommittee of a state body that is comprised of three or more persons and created by a formal action of the body as a “state body” for purposes of the Act. This generally requires state agencies, boards, and commissions to publicly notice meetings, prepare formal agendas, accept public testimony, and conduct meetings in public, unless specifically authorized to meet in closed session.

AB 1643 would require the newly-formed Commission to comply with all provisions of the Bagley-Keene Act.

Similar State Commissions:

• 1. Colorado: The Colorado Commission on Affordable Health Care has a three year mission to analyze health care costs and make policy recommendations to its Legislature and Governor for lowering health care costs in the state. The Colorado Commission is expected to complete its work and submit a report to the Colorado General Assembly and Governor’s Office in late 2017.
  2. Massachusetts: The Massachusetts Health Policy Commission (HPC) is an independent state agency that develops policy to reduce health care cost growth and improve the quality of patient care. The HPC's mission is to advance a more transparent, accountable, and innovative health care system through its independent policy leadership and investment programs. The HPC’s goal is better health and better care at a lower cost across the Commonwealth. The HPC’s main responsibilities include monitoring the performance of the health care system; analyzing the impact of health care market transactions on cost, quality, and access; setting the health care cost growth benchmark; and, investing in community health care delivery and innovations.
  3. Maryland: The Health Services Cost Review Commission (MD Commission) is an independent state agency with seven Commissioners appointed by the Governor. The MD Commission was given broad responsibility regarding the public disclosure of hospital data and operating performance and was authorized to establish hospital rates to promote cost containment, access to care, equity, financial stability, and hospital accountability

Double Referral: AB 1643 was first heard in Assembly Committee on Health on April 4, 2017, and passed on a 10-0 vote (5 members abstaining).

Prior/Previous Legislation: AB 2345 (Ridley-Thomas) of 2015-2016 Session. Would have created the Commission on Health Care Cost Review to study and analyze public policies relating to health care costs and access to health care coverage. (Held in the Assembly Appropriations Committee).

REGISTERED SUPPORT / OPPOSITION:

Support

California Association of Physicians Groups

The National Association of Social Workers, California Chapter

Opposition

None on File

Analysis Prepared by: Kenton Stanhope / G.O. / (916) 319-2531

Date of Hearing: April 4, 2017

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1643

Author:(Bonta) – As Amended Ver:March 28, 2017

SUBJECT: Health Care for All Commission

SUMMARY: Establishes the Health Care for All Commission (Commission) in the Department of Health Care Services (DHCS) to investigate issues related to improving health care access and affordability for all Californians. Specifically, this bill:

1. Requires the Commission to consist of nine members, who have expertise or work experience in the health care field.
2. Requires the Governor, the Senate Rules Committee, and the Speaker of the Assembly to each appoint three members to the Commission by February 1, 2018, and requires the Commission to elect a chair from among its members. Permits each Commissioner to serve until January 1, 2021.
3. Permits a Commissioner to be reimbursed his or her actual and necessary expenses incurred in connection with the performance of his or her duties as a member of the Commission, however, prohibits a member of the Commission from compensation.
4. Allows a Commissioner to be removed for cause by majority vote of the members of the Commission and requires the Chair to appoint a replacement.
5. Requires the Commission to meet quarterly from January 1, 2018 to January 1, 2020, and investigate issues related to improving health care access and affordability for all Californians. Requires the Commission to report its findings to the Legislature and make recommendations for improving health care access and affordability by July 1, 2020.
6. Requires DHCS to provide general support and staff assistance to the Commission.
7. Sunsets the provisions of this bill on January 1, 2021.

EXISTING LAW:

1. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income persons receive health care benefits. Governs and funds the Medi-Cal program, in part, by federal Medicaid program provisions.
2. Establishes the federal Patient Protection and Affordable Care Act (ACA), which enacts various health care coverage market reforms. Establishes the California Health Benefit Exchange (Exchange), also referred to as Covered California, within state government, as an independent public entity not affiliated with any agency or department, and requires the Exchange to compare and make available through selective contracting, health insurance for individual and small business purchasers, as authorized under the ACA. Specifies the powers and duties of the Board governing the Exchange, and requires the Board to facilitate the purchase of qualified health plans (QHP) though the Exchange by qualified individuals and small employers.
3. Requires the Board to determine the criteria and process for eligibility, enrollment, and disenrollment of enrollees and potential enrollees in the Exchange and coordinate that process with state and local government entities administering other specified health care coverage programs, as specified.
4. Defines “insurance affordability programs” to include the Medi-Cal program, Children’s Health Insurance Program, and a program that makes available to qualified individuals coverage in a QHP through the Exchange, with advance payment of the premium tax credit established under the Internal Revenue Code and cost-sharing reduction under federal law.
5. Requires, under the Bagley-Keene Open Meeting Act, that all meetings of a state body be open and public, and all persons be permitted to attend any meeting, except as provided.
6. Requires reports required or requested by law to be submitted by a state or local agency to the Members of either House of the Legislature, generally to be submitted as a printed copy to the Secretary of the Senate, as an electronic copy to the Chief Clerk of the Assembly, and as an electronic or printed copy to the Legislative Counsel.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, AB 1643 allows California to continue to investigate and analyze different proposals related to improving health care access and affordability.  This bill will convene a group of experts that will help explore our options on an issue that impacts all Californians. 
2. BACKGROUND.
   1. ACA. In signing the ACA’s comprehensive health reform legislation, President Obama adopted a dual mandate for the ACA: it needed not only to expand coverage but also to contain costs (despite the additional utilization associated with the increased coverage), and improve quality. In his August 2016 review and recommendations that could improve the health care system, the President found that the ACA has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. The President also indicated that policymakers should build on progress made by the ACA by continuing to implement state exchanges and delivery system reform, increasing federal financial assistance for state exchange enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs.
   2. Prevention and Public Health Fund. The ACA additionally established the Prevention and Public Health Fund (Fund) to provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality. To date, the Fund has invested in a broad range of evidence-based activities including community and clinical prevention initiatives; research, surveillance, and tracking; public health infrastructure; immunizations and screenings; tobacco prevention; and, expanding public health workforce and training.
   3. SB 1159 (Hernandez), Chapter 727, Statutes of 2016. In 2014, California received a federal design grant from the Centers for Medicare and Medicaid Services. The grant provided funds for a technical feasibility analysis of how California might consider developing a cost and quality database that promotes transparency and monitors trends in health care delivery. In 2016, pursuant to SB 1159, the California Health and Human Services Agency (CHHSA) began to explore options for the development of a California Health Care Cost, Quality, and Equity Data Atlas (Data Atlas). SB 1159 requires the research to include certain topics, including, among others, identification of key data submitters and a comparative analysis of potential models used in other states.
      
      On March 1, 2017, CHHSA released a technical feasibility analysis and the intent of this research was to identify ways in which cost, quality, and equity data, when utilized together, can support the development of innovative approaches, services, and programs in both the private and public sectors. The system capability analysis found that DHCS, the California Department of Public Health, and Office of Statewide Health Planning and Development systems and datasets, when combined, could provide some initial use cases to narrow the development options. These datasets can provide meaningful information, which provide a framework for the use cases moving forward. Finally, the report summarized the various governance structures used in states across the country and that they vary from state to state, and each with strengths and weakness. The CHHSA research is intended to inform policy makers and stakeholders of the design and implementation of a potential Data Atlas.
   4. Little Hoover Commission. The Little Hoover Commission (Little Hoover) on California State Government Organization and Economy is an independent state oversight agency that was created in 1962. Its mission is to investigate state government operations through reports, recommendations and legislative proposals and to promote efficiency, economy, and improved service. Little Hoover selects study topics from citizens, legislators, and other sources and explores how programs could and should function in today’s world. Under the direction of Little Hoover members, staff conducts research by bringing key players together for discussions, contacting experts, reviewing academic literature, and interviewing those most closely affected by the targeted topic. Little Hoover also produces in-depth, well-documented reports that serve as a factual basis for crafting effective legislative reform.
   5. Other States.
      1. Colorado. The Colorado Commission on Affordable Health Care has a three year mission to analyze health care costs and make policy recommendations to its Legislature and Governor for lowering health care costs in the state. The Colorado Commission is expected to complete its work and submit a report to the Colorado General Assembly and Governor’s Office in late 2017.
      2. Massachusetts. The Massachusetts Health Policy Commission (HPC) is an independent state agency that develops policy to reduce health care cost growth and improve the quality of patient care. The HPC's mission is to advance a more transparent, accountable, and innovative health care system through its independent policy leadership and investment programs. The HPC’s goal is better health and better care at a lower cost across the Commonwealth. The HPC’s main responsibilities include monitoring the performance of the health care system; analyzing the impact of health care market transactions on cost, quality, and access; setting the health care cost growth benchmark; and, investing in community health care delivery and innovations.
      3. Maryland. The Health Services Cost Review Commission (MD Commission) is an independent state agency with seven Commissioners appointed by the Governor. The MD Commission was given broad responsibility regarding the public disclosure of hospital data and operating performance and was authorized to establish hospital rates to promote cost containment, access to care, equity, financial stability, and hospital accountability.
3. PREVIOUS LEGISLATION. AB 2345 (Ridley-Thomas) of 2016 would have created the Commission on Health Care Cost Review to study and analyze public policies relating to health care costs and access to health care coverage. AB 2345 was held in the Assembly Appropriations Committee.
4. DOUBLE REFERRAL. This bill is double referred, upon passage in this Committee; it will be referred to the Assembly Committee on Governmental Organization.
5. POLICY COMMENTS. This bill would create the Commission to study and analyze issues related to improving health care access and affordability in California and to report its findings to the Governor and Legislature. The Health Committee may want the author to address the following:
   1. The Commission is tasked with investigating issues to improve health care access and affordability in California. Although an important goal, the current Little Hoover can perform the functions of this Commission proposed by this bill.
   2. As drafted, it is unclear the scope of the Commission’s review and whether the Commission should address issues that arise from legislation or questions from the Assembly and Senate Committees on Health or whether the Commission acts as an advisory committee.

REGISTERED SUPPORT / OPPOSITION:

Support

None on file.

Opposition

None on file.

Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097