Bill to mandate reduced cost sharing for Covered California nears passage


Soraya Marashi


A bill requiring Covered California to reduce cost sharing requirements will soon be signed into law. 


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On Wednesday, Senate Bill 944 passed its final floor reading in the Assembly and moved back into the Senate, which concurred with Assembly amendments. The bill would require Covered California to provide health care affordability assistance to reduce cost sharing, including copays, coinsurance, and maximum out-of-pocket costs under the condition that specified enhanced premium subsidies are made available for 2023 and 2024. The bill would also eliminate deductibles for all benefits to the extents feasible.

The Assembly amendments require Covered California to provide financial assistance and other appropriate subsidies to Californians with household incomes at or below 600% of the federal poverty level if funded through an appropriation in the annual Budget Act or an amount otherwise specified by the legislature.

“Health insurance is only beneficial if people are able to use it to access primary, preventive, specialty, and acute care, when needed,” the legislative summary of the author’s comments reads. “This bill is needed to offset copayments and eliminate deductibles so that Californians can get the care that they need without the worry of prohibitive cost sharing that creates barriers and delays to accessing quality health care.”

Health Access California (HAC), the bill’s sponsor, says this bill will help combat rising co-pays and deductibles in the state. 

“Many Covered California enrollees in the subsidized Silver plan currently face deductibles of $3,700, a figure that is set to go up to over $4,750 in 2023 if no action is taken,” the legislative summary of the organization’s supporting position reads. “According to HAC, lower-income Californians may have lower cost sharing, but that still takes a significant percentage of their income and assets. For example, those making up to $2,600 per month face deductibles amounting to almost two month’s income if they are enrolled in standard Silver plans. Few low and middle-income households have the liquid assets required to pay for these deductibles when they need inpatient care.”

The California Department of Finance, in their opposing statement, says the bill “creates significant costs not accounted for in the Administration’s spending plan.” 

The bill passed its final floor reading in a 28-8 vote, and has now been ordered to engrossing and enrolling.