California Gov. Jerry Brown signed several new health and insurance rules into law last week and vetoed a few others.
Self-employed Californians and single-owner start ups can now buy small business insurance, and insurers cannot raise premiums for small business owners based on the health of employees.
Medi-Cal, the state Medicaid agency, will reach out to Californians who lose insurance as result of job loss or legal separation and give them information about subsidized plans available through the state insurance exchange, starting in 2014.
California's essential health benefits benchmark, the Affordable Care Act-required baseline for all plans come 2014, will be a Kaiser Permanente small group HMO plan, with a $30 co-pay for most consultations and treatments.
And in an effort to prevent fraud, it is a crime to claim to represent the California Health Benefits Exchange, although the penalties are not clear.
Brown also vetoed a number of bills, including legislation that would have forced California insurers to cover everyone regardless of medical conditions -- the so-called "guarantee issue" -- and would have required implementation of the ACA as it's presently written. Brown said he supports the guarantee issue, but thought the ACA-implementation provisions were too technical to let California adapt to changes in the federal law -- like if Republicans abolish the individual mandate.
"Without the strong foundation that federal law provides, a state-level mandate on insurers alone could encourage healthy people to wait until they got sick or injured before purchasing coverage," Brown wrote in his veto message, as the Sacramento Bee reported. "This would lead to skyrocketing premiums, making coverage more unaffordable."
[See also: The good news on ACOs]
The California Association of Health Plans (CAHP) opposed the bill, sharing Brown's concerns over the uncertainty of the individual mandate. Another controversial part of the bill would have barred insurers from charging tobacco smokers higher premiums.
Brown also vetoed a bill that would have prohibited insurers from requiring patients to try more than two pain medications before accessing others prescribed by a participating plan provider, and another bill that would have barred insurers from requiring a higher co-pay or deductible for oral anti-cancer medication that for intravenously administered anti-cancer medication.