Two major bills sponsored by the California Nurses Association/National Nurses United that would greatly expand patient access to doctors and hospitals of their choice and hold non-profit hospitals to public accountability on what charity care and community benefits they provide passed key tests in the California legislature Wednesday.
 
On 6-2 votes, the Senate Health Committee approved both AB 2533 that would crack down on higher charges for patients who go outside their approved insurance “network” for medical care, and AB 503 to would combat the rampant abuse of what the hospitals report in how they provide charity care and community benefit programs in exchange for their tax exempt status.
 
A separate bill to assure eligibility to workplace compensation for RNs and other hospital staff who contract the dangerous MRSA skin infection also advanced Wednesday in the Senate Labor Committee. A fourth CNA sponsored bill, to require California hospitals to adopt workplace violence prevention programs, is also moving forward after a committee approval last week.
 

Patient Choice
 
AB 2533, introduced by Assembly member Tom Ammiano, is especially timely, says CNA, for Californians who have just signed up for private insurance coverage through the Affordable Care Act’s state health exchange, Covered California.
 
A major component of the bill is to require health insurers to arrange for enrollees who go outside their “approved” network of doctors or hospitals to obtain needed medical care in a timely manner will be charged the same out-of-pocket costs as they would pay for getting care within their network.
 
Addressing the committee Wednesday, Ammiano noted the bill “aims to protect patients for high out of pocket costs” when they need to go outside their limited insurance network. “Having an insurance card means nothing if you are unable to find a provider when you need it.”
 
That tackles what CNA Co-President Deborah Burger, RN notes is “a gaping hole in the health insurance system that either limits patient choice, forces them to travel long distances to find a provider within their ‘network’ or exposes patients and families to excessively high bills that can lead to financial ruin.”
 
While the practice of imposing much higher costs on patients who seek care outside their limited networks is a long-standing abuse, the bill also responds to reports that some insurers in the new Covered California exchanges have set even more restrictive network limitations.
 
Speaking in support of AB 2533 Wednesday were the American College of Emergency Physicians Emergency, Health Access, National Multiple Sclerosis Society, League of Women Voters, California Association of Retired Americans (CARA) the Older Women’s League, and the California School Employees Association.
 
Speaking against the bill, which has already passed the Assembly, was the insurance industry and the California Chamber of Commerce.
 
AB 2533 would also require health insurers to file annual reports on denials of care and complaints about timely access to care to the California Department of Insurance and Department of Managed Health Care and require the departments to post the information on their website for public review.

 
Charity Care Accountability
 
Assembly member Bob Wieckowski of Fremont and Assembly member Rob Bonta of Oakland have jointly authored AB 503 which had its first hearing of 2014 today.
 
In a statement after the vote, Wieckowski noted that “these hospitals receive favorable tax treatment and the public expects them to deliver community benefits, including charity care. However, as several reports by the California State Auditor” and others have noted, “there is no standard methodology in place to calculate the amount of benefits provided.  If the state wants to increase accountability by establishing a standard methodology, the state auditor recommended that the Legislature define the method or direct the Office of Statewide Health Planning and Development to develop the regulations.  AB 503 does exactly that.”
 
In addition to CNA, the Greenlining Institute and the California Rural Legal Assistance Foundation are bill co-sponsors. The California Labor Federation and CARA also stood in support Wednesday.
 
California’s mammoth hospital industry, which has spent $3.8 million lobbying against AB 503 and on other issues this year alone, is leading a vociferous campaign against it.
 
A 2012 CNA report found that California non-profits were accumulating nearly $2 billion a year in public subsidies, tax exempt benefits, beyond what they were returning in charity care – while rolling up record profits and paying scores of top executives pay packages in excess of $1 million a year.
 
“With the huge tax breaks these hospitals receive, the public has a right to expect good corporate citizenship and accountability, especially as our healthcare crisis continues to escalate and more of our state’s residents enter the health care system,” said Burger.
 
AB 503 seeks more uniform standards in California. It would delineate what constitutes charity care which must be the direct provision of care to the uninsured or underinsured, not promotional activities, marketing, cost containment, or other activities more intended to generate profit, more clearly define community benefit programs, and improve reporting requirements for greater public transparency in how hospitals are meeting their charity care and community benefit obligation.
 
Children’s hospitals, county hospitals, other public facilities, and small rural hospitals are exempted.