drug bill passes California Senate, Report on all health care bills
with two days left in session, new census shows California uninsured
Census data: California uninsured rate rises to 19%; CA among "top
5" worst states
• State Senate passes
AB2911(Nunez/Perata) to negotiate drug discounts
• UPDATE: Some health bills
pass, fail: Report on bills' status in the Legislature
By Anthony Wright
Executive Director of Health
With the legislative session for 2005-06 approaching its
final deadline, health care continues to be in the spotlight, with
pending bills on everything from universal coverage to hospital
On prescription drugs, a major bill to negotiate lower,
fairer prices for millions of uninsured, AB2911(Nunez/Perata)
passed the full Senate on a straight party line vote and now
heads to the Assembly. Other bills on prescription drug
issues, AB71(Chan) and SB452(Alarcon) failed passage. But
other health-related measures, including AB1840(Horton) and
SB1704(Kuehl) passed and headed to the Governor's desk.
A fuller description is below. Many of these bills are
attempts to help the uninsured, and today there was new
information about the extent of the health care crisis in
CENSUS DATA: MORE AMERICANS & CALIFORNIANS UNINSURED
New census data released Tuesday showed the number of
uninsured in 2005 rising in the United States, and in California
specifically. Of particular note, California was one of eight states
to see the proportion of uninsured rise. The likelihood a
Californian is uninsured rose to 19 percent of the population, from
18.5 percent in 2004.
That means nearly 1 in every 5 Californians finds themselves
With these new numbers, California is in the "top 5" states
with the worst rate of residents with health coverage. Only
Texas (24.5%), New Mexico (20.6%), Florida (20.3%) have
higher rates of uninsured: Oklahoma and California are tied
On the national front, the number of Americans without health
coverage rose to 46.6 million. The proportion of Americans with
employer-based coverage went down to 59.5%, which, according to the
Census report, "essentially explains the decrease in total private
health insurance coverage, from 68.2% to 67.7%." While public
insurance programs did pick up some of the slack, it was not enough
to prevent more people from becoming uninsured.
Other Census numbers for the
United States as a whole 2004 and 2005:
Number of Americans without health coverage 45.3 million/46.6
Proportion of Americans who receive health benefits from
their employer 59.8%/59.5%
Number of people covered by government programs 79.4
Number of people born in the U.S. who were uninsured
Uninsured Whites 11.2%/11.3%
Uninsured Blacks 19.3%/19.6%
Uninsured Latinos 32.3%/32.7%
Uninsured Asians 16.5%/17.9%
In this context, the California legislature is set to pass
major legislation to assist the growing uninsured population in the
next week, and send those bills to Governor Arnold Schwarzenegger.
The bills include the landmark SB840(Kuehl), the California Health
Insurance Reliability Act, to extend coverage to all Californians
through a universal, publicly financed health care system.
Among the financial consequences of being uninsured is that
the lack of negotiating power, which means the uninsured end up
paying signfiicantly more for care--including prescription drugs and
hospital care--than anybody else. The legislature is set to pass
major legislation to remedy this issue:
AB774(Chan) would prohibit hospitals from charging more than the Medi-Cal, Medicare,
or worker's compensation rate for hospital care, and provide other
consumer protections against abusive billing and collections
AB2911(Nunez/Perata) and SB1702 (Perata/Nunez)
would create a prescription drug discount program, eventually
allowing the state to use its purchasing power to negotiate
discounts for the uninsured and underinsured.
PRESCRIPTION DRUG LEGISLATION
In fact, California state senators voted 25-12 to give the state
authority to negotiate discounted and fair prescription drug prices
for uninsured Californians. All Democrats in the Senate voted for
The bill, which now heads to the Assembly, authorizes the state to
negotiate for the best possible price for up to 6 million
Californians. The first three years, the program is voluntary,
allowing the drug companies to fulfill their promises made last year
to make a voluntary program work. However, after August 1, 2010, if
drug companies are not participating or their discounts are still
insufficient, the state may use the purchasing power of its Medi-Cal
program to steer some business away from drug companies that give
Senator Perata opened the floor debate by describing the measure as
a compromise, after the "shootout on the ballot" last year between
Propositions 78 & 79. He cited the potential benefits to millions of
uninsured Californians, for discounts of 40-60%.
Senator Ortiz, who proposed a voluntary drug discount program last
year, announced that she would vote for the bill, but raised issues
about the use of Medi-Cal's bargaining power to negotiate discounts,
fearing it might make it harder for some Medi-Cal recipients to get
authorization for the medicines they need. While there are several
protections in existing law and in the bill to ensure that all Medi-Cal
recipients get access to drugs they need, she asked that future
legislators work to ensure protections for Medi-Cal patients.
Republican Sen. Dave Cox called AB2911 and attempt to impose "price
caps'' on drug companies. "I don't have to stand here very long to
tell you that price caps haven't worked in the past. the reason we
don't do that is because they don't work,'' Cox said. While AB2911
attempts to achieve up to 60 percent discount off generic drugs and
40 percent off brand name drugs, using verifiable benchmarks such as
the best price Medicaid pays, the discounts will be based on the
negotiations between the state and the drug companies.
Sen. Jackie Speier, a Democrat, rose to support the bill. Speier had
authored the "Golden Bear'' program in 2001, which asked drug
companies to voluntarily provide discounts for uninsured
Californians. "Guess what happened?'' she asked. "Nothing.'' The
Golden Bear program folded for lack of drug company participation.
Nothing is going to happen without the use of the state's purchasing
power, which this bill provides, she said. "This is too big a market
The program would be available for 5-6 million Californians who earn
less than 300 percent of the federal poverty level ($60,000 for a
family of four); or who have high un-reimbursed medical expenses and
incomes below the state's median family income ($68,310 for a family
of four); or whose drugs are not covered by Medicare may qualify.
In anticipation of this week's vote, a giant, walking pill bottle
and volunteers from Gray Panthers, Older Women's League, Congress of
California Seniors, Latino Coalition for a Healthy California,
Health Access, California Alliance for Retired Americans, Consumers'
Union, AIDS Healthcare Foundation and Health Care for All
distributed more than 1,000 pro-prescription drug leaflets to
Capitol staff, lawmakers and lobbyists arriving at work Monday
morning and leaving for lunch on Tuesday.
BILL UPDATE: WHERE ARE
HEALTH BILLS NOW?
Bills headed to the Governor:
PASSED. Requires the state to disclose names of
employers who, rather than providing health coverage, have their
workers and their families on Medi-Cal and Healthy Families.
SB1704 (Kuehl) PASSED.
Extends the sunset for the existing California Health Benefits
Review program to 2011.
Voted on Assembly Floor Tuesday: (Need 41 votes to pass)
SB452 (Alarcon) FAILING.
34-37. Requires Medi-Cal to report to Governor on whether Medi-Cal
prices are higher than prices for federal programs. (Democrats
voting against the bill included: Ed Chavez, La Puente; Jerome
Horton, Los Angeles; Ted Lieu, El Segundo; Barbara Matthew, Tracy;
Nicole Parra, Bakersfield; Leland Yee, San Francisco. Democrats
abstaining or absent at voting time included: Ron Calderon,
Montebello; Joe Canciamilla, Martinez; Paul Koretz, Hollywood; Gene
Mullin, South San Francisco; Gloria Negrete-McLeod, Cino; Alberto
Torrico, Newark; and Lois Wolk, Davis.)
Pending on the Assembly
SB437 (Escutia) Streamlines enrollment into children's insurance programs. This bill has
been amended significantly, but would make enrollment easier through
a WIC Gateway, and by expanding pre-enrollment for Healthy Families
for county applications. It will also seek to keep more children
retained on the program by simiplying annual renewals to allow
self-certification of income for Healthy Families, and creating a
pilot for self-certification in Medi-Cal.
Allows patients in the individual market to transfer to similar
health plans without underwriting that would lead to denial of
coverage based on "pre-existing conditions."
Creates a feasibility study on simplifying application for Medi-Cal
and Healthy Families using CHDP Gateway and electronic application.
Voted on Senate Floor Tuesday: (Needs 21 votes to pass)
18-18. Establishes a clearinghouse for information about the safety
and effectiveness of prescription drugs that are advertised on
television. (Democrats voting against the bill included: Denise
Ducheny, San Diego; Dean Florez, Fresno; Mike Machado, Stockton; Ed
Vincent, Los Angeles. Democrats abstaining or absent were: Christine
Kehoe, San Diego; Kevin Murray, Los Angeles).
AB2911 (Nunez/Perata) PASSED
25-15. Allows the state of California to use its Medi-Cal purchasing
power to negotiate discounted prescription drug prices for uninsured
and underinsured Californians.
Still pending on Senate
(Chan) Provides consumer protections against abusive hospital billing and
collections practices, including those that charge uninsured
patients multiple times what insurers pay for the same service.
Extends the sunset for the Managed Risk Medical Insurance Program (MRMIP),
which covers patients with "pre-existing conditions" unable to get
(Baca) Allows the state to monitor Part D prescription drug plans in the same
way it monitors health plans.
Establishes a website listing sources that are safe for purchasing
more affordable drugs from other countries.
SB840 (Kuehl) Concurrence.
Called the California Health Insurance Reliability Act, creates a
universal, publicly financed (single-payer) health care system for
the state similar to Medicare.
SB1405 (Soto) Concurrence.
Creates a Task Force on Reimbursement for Language Services to
recommend actions for achieving linguistic access to care.