Out-of-pocket caps OK’d by panel

cost of health insurance imageCalifornia consumers worried that out-of-pocket insurance expenses could soar under the Affordable Care Act are nearing the protection of state law.

The California Assembly Health Committee has approved a sweeping Senate Bill that reins in consumer costs under the Covered California health insurance exchange. The bill already was OK’d by the Senate.

Obamacare faced more negative headlines in recent days with reports that consumers could face dual out-of-pocket maximums — one for medical work, another for prescriptions.

The administration agreed to a one-year delay in establishing a single co-pay cap for some insurers due to administrative integration issues with multiple vendors. The problem, apparently, is one of accounting systems keeping track of patient spending across different companies.

The one-year reprieve actually dates back to at least February, but news reports of the loophole just surfaced.

Consumer groups warned of “enormous financial exposure” for some seriously ill patients.

Covered California, the state health insurance exchange, already has capped out-of-pocket expenses, but the eventual passage of SB 639 would lock in the protections. The bill cleared the Senate in late May and is advancing in the Assembly.

The bill, from state Sen. Ed Hernandez, caps consumer out-of-pocket costs at the $6,350 limit established under the Affordable Care Act. Hernandez, a doctor, is one of the key legislators pushing through ACA-related measures.

The Assembly Health Committee approved the bill Aug. 13, hours after widespread news reports of the Obamacare loophole.

The consumer group Health Access said the legislation would “would help prevent bankruptcies due to medical bills.”

“A core part of Obamacare and this bill is to remove fear of the fine print that consumers have when buying coverage, that the plan won’t adequately protect their financial future,” wrote Health Access chief Anthony Wright. “These consumer protections are crucial for (patients) with high prescription drug costs or any of us who end up in the hospitals for an extended time — that we are not on the hook for tens of thousands of dollars. …

“With this bill, California can once again not just implement the federal law, but improve upon it,” Wright wrote.

President Obama has hailed California for its leadership in enacting the Affordable Care Act.

Covered California will offer health insurance plans to individuals and small-business groups beginning Oct. 1 for coverage that goes into effect Jan. 1, 2014.

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