Fiona Ma for State Assembly

Assemblywoman Ma’s Bill to Cap Patient Costs and Expand Federal Health Care Act Benefits in California, Passes out of Senate

One week prior to the due date for the Supreme Court’s ruling on the federal Affordable Care Act, California is taking the lead on ensuring out-of-pocket expenses are capped and kept financially feasible for California’s most vulnerable. Assemblywoman Fiona Ma's (D-San Francisco and San Mateo Counties) AB 1800, which would set a cap on out-of pocket expenses in the amount of $5,950 for a single patient, or $11,900 for a family of any size, passed out of the California State Senate Committee on Health today.

This deductible would include all out-of-pocket (OOP) costs for covered benefits such as: doctor visits, lab tests, and prescriptions for patients that have cancer, Multiple sclerosis, HIV and other chronic conditions that are costly to manage.

As current law stands, out of pocket expenses have no limit. The hefty bills associated with expensive “specialty tier” drugs prescribed to patients costs thousands of dollars each year. AB 1800 would ensure insurance plans do not continue to pass the buck on to patients.

“The unconscionable expenses associated with medical care force patients with chronic conditions to make desperate choices between paying for vital prescriptions, or paying for their mortgage and groceries,” said Assemblywoman Ma. “AB 1800 provides California with the security and peace of mind that even if the Supreme Court rules against the Affordable Care Act, patients in California will know the maximum that they will have to pay out of their own pockets for vital health care services.”

AB 1800 goes beyond the federal Care Act in that it will also apply these limits to large group employers and grandfathered plans. If this bill were signed by Governor Edmund Brown Jr., it would be implemented in January 2014.

The bill is on its way to the Senate Committee on Appropriations.