California Health Insurance
Transcript of California Health Insurance
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California
Health Benefits
Review Program
California Health Insurance
John Lewis, MPA
Associate Director
February 11, 2021
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
• Covers medically necessary test,
treatments, and services (excepting
some exclusions)
• Protects against some or all financial
loss due to health-related expenses
• Can be publicly or privately financed
HEALTH INSURANCE…
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
HEALTH INSURANCE…
• Is regulated at the federal
level or both the federal
and state level
• May be (or may not be)
subject to state laws, such
as benefit mandates
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
STATE-REGULATED HEALTH INSURANCE…
Health care service plan contracts are:
• Subject to CA Health and Safety Code
• Regulated by DMHC
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
STATE-REGULATED HEALTH INSURANCE…
Health insurance policies are:
• Subject to CA Insurance Code
• Regulated by CDI
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
SOURCES OF HEALTH INSURANCE
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2022 ESTIMATES – SOURCES OF HEALTH INSURANCE
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
HEALTH INSURANCE MARKETS IN CALIFORNIA
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DMHC-Regulated Plans CDI-Regulated Policies
Large Group (101+) Large Group (101+)
Small Group (2-100) Small Group (2-100)
Individual Individual
Medi-Cal Managed Care* ----------------
*except county organized health systems (COHS)
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
BENEFIT MANDATE LIST
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
BENEFIT MANDATES
• State Laws (Health & Safety/Insurance Codes)– 79 benefit mandates in California
• Federal Laws– Pregnancy Discrimination Act
– Newborns’ & Mothers’ Health Protection Act
– Women’s Health and Cancer Rights Act
– Mental Health Parity and Addiction Equity Act
– Affordable Care Act (ACA)
• Federal Preventive Services
• Essential Health Benefits (EHBs)
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
FEDERAL PREVENTIVE SERVICES
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
FEDERAL PREVENTIVE SERVICES
73 Benefit Mandates from these sources:• USPSTF (United States Preventive Services Task Force) A and B recommendations
• HRSA (Health Resources and Services Administration)
– Health plan coverage guidelines for women’s preventive services
– Comprehensive guidelines for infants, children, and adolescents
• ACIP (Advisory Committee on Immunization Practices) recommendations adopted by the CDC
(Centers for Disease Control and Prevention)
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
ESSENTIAL HEALTH BENEFITS (EHBS)
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
ESSENTIAL HEALTH BENEFITS (EHBS)
Categories1. Ambulatory patient services;
2. Emergency services;
3. Hospitalization;
4. Maternity and newborn care;
5. Mental health substance use disorder services, including behavioral health treatment;
6. Prescription drugs;
7. Rehabilitative and habilitative services and devices;
8. Laboratory services;
9. Preventive and wellness services and chronic disease management; and
10. Pediatric services, including oral and vision care.
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ESSENTIAL HEALTH BENEFITS (EHBS)
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California
Health Benefits
Review Program
California Health Insurance
John Lewis, MPA
Associate Director
February 11, 2021
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California
Health Benefits
Review Program
Overview: CHBRPProviding Evidence-Based Analysis to the
California Legislature
Garen Corbett, MS
Director
February 11, 2021
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
• What is CHBRP?
• Who is CHBRP?
• How does CHBRP work?
• What resources does CHBRP have available?
CHBRP: BRIDGING ACADEMIA & THE LEGISLATURE
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
WHAT IS CHBRP?
• Independent analytic resource located in UC
• Multi-disciplinary
• Provides rapid, evidence-based information to the Legislature
• Neutral analysis of introduced bills at the request of the
Legislature
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
WHO IS CHBRP?
• CHBRP Staff (based at UC Berkeley)
• Contract CHBRP Leads
• Task Force of faculty and researchers
• Actuarial firm: Milliman, Inc.
• Librarians
• National Advisory Council
• Content Experts
• Student Assistants
• Graduate Summer Interns
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
HOW CHBRP WORKS
• Upon receipt Legislature’s request, CHBRP convenes multi-
disciplinary, analytic teams to provide rigorous, objective
analysis before policy committee hearing
• CHBRP typically analyzes health insurance benefit mandates or
other health insurance-related legislation
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
Mandate Bill Introduced and Request sent to
CHBRP
Team AnalysisVice Chair/CHBRP
Director Review
RevisionsNational Advisory
Council Final to
Legislature
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CHBRP’S 60 DAY OR LESS TIMELINE
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ImpactsWould benefit coverage,
utilization, or cost change?Would the public’s health
change?
Medical EffectivenessWhich services and treatments
are most relevant?Does evidence indicate impact
on outcomes?
Policy ContextWhose health insurance would
have to comply?Are related laws already in
effect?
CHBRP ANALYSES PROVIDE:
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CHBRP’S WEBSITE: WWW.CHBRP.ORG
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CHBRP’S WEBSITE: OTHER PUBLICATIONS
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CHBRP IS ON SOCIAL MEDIA!
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California
Health Benefits
Review Program
Showcasing CHBRP’s Methods:A review of AB 2203 Insulin Cost-Sharing Cap
Adara Citron, MPH
Principal Policy Analyst
February 11, 2021
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
As introduced, AB 2203 would limit cost sharing for insulin prescriptions to:
• $50 for a 30-day supply and no more than $100 per month
• regardless of the type or quantity prescribed
• applies to co-payments, co-insurance, and deductibles
Quick facts:
• About 10% of the CA population has been diagnosed with diabetes
• Insulin can be used to treat all three types of diabetes
2020 ANALYSIS: AB 2203 INSULIN COST SHARING CAP
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
KEY FINDINGS
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
MEDICAL EFFECTIVENESS IMPACTS
Key Questions:
1. Effects of cost sharing on insulin use/adherence for enrollees with diabetes?
2. Associated effects of cost sharing for insulin on health outcomes and utilization?
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
MEDICAL EFFECTIVENESS IMPACTS, CONT.
Key Findings
1. Limited evidence that cost sharing affects insulin use and adherence in patients with diabetes
2. Insufficient evidence on the effect of cost sharing for insulin on diabetes-related health outcomes and
utilization
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
BENEFIT COVERAGE, UTILIZATION, AND COST IMPACTS
• Cost sharing exceeding cap among enrollees using insulin:
38% at baseline
• Utilization of insulin
• Total net annual expenditures by $2,581,000 or 0.002%
– Increase in total premiums of $20,310,000
–Decrease in enrollee cost sharing of $17,729,000
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
PUBLIC HEALTH IMPACTS
• cost-sharing
• utilization
• ? glycemic control, healthcare utilization, long-term
complications, quality of life
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CALIFORNIA HEALTH BENEFITS REVIEW PROGRAM
Questions? Want more info?
www.chbrp.org
Contacts:
Garen Corbett, MS, Director
John Lewis, MPA, Associate Director
Adara Citron, MPH, Principal Policy Analyst
Karen Shore, PhD, An-Chi Tsou, PhD
Follow CHBRP:
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