Since being introduced in March, AKF has focused a good deal of time and effort opposing a California bill, SB 1156, which would limit the ability of nonprofit charitable organizations like AKF to provide financial assistance to California dialysis patients who are unable to afford their health coverage. The bill passed the California Senate on May 30; an amended version of the bill then passed the Assembly Health Committee on June 26. The Senate-passed version of the bill required AKF, as a condition of being allowed to make a third party premium payment, to submit an annual statement to the insurer and the Department of Insurance (DOI) attesting that each recipient of premium assistance has applied and been determined ineligible for Medi-Cal coverage, and attesting to whether they would be eligible for Medicare. In addition, AKF would have to provide notice to the insurer and DOI at least 60 days prior to making the initial premium payment for each recipient.
After the bill’s passage in the Senate, it moved to the Assembly for a hearing and a vote in the Health Committee on June 26. The committee chairman significantly amended the bill prior to the hearing. The amended bill eliminated the requirement that patients receiving charitable premium assistance must not be eligible for Medi-Cal or Medicare, eliminated the 60-day notice requirement, and added language that protects patients from balance billing. Unfortunately, while the Assembly Health Committee made many of the changes we requested, the bill essentially became a rate-setting bill because it says that “financially interested” providers, which would include dialysis providers who contribute to HIPP, would only receive Medicare reimbursement rates, even for patients on private insurance who receive assistance from HIPP. Therefore, we have serious concerns that the legislation may lead to unintended consequences that may affect patients’ access to dialysis care, particularly in urban and rural parts of the state. It also provides rather perverse incentives for provides not to contribute to HIPP since their reimburse rates would be higher if they did not do so.
The legislation is supported by the SEIU California State Council and Blue Shield of California, both of which have an obvious financial interest in removing expensive patients from their insurance rolls.
AKF’s advocacy efforts have included press releases, an action alert to our advocates, a landing page on our website about SB 1156, op-eds, interviews with local California press, testifying before the Senate and Assembly Health Committees, and conducting many in-person meetings with state lawmakers and their staff. We held our first state fly-in on June 11-12, where we brought California HIPP grant recipients to Sacramento to meet with their Assembly members and staff to tell their story and explain how AKF has helped them maintain their health coverage. We also held a rally in front of the state capitol where patients shared their stories of living with kidney disease and voiced their opposition to SB 1156.
The amended bill passed the Assembly Health Committee and the Assembly Appropriations Committee. We have urged the Assembly to carefully analyze the potential ramifications of this bill in its current form before it comes to the Assembly floor; however, we do expect the bill to pass. We are also pursuing a veto strategy and are focused on outreach to Governor Brown’s office, and the Departments of Insurance and Managed Health Care.