Provided health care coverage
1. What services would be covered?
SB 840 provides comprehensive benefits with
a single standard of care for every resident. They include, but are
not limited to preventive, primary, specialty, emergency, hospice,
adult day, and home health care; diagnostic and evaluative services;
hospitalization; surgery; mental and behavioral health care; substance
abuse treatment; prescription drugs and medical equipment; blood and
blood products; dialysis; rehabilitative care; chiropractic care;
podiatric care; acupuncture; dental, vision and hearing care; health
education; language translation for health care services; and emergency
transportation and necessary transportation for health services for
disabled and indigent persons.
2. Would Kaiser still exist under the new system?
SB 840 provides that the current health care
delivery system remains private. All providers will continue as private
entities. However, SB 840 prohibits health care service plans and
insurance policies from being sold in California for any services
provided under the California Universal Healthcare System.
Kaiser and other providers can choose to provide
health services under the new health care system. Then Kaiser will
negotiate with the Payments Board for a capitated rate, which the
Universal Healthcare Fund will pay for covered services provided for
Kaiser members. All other licensed and accredited providers who choose
to participate under the health system also can negotiate with the
Payments Board to set rates of reimbursement for the services they
provide.
3. Would retirees continue to get the same
health benefits they have now?
Under the current trend, many retirees are at
risk of having health benefits reduced or eliminated. Companies like
General Motors and IBM as well as some public retirement systems are
backing away from commitments they have made to retirees because of
the economic burden of costly health care premiums.[1]
According to a 2006 Kaiser Family Foundation and Hewitt Associates
survey, three out of four firms raised premiums for those under age
65 while 58 percent increased premiums for those 65 and older; one
in three firms raised cost-sharing requirements for younger retirees
while one in four raised the requirements for those 65 and older.[2]
SB 840 provides that retirees who receive health
care benefits from collateral sources such as previous employers,
employee benefit contracts and pension plans will be eligible for
the same health care from the publicly financed health care system.
The above sources have an obligation to pay retirement premiums under
retiree contracts. In turn, the health care system will collect costs
for health care services from these sources that are provided to retirees
under contract.
Retirees, whose health care is covered by contracts
or plans, also will be eligible for wrap-around benefits from the
health care system. These benefits will include all the benefits provided
by the health care system, which are superior to the benefits retirees
have under any current contracts or plans.
Most retirees cannot be assured that their benefits
will continue unchanged or at all. In contrast, SB 840 provides affordable
and secure comprehensive benefits for all Californians--from birth
to death.
4. Would undocumented residents be covered?
SB 840 provides that undocumented residents
are covered. It costs less to insure them than to exclude them. Most
undocumented Californians are employed in essential jobs, which pay
low wages and do not provide insurance. People without health insurance
do not get ongoing primary or preventative care. They often do not
seek care until their illnesses have progressed to a stage where it
costs more to treat them or they die prematurely. Providing primary
and preventative care to all residents reduces health care costs.[3]
Also, providing coverage to the entire population
helps control epidemics or outbreaks that expose everyone to disease.
It not only saves money to cover the undocumented, it is good public
health policy.[4]
5. Would workers' compensation be covered?
The workers' compensation system is not covered
under SB 840. Current state and federal law requires that workers'
compensation costs be paid by funds that are collected by employers.
This system covers more than medical care. It also administers indemnity
claims such as work time lost, disability, and survivor's benefits.
Residents receive comprehensive coverage under
the publicly financed health care system. However, individuals that
are required to file worker’s compensation medical claims will have
those claims processed by the worker’s compensation system instead
of the new health system. Additional legislation would be required
to change the complex worker’s compensation system.
6. Does SB 840 provide coverage for abortions?
Federal law protects a woman's right to an abortion.
As it is now, abortion is covered if determined to be medically appropriate
by a health care provider.
7. Would anyone lose benefits they now have?
SB 840 provides that no one who currently has
coverage will lose his or her benefits. The publicly financed health
care system provides individuals and families, including retirees,
comprehensive coverage that is better than most have at this time.
Individuals who have coverage under existing
collateral sources such as health insurance policies, health care
service and pension plans, employers, employee benefit contracts and
government benefit programs will receive full comprehensive coverage
under the health care system. In turn, the health care system will
collect costs for providing health care services from the collateral
sources.
Individuals covered by a contract or plan that
is preempted by federal law must continue to seek benefits from that
contract or plan. Providers contracted under the new system will provide
covered health care services to these individuals and would seek payment
for their services from the preempted contracts and plans instead
of the health care system. This condition would remain in effect until
the role of these contracts or plans has been terminated or they release
the funds that pay for provided benefits to the health care system.
However, individuals covered by preempted contracts
and plans also will be eligible for wrap-around benefits from the
health care system. These benefits will include all the other benefits
provided by the system, which are superior to the benefits individuals
have under any current contracts or plans.
8. Why does SB 840 provide for religious healing?
SB 840 provides for coverage for healing by
prayer or spiritual means by a practitioner of a bona fide church,
sect, denomination, or organization. Existing federal and state statues
require religious healing, and Medicare covers it.
