Pauline Bartolone

One of California’s largest insurers has proposed a change in the benefits of commercial plans next year that would require consumers to pay more for drugs at pharmacies outside an established network.

Blue Shield of California wants to create “a tiered pharmacy network” in its 2018 small- and large-group plans, according to preliminary proposals the company submitted to the California Department of Managed Health Care (DMHC), a state health insurance regulator.

If the proposal is approved by the department before the end of the year, it would affect the coverage of more than 1.8 million consumers, based on 2015 numbers from the regulator.

Under Blue Shield’s proposal, consumers still would have a broad selection of pharmacies, but they would have to choose a “preferred” pharmacy to maintain this year’s copayment amount. Outside of that network, consumers could pay up to $50 more for the same prescription, the company document says.

The move is part of a larger trend among insurers and other health care payers to narrow networks of providers to keep costs down, experts say. Consumers already are familiar with insurers steering them toward certain physicians and hospitals to save money. And narrower pharmacy networks are increasingly common in Medicare and employer-sponsored health coverage.

The Blue Shield proposal would expand pharmacy networks to commercial plans – something California regulators say insurers under their purview aren’t currently doing.

Nationally, insurers and their pharmaceutical benefit managers have been known to selectively contract with pharmacies, although it’s difficult to say how common that practice is.

Pharmacy chain CVS Health expects to dispense tens of millions fewer prescriptions in 2017 as a result of being excluded from health plan pharmacy networks around the nation, according to news media reports. And late last year, because CVS was not included in a Blue Cross of Alabama network, hundreds of thousands of customers were notified that they should switch to a preferred pharmacy if they wanted lower prices.

Raymond Brown, a clinical pharmacy leader at Mercer, a New York-based employee benefits consulting firm, says every health care payer – government, employers, and insurers – scrutinizes the pharmaceutical supply chain to find places to control rising drug costs.

“They’re saying, ‘What else can we do?’ ” he said. “To say ‘Can we do something on the distribution side?’ … I think is a natural additional step.”

Blue Shield of California spokeswoman Molly Weedn said the preferred pharmacy network proposal is an effort to “stabilize the increasingly high cost of drugs for our members.” Blue Shield of California already has preferred pharmacies in its Medicare plans, including CVS/Target, Walmart, Costco, and Safeway/Albertsons and some independent pharmacies. The insurer’s latest proposal would use that same network of pharmacies in its state-regulated commercial market.

But some patient advocates and pharmacists say pharmacy networks can confuse consumers and interfere with patient care.

Another major California insurer, Anthem Blue Cross, joined Blue Shield of California in proposing to create preferred pharmacy networks in Covered California policies for 2018.

But in a letter in December to the health insurance marketplace, attorneys for low-income consumers and other advocacy groups objected. “We reject the allowance of tiered pharmacies as the right solution to our shared concerns about the ever-escalating prices of prescription drugs,” the letter said.

Covered California staff decided not to allow the change in the 2018 health insurance marketplace, spokeswoman Amy Palmer said, because it wouldn’t have considerably brought down health care costs.

Advocates with Consumers Union, which hasn’t taken a position on the most recent Blue Shield proposal, say pharmacy networks could create more complexity for lower-income people in an already complicated health insurance system, one that faces more uncertainty under an Obamacare repeal.

“It’s really not a good time to add one more layer of information that [patients] have to deal with,” said Betsy Imholz, special projects director at Consumers Union. “People will be befuddled.”

Imholz said creating economic incentives to steer patients toward network pharmacies could inconvenience the most vulnerable patients. If the preferred pharmacy is farther away, or in a rural area, lower-income patients dependent on public transit could have a harder time reaching the preferred pharmacy, she said.

“It’s going to add to your costs and your time, and if you have a medical condition, to get to … the cheaper tier of pharmacy, that can be a real burden,” Imholz said.

Many pharmacists don’t like narrow pharmacy networks, either.

Jon Roth, CEO of the California Pharmacists Association, says creating preferred pharmacies can sever long-term relationships that pharmacists have with patients.

Pharmacists “may know everything about [a patient’s] health history, their medication use” and help patients “adhere to their medication instructions,” Roth said. “It’s very distressing.”

But Blue Shield, in its proposals to the DMHC, said its pharmacy network idea is intended to make “health care affordable for all Californians.” And the company suggests that almost all of its commercial plan members live close to a preferred pharmacy.

Still, Katie Keith, a policy consultant and contributor to a recent report on pharmacy access, says the preferred pharmacy approach is not a panacea for rising drug prices.

“It’s not going to solve everything or even get close to solving the whole problem,” Keith said. “It’s a trend to keep an eye on, but I’m not sure how far this will go.”
 

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

One of California’s largest insurers has proposed a change in the benefits of commercial plans next year that would require consumers to pay more for drugs at pharmacies outside an established network.

Blue Shield of California wants to create “a tiered pharmacy network” in its 2018 small- and large-group plans, according to preliminary proposals the company submitted to the California Department of Managed Health Care (DMHC), a state health insurance regulator.

If the proposal is approved by the department before the end of the year, it would affect the coverage of more than 1.8 million consumers, based on 2015 numbers from the regulator.

Under Blue Shield’s proposal, consumers still would have a broad selection of pharmacies, but they would have to choose a “preferred” pharmacy to maintain this year’s copayment amount. Outside of that network, consumers could pay up to $50 more for the same prescription, the company document says.

The move is part of a larger trend among insurers and other health care payers to narrow networks of providers to keep costs down, experts say. Consumers already are familiar with insurers steering them toward certain physicians and hospitals to save money. And narrower pharmacy networks are increasingly common in Medicare and employer-sponsored health coverage.

The Blue Shield proposal would expand pharmacy networks to commercial plans – something California regulators say insurers under their purview aren’t currently doing.

Nationally, insurers and their pharmaceutical benefit managers have been known to selectively contract with pharmacies, although it’s difficult to say how common that practice is.

Pharmacy chain CVS Health expects to dispense tens of millions fewer prescriptions in 2017 as a result of being excluded from health plan pharmacy networks around the nation, according to news media reports. And late last year, because CVS was not included in a Blue Cross of Alabama network, hundreds of thousands of customers were notified that they should switch to a preferred pharmacy if they wanted lower prices.

Raymond Brown, a clinical pharmacy leader at Mercer, a New York-based employee benefits consulting firm, says every health care payer – government, employers, and insurers – scrutinizes the pharmaceutical supply chain to find places to control rising drug costs.

“They’re saying, ‘What else can we do?’ ” he said. “To say ‘Can we do something on the distribution side?’ … I think is a natural additional step.”

Blue Shield of California spokeswoman Molly Weedn said the preferred pharmacy network proposal is an effort to “stabilize the increasingly high cost of drugs for our members.” Blue Shield of California already has preferred pharmacies in its Medicare plans, including CVS/Target, Walmart, Costco, and Safeway/Albertsons and some independent pharmacies. The insurer’s latest proposal would use that same network of pharmacies in its state-regulated commercial market.

But some patient advocates and pharmacists say pharmacy networks can confuse consumers and interfere with patient care.

Another major California insurer, Anthem Blue Cross, joined Blue Shield of California in proposing to create preferred pharmacy networks in Covered California policies for 2018.

But in a letter in December to the health insurance marketplace, attorneys for low-income consumers and other advocacy groups objected. “We reject the allowance of tiered pharmacies as the right solution to our shared concerns about the ever-escalating prices of prescription drugs,” the letter said.

Covered California staff decided not to allow the change in the 2018 health insurance marketplace, spokeswoman Amy Palmer said, because it wouldn’t have considerably brought down health care costs.

Advocates with Consumers Union, which hasn’t taken a position on the most recent Blue Shield proposal, say pharmacy networks could create more complexity for lower-income people in an already complicated health insurance system, one that faces more uncertainty under an Obamacare repeal.

“It’s really not a good time to add one more layer of information that [patients] have to deal with,” said Betsy Imholz, special projects director at Consumers Union. “People will be befuddled.”

Imholz said creating economic incentives to steer patients toward network pharmacies could inconvenience the most vulnerable patients. If the preferred pharmacy is farther away, or in a rural area, lower-income patients dependent on public transit could have a harder time reaching the preferred pharmacy, she said.

“It’s going to add to your costs and your time, and if you have a medical condition, to get to … the cheaper tier of pharmacy, that can be a real burden,” Imholz said.

Many pharmacists don’t like narrow pharmacy networks, either.

Jon Roth, CEO of the California Pharmacists Association, says creating preferred pharmacies can sever long-term relationships that pharmacists have with patients.

Pharmacists “may know everything about [a patient’s] health history, their medication use” and help patients “adhere to their medication instructions,” Roth said. “It’s very distressing.”

But Blue Shield, in its proposals to the DMHC, said its pharmacy network idea is intended to make “health care affordable for all Californians.” And the company suggests that almost all of its commercial plan members live close to a preferred pharmacy.

Still, Katie Keith, a policy consultant and contributor to a recent report on pharmacy access, says the preferred pharmacy approach is not a panacea for rising drug prices.

“It’s not going to solve everything or even get close to solving the whole problem,” Keith said. “It’s a trend to keep an eye on, but I’m not sure how far this will go.”
 

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

One of California’s largest insurers has proposed a change in the benefits of commercial plans next year that would require consumers to pay more for drugs at pharmacies outside an established network.

Blue Shield of California wants to create “a tiered pharmacy network” in its 2018 small- and large-group plans, according to preliminary proposals the company submitted to the California Department of Managed Health Care (DMHC), a state health insurance regulator.

If the proposal is approved by the department before the end of the year, it would affect the coverage of more than 1.8 million consumers, based on 2015 numbers from the regulator.

Under Blue Shield’s proposal, consumers still would have a broad selection of pharmacies, but they would have to choose a “preferred” pharmacy to maintain this year’s copayment amount. Outside of that network, consumers could pay up to $50 more for the same prescription, the company document says.

The move is part of a larger trend among insurers and other health care payers to narrow networks of providers to keep costs down, experts say. Consumers already are familiar with insurers steering them toward certain physicians and hospitals to save money. And narrower pharmacy networks are increasingly common in Medicare and employer-sponsored health coverage.

The Blue Shield proposal would expand pharmacy networks to commercial plans – something California regulators say insurers under their purview aren’t currently doing.

Nationally, insurers and their pharmaceutical benefit managers have been known to selectively contract with pharmacies, although it’s difficult to say how common that practice is.

Pharmacy chain CVS Health expects to dispense tens of millions fewer prescriptions in 2017 as a result of being excluded from health plan pharmacy networks around the nation, according to news media reports. And late last year, because CVS was not included in a Blue Cross of Alabama network, hundreds of thousands of customers were notified that they should switch to a preferred pharmacy if they wanted lower prices.

Raymond Brown, a clinical pharmacy leader at Mercer, a New York-based employee benefits consulting firm, says every health care payer – government, employers, and insurers – scrutinizes the pharmaceutical supply chain to find places to control rising drug costs.

“They’re saying, ‘What else can we do?’ ” he said. “To say ‘Can we do something on the distribution side?’ … I think is a natural additional step.”

Blue Shield of California spokeswoman Molly Weedn said the preferred pharmacy network proposal is an effort to “stabilize the increasingly high cost of drugs for our members.” Blue Shield of California already has preferred pharmacies in its Medicare plans, including CVS/Target, Walmart, Costco, and Safeway/Albertsons and some independent pharmacies. The insurer’s latest proposal would use that same network of pharmacies in its state-regulated commercial market.

But some patient advocates and pharmacists say pharmacy networks can confuse consumers and interfere with patient care.

Another major California insurer, Anthem Blue Cross, joined Blue Shield of California in proposing to create preferred pharmacy networks in Covered California policies for 2018.

But in a letter in December to the health insurance marketplace, attorneys for low-income consumers and other advocacy groups objected. “We reject the allowance of tiered pharmacies as the right solution to our shared concerns about the ever-escalating prices of prescription drugs,” the letter said.

Covered California staff decided not to allow the change in the 2018 health insurance marketplace, spokeswoman Amy Palmer said, because it wouldn’t have considerably brought down health care costs.

Advocates with Consumers Union, which hasn’t taken a position on the most recent Blue Shield proposal, say pharmacy networks could create more complexity for lower-income people in an already complicated health insurance system, one that faces more uncertainty under an Obamacare repeal.

“It’s really not a good time to add one more layer of information that [patients] have to deal with,” said Betsy Imholz, special projects director at Consumers Union. “People will be befuddled.”

Imholz said creating economic incentives to steer patients toward network pharmacies could inconvenience the most vulnerable patients. If the preferred pharmacy is farther away, or in a rural area, lower-income patients dependent on public transit could have a harder time reaching the preferred pharmacy, she said.

“It’s going to add to your costs and your time, and if you have a medical condition, to get to … the cheaper tier of pharmacy, that can be a real burden,” Imholz said.

Many pharmacists don’t like narrow pharmacy networks, either.

Jon Roth, CEO of the California Pharmacists Association, says creating preferred pharmacies can sever long-term relationships that pharmacists have with patients.

Pharmacists “may know everything about [a patient’s] health history, their medication use” and help patients “adhere to their medication instructions,” Roth said. “It’s very distressing.”

But Blue Shield, in its proposals to the DMHC, said its pharmacy network idea is intended to make “health care affordable for all Californians.” And the company suggests that almost all of its commercial plan members live close to a preferred pharmacy.

Still, Katie Keith, a policy consultant and contributor to a recent report on pharmacy access, says the preferred pharmacy approach is not a panacea for rising drug prices.

“It’s not going to solve everything or even get close to solving the whole problem,” Keith said. “It’s a trend to keep an eye on, but I’m not sure how far this will go.”
 

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Some states could keep their federally funded insurance exchange with consumer protections intact under a proposal unveiled Monday by two Republican U.S. senators.

Sen. Bill Cassidy (R-La.) and Sen. Susan Collins (R-Maine) said their proposed legislation would allow states that embraced the Affordable Care Act to keep operating under many of the current federal rules.

Another option is for states to pursue a less-regulated alternative to Obamacare under the Patient Freedom Act. Or they could reject federal dollars completely in favor of a new state solution for health coverage.

“We give states the option,” Sen. Cassidy said at press conference Jan. 23.

Some health law supporters say the Cassidy-Collins proposal, one of several in the GOP-controlled Congress, could represent a lifeline for states such as California that have invested heavily in expanding coverage under the ACA.

But many Democrats at the state and national level criticized the plan as potentially harmful to millions of Americans who rely on the health law because it does not promise sufficient funding and consumer protections.

“It provides a somewhat illusory option to stay in the ACA without the guarantee of federal assistance necessary to allow states to maintain the level of coverage they are currently providing,” California Insurance Commissioner Dave Jones, an elected Democrat, said in an interview.

California fully implemented the health law by expanding Medicaid coverage to millions of low-income people and creating its own insurance exchange, which ultimately covered 1.3 million enrollees. Supporters have held the state up as proof that the health law can work as intended – and as a counterpoint to Republican contentions that Obamacare is collapsing nationally.

Sen. Cassidy said his legislation promotes the Republican doctrine of states’ rights while avoiding the one-size-fits-all approach from Washington.

Sen. Collins echoed that sentiment, saying she favors letting states that had success with the health law maintain the status quo. She described it as “reimplementation of the ACA” in those states.

“If a state chooses to remain covered by the ACA, exchange policies will continue to be eligible for cost-sharing subsidies and advance premium tax credits,” she said in a Senate floor speech Jan. 23. “The insurance market will still be subject to ACA requirements, and the individual mandate and employer mandate will also remain in place in that state.”

Sen. Cassidy and Sen. Collins acknowledged that details of their bill haven’t been worked out, nor is it clear how it will mesh with other proposals. Competing plans in Congress don’t envision these state options, and it’s unclear what approach President Donald Trump and his nascent administration will take in crafting a replacement plan.

Still, some industry experts and analysts say the Cassidy-Collins proposal is intriguing.

“The advantage to a state like California is we could protect what we have accomplished already,” said Howard Kahn, former chief executive of L.A. Care Health Plan, an insurer on the Covered California exchange. The large managed care plan serves patients in Medi-Cal, the state’s Medicaid program.

“Cassidy’s proposal could work for California better than other alternatives in the short term. The question is whether they maintain federal funding for the longer term,” Mr. Kahn said. “My feeling is you do have to engage with the rational Republicans who are trying to find something that doesn’t tear it all apart.”

Federal funding is a key issue for states. In a summary of the bill posted by Sen. Collins, it said states choosing to retain Obamacare or pick the Republican alternative could receive “funding equal to 95% of federal premium tax credits and cost-sharing subsidies, as well as the federal match for Medicaid expansion.”

Dylan H. Roby, of the department of health services administration at the University of Maryland School of Public Health, College Park, said “California would still have to absorb a 5% cut, at least, in the premium tax credits and cost-sharing subsidies.”

Republicans will need 60 votes in the U.S. Senate to pass a full replacement for the ACA. Sen. Cassidy said his compromise approach is designed to win over some Democrats and reach that 60-vote majority.

In her speech on the Senate floor, Sen. Collins said children could still stay on their parents’ health plans until they are 26 years old. There would be no discrimination against preexisting conditions and no caps on annual or lifetime coverage, she said.

Other key features of the legislation include a provision allowing states to automatically enroll eligible people in health plans unless they opt out. The plan also promotes health savings accounts and price transparency requiring hospitals and other providers to disclose costs so consumers can shop around for the best price.
 

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Some states could keep their federally funded insurance exchange with consumer protections intact under a proposal unveiled Monday by two Republican U.S. senators.

Sen. Bill Cassidy (R-La.) and Sen. Susan Collins (R-Maine) said their proposed legislation would allow states that embraced the Affordable Care Act to keep operating under many of the current federal rules.

Another option is for states to pursue a less-regulated alternative to Obamacare under the Patient Freedom Act. Or they could reject federal dollars completely in favor of a new state solution for health coverage.

“We give states the option,” Sen. Cassidy said at press conference Jan. 23.

Some health law supporters say the Cassidy-Collins proposal, one of several in the GOP-controlled Congress, could represent a lifeline for states such as California that have invested heavily in expanding coverage under the ACA.

But many Democrats at the state and national level criticized the plan as potentially harmful to millions of Americans who rely on the health law because it does not promise sufficient funding and consumer protections.

“It provides a somewhat illusory option to stay in the ACA without the guarantee of federal assistance necessary to allow states to maintain the level of coverage they are currently providing,” California Insurance Commissioner Dave Jones, an elected Democrat, said in an interview.

California fully implemented the health law by expanding Medicaid coverage to millions of low-income people and creating its own insurance exchange, which ultimately covered 1.3 million enrollees. Supporters have held the state up as proof that the health law can work as intended – and as a counterpoint to Republican contentions that Obamacare is collapsing nationally.

Sen. Cassidy said his legislation promotes the Republican doctrine of states’ rights while avoiding the one-size-fits-all approach from Washington.

Sen. Collins echoed that sentiment, saying she favors letting states that had success with the health law maintain the status quo. She described it as “reimplementation of the ACA” in those states.

“If a state chooses to remain covered by the ACA, exchange policies will continue to be eligible for cost-sharing subsidies and advance premium tax credits,” she said in a Senate floor speech Jan. 23. “The insurance market will still be subject to ACA requirements, and the individual mandate and employer mandate will also remain in place in that state.”

Sen. Cassidy and Sen. Collins acknowledged that details of their bill haven’t been worked out, nor is it clear how it will mesh with other proposals. Competing plans in Congress don’t envision these state options, and it’s unclear what approach President Donald Trump and his nascent administration will take in crafting a replacement plan.

Still, some industry experts and analysts say the Cassidy-Collins proposal is intriguing.

“The advantage to a state like California is we could protect what we have accomplished already,” said Howard Kahn, former chief executive of L.A. Care Health Plan, an insurer on the Covered California exchange. The large managed care plan serves patients in Medi-Cal, the state’s Medicaid program.

“Cassidy’s proposal could work for California better than other alternatives in the short term. The question is whether they maintain federal funding for the longer term,” Mr. Kahn said. “My feeling is you do have to engage with the rational Republicans who are trying to find something that doesn’t tear it all apart.”

Federal funding is a key issue for states. In a summary of the bill posted by Sen. Collins, it said states choosing to retain Obamacare or pick the Republican alternative could receive “funding equal to 95% of federal premium tax credits and cost-sharing subsidies, as well as the federal match for Medicaid expansion.”

Dylan H. Roby, of the department of health services administration at the University of Maryland School of Public Health, College Park, said “California would still have to absorb a 5% cut, at least, in the premium tax credits and cost-sharing subsidies.”

Republicans will need 60 votes in the U.S. Senate to pass a full replacement for the ACA. Sen. Cassidy said his compromise approach is designed to win over some Democrats and reach that 60-vote majority.

In her speech on the Senate floor, Sen. Collins said children could still stay on their parents’ health plans until they are 26 years old. There would be no discrimination against preexisting conditions and no caps on annual or lifetime coverage, she said.

Other key features of the legislation include a provision allowing states to automatically enroll eligible people in health plans unless they opt out. The plan also promotes health savings accounts and price transparency requiring hospitals and other providers to disclose costs so consumers can shop around for the best price.
 

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Some states could keep their federally funded insurance exchange with consumer protections intact under a proposal unveiled Monday by two Republican U.S. senators.

Sen. Bill Cassidy (R-La.) and Sen. Susan Collins (R-Maine) said their proposed legislation would allow states that embraced the Affordable Care Act to keep operating under many of the current federal rules.

Another option is for states to pursue a less-regulated alternative to Obamacare under the Patient Freedom Act. Or they could reject federal dollars completely in favor of a new state solution for health coverage.

“We give states the option,” Sen. Cassidy said at press conference Jan. 23.

Some health law supporters say the Cassidy-Collins proposal, one of several in the GOP-controlled Congress, could represent a lifeline for states such as California that have invested heavily in expanding coverage under the ACA.

But many Democrats at the state and national level criticized the plan as potentially harmful to millions of Americans who rely on the health law because it does not promise sufficient funding and consumer protections.

“It provides a somewhat illusory option to stay in the ACA without the guarantee of federal assistance necessary to allow states to maintain the level of coverage they are currently providing,” California Insurance Commissioner Dave Jones, an elected Democrat, said in an interview.

California fully implemented the health law by expanding Medicaid coverage to millions of low-income people and creating its own insurance exchange, which ultimately covered 1.3 million enrollees. Supporters have held the state up as proof that the health law can work as intended – and as a counterpoint to Republican contentions that Obamacare is collapsing nationally.

Sen. Cassidy said his legislation promotes the Republican doctrine of states’ rights while avoiding the one-size-fits-all approach from Washington.

Sen. Collins echoed that sentiment, saying she favors letting states that had success with the health law maintain the status quo. She described it as “reimplementation of the ACA” in those states.

“If a state chooses to remain covered by the ACA, exchange policies will continue to be eligible for cost-sharing subsidies and advance premium tax credits,” she said in a Senate floor speech Jan. 23. “The insurance market will still be subject to ACA requirements, and the individual mandate and employer mandate will also remain in place in that state.”

Sen. Cassidy and Sen. Collins acknowledged that details of their bill haven’t been worked out, nor is it clear how it will mesh with other proposals. Competing plans in Congress don’t envision these state options, and it’s unclear what approach President Donald Trump and his nascent administration will take in crafting a replacement plan.

Still, some industry experts and analysts say the Cassidy-Collins proposal is intriguing.

“The advantage to a state like California is we could protect what we have accomplished already,” said Howard Kahn, former chief executive of L.A. Care Health Plan, an insurer on the Covered California exchange. The large managed care plan serves patients in Medi-Cal, the state’s Medicaid program.

“Cassidy’s proposal could work for California better than other alternatives in the short term. The question is whether they maintain federal funding for the longer term,” Mr. Kahn said. “My feeling is you do have to engage with the rational Republicans who are trying to find something that doesn’t tear it all apart.”

Federal funding is a key issue for states. In a summary of the bill posted by Sen. Collins, it said states choosing to retain Obamacare or pick the Republican alternative could receive “funding equal to 95% of federal premium tax credits and cost-sharing subsidies, as well as the federal match for Medicaid expansion.”

Dylan H. Roby, of the department of health services administration at the University of Maryland School of Public Health, College Park, said “California would still have to absorb a 5% cut, at least, in the premium tax credits and cost-sharing subsidies.”

Republicans will need 60 votes in the U.S. Senate to pass a full replacement for the ACA. Sen. Cassidy said his compromise approach is designed to win over some Democrats and reach that 60-vote majority.

In her speech on the Senate floor, Sen. Collins said children could still stay on their parents’ health plans until they are 26 years old. There would be no discrimination against preexisting conditions and no caps on annual or lifetime coverage, she said.

Other key features of the legislation include a provision allowing states to automatically enroll eligible people in health plans unless they opt out. The plan also promotes health savings accounts and price transparency requiring hospitals and other providers to disclose costs so consumers can shop around for the best price.
 

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.