Senate Health Committee Hearing on ABX1-1 Agenda

Previously I’ve written about the thorough vetting Assembly Bill X1-1 was likely to receive before the Senate Health Committee. That should be Vetting, with a capital “V.”

ABX1-1, the compromise health care reform package has yet to be subjected to a thorough, formal review. Drafted by Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nunez, it passed the full Assembly the same day it was printed in final form. This may be business as usual in the legislature, but it’s no way to review complex, complicated and critical legislation.

So Senate Health Committee Chair Sheila Kuehl is doing Californians a favor by making the time to thoroughly analyze the bill. Her motivation may be fueled, at least in part, by her numerous problems with ABX1-1 (as described in that previous post),  but who cares? What’s important is that lawmakers understand what’s in the bill before they vote on it.

Senator Kuehl’s approach to reviewing the bill, breaking it up into manageable pieces, should make it easier for Senators to dive deeply into different aspects of the legislation. One can question the way it’s broken up. For example, reviewing the mandate on residents to maintain minimum creditable coverage separate from the market reform which requires carriers to issue coverage regardless of an applicant’s health condition, is a bit disjointed. The reason a mandate to buy coverage is necessary is to make the mandate to sell policies work. However, that’s a relatively minor quibble with the approach. Far more important is that details of the bill will have a better chance of coming to light.

The Committee will take up the bill on January 23rd at 9:00 am. Based on the agenda the hearing should last all day. While all witnesses are created equal, some are more interesting than others. The representative of the Legislative Analyst’s Office (LAO) will be the marquee witness. Senate President Pro Tem Don Perata asked the LAO to analyze the impact ABX1-1 was likely to have on the state’s finances back in December when he felt passage of health care reform legislation before Sacramento addresses the state’s budget crisis was “imprudent and impolitic.” He’s since managed to overcome his reluctance, much as Governor Arnold Schwarzenegger seems to have overcome his concerns about changing the state’s term limit laws without redistricting reforms. Coincidence? Nahhhh.

Anyway, back to the hearing, Elizabeth Hill, the Legislative Analyst, is highly regarded by legislators of all parties. Her office’s report will be highly influential if,and it’s a big if, it makes definitive statements instead of couching it’s findings in an ocean of hedges. If the report is full of “ifs,” “potentiallies” “coulds” and “perhapses” then it’s impact will be muted, unless Committee members can get the LAO’s representative at the hearing to refine the conclusions a bit. We’ll have to wait a few more days to see if that will even be necessary.

For those who want to follow along at home on the 23rd (again, beginning at 9:00 am), the hearing will be broadcast online. To listen in, visit the California Senate’s web site and click on room 4203. The Committee’s expected agenda, subject to change, follows:

Outline for Hearing on ABX1 1 (Nunez)

I. Author’s presentation, including presentation by Secretary Belshe or administration representative

II. LAO presentation of fiscal analysis 

III. Testimony, by topic (order for each topic will be support, support if amended or with amendments, concerns, oppose unless amended, oppose)

  A. Mandate to maintain minimum creditable coverage

  B. Purchasing pool, coverage expansions, and proposed tax credits

  C. Requirements for health coverage outside of purchasing pool

  D. Health insurance market and regulatory reforms

  E. Financing (including provisions of proposed initiative) 
     — Employer assessments
     — Redirection of county funds
     — Tobacco tax
     –Hospital assessments
     –Federal funds
     –Individual contributions
     –Contingencies in event of funding shortfall

  F. Testimony on Massachusetts health plan

  G. Scope of practice changes

  H. Data collection and transparency and pay for performance provisions

  I. Other provisions
     –Hospital and physician rates
     –In-Home Supportive Service (IHSS) worker provisions
     –Electronic prescribing and medical records
     –Healthy actions and incentive rewards
     –Public insurer provisions
     –Diabetes, obesity and smoking provisions
     –Prohibition on hospital balance billing
     –Other

IV. Author’s close