Governor Brown formally called for a special session of the California Legislature to tackle implementation of the Affordable Care Act (ACA) during his State of the State Speech. The formal proclamation was executed later that same day, January 24, and the special session convened January 28.
The Governor waited until after the November 2012 general election results were clear that the Obama administration would remain in office and ACA implementation would move forward. The Sacramento “Capitol Community” had been expecting the Governor to call the special session for some time.
As earlier reported in the California Healthline[i]:
In his State of the State speech, Brown said the special session would "deal with those issues that must be decided quickly if California is to get the Affordable Care Act started by next January."
Brown also said the two options for Medi-Cal expansion – a state- or county-based approach – would not be decided as part of the special session. "The broader expansion of Medi-Cal … is incredibly complex and will take more time," Brown said. "Working out the right relationship with the counties will test our ingenuity and will not be achieved overnight."
According to Diana Dooley, secretary of the state Health and Human Services Agency, the expansion details should take a much broader and more inclusionary approach. "We need to get it right and work it out with the counties," Dooley said. "It's complex. There is some urgency, certainly, but we need to make sure we get it right."
There are three core issues the governor would like addressed in the special session, formally called for in a proclamation:
- Individual and small group insurance market reforms. These were included in legislation passed last session, and then vetoed by Brown in August. Brown said at the time that he wanted to wait until we saw the outcome of the national presidential election, so that California didn't end up holding the financial bag of individual and small group market reforms if President Obama had not been re-elected.
- Conforming to federal eligibility, enrollment and retention rules. "We need a state statute on conforming to federal laws for new eligibility," Dooley said.
- Bridge to reform. Dooley, chair of the California Health Benefit Exchange, branded recently as Covered California said, "We want to establish a bridge program at the exchange." That means having low-cost health coverage in the exchange for individuals at up to 200% of FPL (federal poverty level).
"Those are the three specific things that are time-sensitive," Dooley said. Any laws passed in special session, she said, will take effect in 90 days.
Assembly Member Richard Pan, MD (D-Sacramento), chair of the Assembly Committee on Health, said he's uncertain whether lawmakers might add any other topics of discussion to the special session. "We'll see," Pan said. "We just got the proclamation, so I don't know if other people have things they want to add."
Pan did have an opinion on the two Medi-Cal expansion choices, though. "My guess is we'd want to limit fragmentation," Pan said, which would mean choosing the state-based option, rather than having 58 counties each handle the expansion, he said. "When you have more fragmentation, you have more opportunity for problems," Pan said. "To me, that doesn't lead to good coordination of care. I understand, though, there's also the fiscal piece tied to it, from the administration's point of view.
The CSA will continue to monitor the special session, ACA implementation, and the regular session of the 2013-14 Legislature, and keep you apprised. Stay tuned to the CSA and ASA websites for more updates to follow, with a particular focus on how this will affect us in particular, as anesthesiologists. There will be many opportunities to get involved in shaping our future.
Together we are stronger!
This CSA Online First was authored by LPAD Chair, Paul Yost, MD and CSA lobbyists, Bill Barnaby Sr. & Jr.
[i] Three Items on Special Session Agenda, by David Gorn,