Legislation from Assembly Member Mia Bonta, D-Alameda, would eliminate most out-of-pocket expenses for patients 21 and younger.
Source: San Francisco Chronicle
Up to 3 million Californians could see health care savings under legislation coming Thursday morning that would end out-of-pocket costs for young patients.
Assembly Member Mia Bonta, D-Alameda, said her first-in-the-nation bill would eliminate co-pays, deductibles or cost-sharing on most health insurance plans in the state for patients 21 and younger. Some health savings account plans would not be subject to the legislation.
“We have to be focused now more than ever on ensuring that we are addressing affordability issues and things that are hitting families in their pocketbook,” Bonta said.
The costs associated with the legislation “would be limited,” Bonta’s office said, largely due to Medi-Cal — the state’s public health insurance covering 40% of Californians — already not charging copays. Private insurers that this bill would affect would lose revenue associated with out-of-pocket costs and would likely push back on the legislation, Bonta’s office said.
Major insurers like Elevance Health and Anthem Blue Cross donated tens of thousands of dollars to California lawmakers from both parties in 2023 and 2024, state records show, and contributed $250,000 to Gov. Gavin Newsom’s ballot measure committee.
Bonta’s office said that, as of 2018, the average California family spent about $3,000 annually on out-of-pocket health care costs.
Dr. Naomi Bardach, professor of pediatrics and policy at UC San Francisco, said that copays can be financial disincentives for patients to go to the doctor. If they no longer have to pay even a small fee for a visit, they can be more likely to go to an appointment, Bardach said.
“Access to preventive care is the first step to improved health for children and families,” Bardach said.
Bardach said that getting vaccines is one of the most important aspects of preventative care for children, leading to better health outcomes and savings compared to treating preventable diseases. The pediatrician also said that early diagnosis and intervention of diseases like asthma and obesity in children and sexual health in adolescents can lead to better control — and more savings — than addressing illnesses later on.
Bonta said her bill aims to reduce costs for California families ahead of potential higher costs that could come if President Donald Trump were to repeal some aspects of the Affordable Care Act. Trump has signed orders reversing expansions to the ACA under President Joe Biden, but other threats to the law remain unknown.
Bonta, chair of the Assembly Health Committee, estimates that increased costs from changes to the ACA could be defrayed by savings included in her legislation.
Bonta said her push to cut copays comes from personal experience growing up in the Bronx, while she dealt with recurring tonsillitis, laryngitis and strep throat.
“I remember very vividly at 6 and 7 years old, having my mom have a lot of anxiety whenever I had a sore throat,” Bonta said. “We’d have to travel for an hour on the train to go see a doctor that had a copay that would be $15 instead of $50.”
Bonta said that parents should not have to worry about finances when trying to address their children’s health concerns.
Bonta said her team partially modeled its approach to the Children and Youth Behavioral Health Initiative, passed in 2021. The measure prohibits out-of-pocket costs for youth mental-health care at schools.
The legislation comes as state lawmakers continue to discuss prioritizing affordability for Californians during the legislative session that began in December. Senate President Pro Tem Mike McGuire, D-Geyserville, and Assembly Speaker Robert Rivas, D-Hollister, have both emphasized a desire to focus legislation on financial relief, especially in the wake of Republicans capturing Congress in November.
Like Bonta, many lawmakers are looking to anticipate and preempt Trump. Legislators continue to consider bills to provide additional money to Attorney General Rob Bonta’s office for lawsuits related to Trump’s actions, as well as funding legal aid organizations to fight mass d.
While Newsom originally planned for the special session bills to be passed prior to Trump taking office, wildfires in Southern California delayed the process. Votes on the original bills are expected next week.
Bonta said she expects her bill to contend with other requests for state funding. State finance director Joe Stephenshaw said earlier this month that California is expected to have a “modest surplus” of $363 million, but that the Los Angeles wildfires will probably delay tax deadlines for people in affected areas, which will make it hard for state officials to accurately budget state spending for the next year.
The introduction of Bonta’s bill also follows a nationwide fervor over denials and delays in coverage by health insurance companies following the murder of UnitedHealthcare CEO Brian Thompson.
“I think the average Californian right now is frantic about wanting to make sure that they can keep themselves and their family and their loved ones healthy and safe,” Bonta said. “I know for sure, from my perspective, that we need to be focusing on every individual and making sure that we’re not benefiting the billion-dollar multinational corporations.”