The bill considered for this paper is Bill No. AB 29, authored by Price and Swanson, with subject âHealthcare Coverageâ. The bill was introduced in 1st December 2008 and amended on the 24th of March 2010. 1. Overview of the health problem Based from the analyses provided for the bill, this bill has been proposed and argued for on the grounds that it has the ability to curve statistics for the largest uninsured segment of the population in California which is comprised of teenagers aged 19-23 (Bill Analysis, 2009, p.
3). This age range, consisting the 27. 3% of the uninsured individuals in California, has been excluded from eligibility to received healthcare benefits under their parentâs insurance coverage, on the basis of age (Bill Analysis, 2009, p. 3). This then, according to the research presented by the proponents of the bill, disposes these individuals of this age to seek their insurance coverage somewhere and shoulder the costs themselves (Bill Analysis, 2009, p.
3). The costs of which may be considered expensive for these people to handle and thus, they prefer to skip making applications (Bill Analysis, 2009, p. 3). This is the current situation in California, and one which the bill specifically targets to address. The bill seeks to extend the dependent coverage for medical insurance of children up to 27 years of age.
While the existing legal provisions- also those apparent in Knox and Keene Health Service Care Plan of 1975- do not impose any restrictions to the current conditions imposed by employers on matters concerning the medical insurance coverage for dependent children, the statistics for insured population belonging to the young adult group remains to be high and these statistics cause an alarming reality of the current status of accessibility to quality health care by the young adult population.
The bill seeks to extend the medical insurance coverage of children who have been considered as dependents of their parents. For parents whose insurance coverage is paid for by the employer, the bill provides them the opportunity to maintain the dependent coverage for their children by making payments of the additional premiums (Bill Analysis, 2009, p. 4) Presently, children who reach the age of 21 or after they graduate high school or college are disabled from further being enrolled as dependents of their parents for premium coverage or health care insurance.
This scenario reveals that this particular group of individuals will remain to get neglected, as far as matters about fair and equal accessibility to heath care insurance policies are concerned if no actions are done now to at lest protect them from being excluded from necessary accesses. This bill will affect the almost 30% uninsured population of California, as well as the number of insurance companies and employers whoa re currently providing health care insurance overage for parents whose children or who have any children that belong to this particular age-group.
2. Severity of the health problem As there are no existing legal provisions that would discourage the current situation, this business culture presents a serious problem for any society who puts high importance to the accessibility of quality healthcare to its citizens, regardless of age. The current practices regarding the admission of young adults for medical coverage under their parentsâ insurance accounts have very stringent rules.
The background research provided in the Bill Analysis identify that most parents who cover their children as listed beneficiaries of medical coverage that is under their insurance account are working parents whom medical coverage was obtained though the employersâ provisions. However, the existing agreement between the employer and most insurance providers revoke young adultsâ eligibility to remain beneficiaries under their parentsâ insurance account on two grounds: (1) if they are not enrolled in college for full-time; or (2) after the children turn 19, graduate from high school, or graduate from college (Bill Analysis, 2009, p.
3). The gravity of the reality of the situation is compounded by the fact that, according to the research background provided in the Bill Analysis, young adults encounter difficulty applying for medical insurance coverage and getting accepted with their applications (Bill Analysis, 2009, p. 3). This reality is based on several reasons. According to the research background provided in the bill analysis, statistics show that these particular age range, the young adult population, often end up with low paying jobs and hold temporary positions (Bill Analysis, 2009, p.
3). Thus, they receive meager salaries and are excluded from receiving health insurance benefits provided for by the company as one of the incentives employees get (Bill Analysis, 2009, pp. 3-4). Existing legal provisions also support exclusion of this particular age range from being eligible to receive benefits from public programs if they are considered healthy and childless (Bill Analysis, 2009, p. 4).
According to the presented report on public programs in the Bill Analysis, children are only included in the Medi-Cal program before they reach the age of 21, after which, they are pretty much on their own. Only young adults with children, pregnant, or with disability are qualified to receive the benefits of the program of the Medi-Cal (Bill Analysis, 2009, p. 4). The risks associated with the present circumstances are high. Generally, it curves down the access of this particular population to quality health care (Bill Analysis, 2009, p.
4). This leaves serious implications to the young adult and his or her family. The most obvious is that, in case of medical emergencies, a large-out of the pocket expenses would be required from the family if the young adult patient happens to be not covered by any health care insurance policy (Bill Analysis, 2009, p. 4). 3. Overview of the bill The bill has undergone two Assembly Committee Analyses and one Senate Committee Analysis on the 28th and 14th of April 2008 and on the 26th of March 2009, respectively.
This bill inserts some additional conditions and requirements to the existing Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act). Essentially, the bill requires the lifting of the existing age limit implemented by employers and health care insurance providers upon dependent coverage; and provide the conditions under which these additional requirements can be fulfilled without necessarily passing the costs of which to employers health care insurance firms.
Specifically, it targets to impose these four conditions: First, the bill âwould prohibit, with a specified exception, the limiting age for dependent children covered by these health care service plan contracts and group health insurance policies from being less than 27 years of ageâ (Legislative Counselâs Digest, 2009, par. 2). Secondly, the âbill would also provide that no employer is required to pay the cost of coverage for dependents who are at least 23 years of age, but less than 27 years of age.
The bill instead would authorize subscribers and insureds to elect to provide coverage tot hose dependents by contributing the premium for that coverageâ (Legislative Counselâs Digest, 2009, par. 2). Thirdly, while the constitution of California requires the reimbursements of costs to local agencies and school districts based in the mandate of the state, the bill âwould provide that no reimbursement is required by this act for a specified reasonâ (Legislative Counselâs Digest, 2009, pars.
4-5). Lastly, the bill imposes that any violations of the additional requirements it has on the Know-Keene Act is to be considered a crime (Legislative Counselâs Digest, 2009, par. 3). Section 1 of the bill stipulates conditions requiring the deletion of age limit to criteria eligibility and changing the age limit of the child into twenty-seven.
This section also provides that the plan contract should not specify any conditions leading to the individualâs exemption from Medi-Calâs benefits; automatic inclusion to benefits entitlement of children and spouses to medical coverage upon moment of birth, or in case of adopted child, from the moment that the legal documents for adoption have been signed or any document stating that the responsibility for health care for the adopted is admitted by the individual adopting; and no plan contract shall be entered upon if there exist conditions in the plan that waive or disclaim or state any other terms of limitation that apply to newborn infants or to adopted children, and allowing the firms to either offer or not mental health and eye health services (Legislative Counselâs Digest, 2009, Sec. 1, A-G). The section 2 of the bill stipulates the conditions that plan holders have the freedom to choose the medical professional they prefer and that this selection would not be under the discretion of the health insurance firm provider, except for mental and vision health care professionals (Legislative Counselâs Digest, 2009, Sec. 2, A-D).
The Section 3 of the bill reinforces that none of the provisions included in the bill supports or tolerates the performance of any medical activity by any licensed someone who does not have the capacity to do so,; the chosen medical or licensed professional should perform on that which is within the field of his or her specialization. The Section 4 of the Bill stipulates the definition of âmarriage and family therapistâ. The section states that the person should be a licensed professional who has received specific instructions that are equivalent with the instructions or learning required for the January 1, 1981 licensure test (Legislative Counselâs Digest, 2009, Sec. 4).
This section 5 of the Bill requires that the vision and/ or mental health care professional to be chosen by the plan holder should be one that is affiliated with the health insurance provider (Legislative Counselâs Digest, 2009, Sec. 5). This section also suggests ready availability of psychologists provided by health insurance firms that offer mental services; however, the failure to comply does not constitute a crime (Legislative Counselâs Digest, 2009, Sec. 5). The Section 6 of the Bill states that the definition for âindividual practice associationâ adopted in the Bill is consistent with the definition used in the Sec. 1307 of the Federal Public health service Act (Legislative Counselâs Digest, 2009, Sec. 6).
The rest of the bill also talks about that a child, 18 years of age and enrolled fulltime in secondary or post secondary school, and enrolled in a medical coverage remains to be eligible during break from schools (Legislative Counselâs Digest, 2009, Sec. 7); any child who takes medical leave from school and whose conditions render him physically incapable of maintaining self-employment, the provisions stipulated in (D) applies if the child is primarily dependent on the policy holder (Legislative Counselâs Digest, 2009, Sec. 6); requires that the health insurance firm informs about the termination of coverage if the child reaches appropriate age (Legislative Counselâs Digest, 2009, Sec.
7); submission of certification of the medical necessity for leave of absence is necessary to be made to the health care insurance firm within thirty days after the first day of the leave of absence (Legislative Counselâs Digest, 2009, Sec. 7). 4. Promises/ Expected Outcome The promises and expected outcome of the bill would definitely be evident in the statistics concerning the number of young adults without insurance coverage. With the outright provision that lifts the age-limit and substitute it with longer age, the population of young adults without any insurance coverage will be decreased. The Bill also allows better access to health care options for this particular segment of people (young adults).
It also relieves the parents the worries that in case of serious medical emergencies involving a young adult of their family, very high of the pocket costs would be required for medication. 5. Supporters of the bill This bill, with its current status of being âproposedâ, receives a great deal of support from concerned individuals and different organizations. According to the Bill Analysis report, supporters of the proposal include âthe American College of Obstetricians and Gynecologists, the California Commission on the Status of Women, the California Medical Association, and Health Access California âŚ American Federation of State, and County ad Municipal Employeesâ (Bill Analysis, 2009, p. 4). These groups supporting the bill agree in two major points.
Firstly, it is pointed out that the bill provides a very good channel for young adults who still rely upon their parents for financial assistance to remain covered by adequate health insurance coverage, especially at the current time when there is difficulty securing and maintaining health care coverage for this particular age group (Bill Analysis, 2009, p. 4). Secondly, it is argued that the proposed provision that allows employees to shoulder premiums for the health care insurance coverage of their children who belong in this particular age range can be translated into additional revenues for the state, aside from the fact that there will be a peace of mind for parents that comes with the awareness that every member of their family is being adequately covered (Bill Analysis, 2009, pp. 4-5). 6. Opponents of the bill Not everyone welcomes the proposal of the bill though.
According to the Bill Analysis Report, the opponents of the proposed bill include the representatives of health plans, health insurance firms, as well as employers. The arguments are always associated with financial risks and additional costs that the firms may incur once the bill is passed and implemented. These groups argue that the inclusions of this particular age group for eligibility to receive coverage under premiums paid for by their parents, until the age of 27, would only result to the conflict between the premiums and the existing federal tax rules referring to deductibility of taxes imposed on health insurance premiums (Bill Analysis, 2009, p. 5).
More than that, however, the proposed bill does not give enough allowance of time and opportunity for the concerned parties (insurance provider firms and employers) to calculate and predict the risk and costs that they might incur when the extension for the eligibility for insurance coverage, under premiums paid for by the parents, for this particular age group is finally implemented (Bill Analysis, 2009, p. 5). These opponents that such drastic a change might result to employers totally waiving off the coverage for dependents completely due to increased costs and risks the bill can cause them to incur (Bill Analysis, 2009, p. 5). 7. Recommendation This bill contains provisions that, in my view, bring only positive contributions in improving the health care access to young adults. However, I need to agree with the insurance firms and employers that it does not seem to tackle the other side of the coin to make the arguments well-balanced.
In other words, no attention has been given yet, neither is there any detail in the bill that indicates research has been done to ensure that risks and costs would not cause serious problems with insurance firms and companies in the future. References http://www. leginfo. ca. gov/pub/09-10/bill/asm/ab_0001-0050/ab_29_bill_20090324_amended_asm_v98. html http://www. leginfo. ca. gov/pub/09-10/bill/asm/ab_0001-0050/ab_29_cfa_20090326_100055_sen_comm. html http://www. leginfo. ca. gov/pub/09-10/bill/asm/ab_0001-0050/ab_29_cfa_20090413_093510_asm_comm. html http://www. leginfo. ca. gov/cgi-bin/postquery? bill_number=ab_29&sess=CUR&house=B&author=price