Today's Law As Amended

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AB-174 Health care coverage: financial assistance.(2019-2020)



SECTION 1.

 Section 100504.1 is added to the Government Code, to read:

100504.1.
 (a) The Legislature finds and declares all of the following:
(1) Although Covered California provides financial assistance for premiums, financial help to reduce copays and deductibles, and other cost sharing, many low- and moderate-income Californians who receive that financial help still have difficulty paying their premiums, obtaining access to care, or affording the necessities of life, such as food and housing.
(2) Under existing federal law, most Californians are assured that their health insurance premiums will cost no more than 10 percent of their incomes, but some Californians who buy coverage as individuals may still face health insurance premiums that cost far more than 10 percent of their incomes.
(3) There are still over 1,000,000 Californians in the individual market who remain uninsured because they cannot afford health care coverage due to high health care costs and the high cost of living in this state.
(b) It is the intent of the Legislature that a California taxpayer who buys coverage as an individual shall not spend more than 15 percent of the taxpayer’s income on health care coverage premiums that meet minimum standards of affordability.
(c) It is further the intent of the Legislature that the total uninsured population in the individual market shall be reduced by one-half because more Californians will have more affordable coverage.

SEC. 2.

 Section 100504.2 is added to the Government Code, to read:

100504.2.
 (a) (1) The board shall administer enhanced premium assistance to an individual who enrolls in health care coverage through the Exchange. The enhanced premium assistance shall be based on the adjusted monthly premium for the applicable second lowest cost silver level health care coverage with respect to the individual.
(2) For an individual with a household income at or below 138 percent of the federal poverty level, the enhanced premium assistance shall reduce the individual’s premiums to zero.
(3) For an individual with a household income at or between 139 percent and 400 percent of the federal poverty level, the enhanced premium assistance shall be scaled to reduce the individual’s premiums to 1 percent of the individual’s household income for an individual with a household income of 139 percent of the federal poverty level to 8 percent of the individual’s household income for an individual with a household income of 400 percent of the federal poverty level.
(4) For an individual with a household income of 401 percent or more of the federal poverty level who is not otherwise eligible for federal advanced premium tax credit, the enhanced premium assistance shall reduce the individual’s premiums to 8 percent of the individual’s household income for coverage with an actuarial value of 70 percent with respect to essential benefits for an individual with a household income of 401 percent of the federal poverty level, scaled to reduce the individual’s premiums to 12 percent of the individual’s household income for an individual with a household income of 600 percent of the federal poverty level, and scaled to reduce the individual’s premiums to 15 percent of the individual’s household income for an individual with a household income of 800 percent of the federal poverty level.
(5) The enhanced premium assistance shall be in addition to applicable federal tax premium subsidies and shall not replace those subsidies.
(6) The board may proportionally reduce the amount of enhanced premium assistance administered in a fiscal year if the amount appropriated in that fiscal year is less than the projected cost of full implementation so that the enhanced premium assistance costs do not exceed the appropriation amount adopted in the Budget Act for that fiscal year.
(b) The board shall administer additional cost-sharing financial assistance to those who are otherwise eligible for premium tax credits and who have incomes determined to be below 400 percent of the federal poverty level as follows:
(1) An individual with a household income at or below 138 percent of the federal poverty level shall be offered products with an actuarial value of 100 percent with respect to essential benefits.
(2) An individual with a household income at or between 200 percent and 400 percent of the federal poverty level shall be offered products with an actuarial value of 80 percent with respect to essential benefits. The benefit design for these products shall be consistent with the benefit design for a gold level of coverage.
(c) For purposes of this section, “cost-sharing financial assistance” includes direct assistance with copays and deductibles.
(d) For the purposes of this section, the term “silver level” has the same meaning as set forth in Section 1367.009 of the Health and Safety Code, and Section 10112.295 of the Insurance Code.
(e) If the federal government reduces or eliminates funding for the applicable federal advanced premium tax credit, the administration of enhanced premium assistance under this section shall cease six months after the effective date of the federal law or other action reducing or eliminating the federal advanced premium tax credit.
(f) The board shall implement this section contingent on the appropriation of funds in the 2019–20 Budget Act.