Senator Wiener Introduces Health Care Accountability and Access Legislation to Support Improved Patient Care

January 20, 2022

SACRAMENTO - Today, Senator Scott Wiener (D-San Francisco) introduced Senate Bill 858 and Senate Bill 853 to improve patient access to quality health care. SB 858, the Health Plan Accountability Act, updates and increases penalties for health plans that violate state law in denying or delaying insurance coverage. SB 853, the Medication Access Act, requires health plans to cover medications through the duration of any appeals of a denial of insurance coverage.

Patient care is of paramount importance in the era of COVID-19, and both pieces of legislation will facilitate better health care for all Californians. 

Health plan premiums have quadrupled in the past 20 years, while fine amounts for health plan violations of the law haven’t changed since 1999. This allows plans to skirt responsibility and withhold care if they deem the fine amount inconsequential or just a cost of doing business. For example, in October 2020, California’s Department of Managed Health Care (DMHC) fined Anthem Blue Cross $1.2 million for not providing gender-affirming care, which is required by state law. Even after they were notified of the fine, they failed to provide these services to enrollees.

SB 858, the Health Plan Accountability Act, gives the Department of Managed Healthcare the additional authority to levy higher fines and impose corrective action when necessary. This will ensure that penalty amounts increase as health plan premiums increase. It is sponsored by Health Access California.

Additionally, Senator Wiener introduced SB 853, the Medication Access Act, to ensure patients can obtain medications they need during an appeals process after a health plan has denied coverage. Insurance companies can deny coverage of a medication (or a specific dose that a patient has previously been prescribed, or an optimized dose of a previously prescribed medication), and patients have the right to appeal this decision. Currently, for the duration of the appeals process, patients don’t have access to the medication they need to stay healthy or even alive. The Medication Access Act would ensure that patients aren’t hung out to dry as their appeals are reviewed, allowing them to access critically important medication and avoid a lapse in treatment.

SB 853 additionally requires plans to cover medication at the prescribed therapeutic dose, and prohibits plans from seeking reimbursement if a denial is granted. By expanding this coverage and these protections, SB 853 strengthens patient stability and wellbeing. This bill is sponsored by the Chron’s and Colitis Foundation.

“Sadly, many Californians have – at one point or another – been denied insurance coverage for an important procedure or medication, and we need to ensure people have access,” said Senator Scott Wiener. “When insurance companies fail to comply with state law, or refuse to cover medications, those actions can pose significant – and even life-threatening – health challenges. By strengthening California’s ability to levy behavior-changing fines on non-compliant health plans, and by allowing patients to continue accessing medication during an appeal process, access to health care will improve.”

"California’s strong patient protection laws can't work if health care plans flout them and then get just a small financial hit," said Diana Douglas, Manager of Policy and Advocacy with Health Access California. "Californians suffer when not able to access appropriate care, while the fines levied on health care plans are a drop in the bucket compared to their huge operating budgets and profit margins. Money talks, and this bill will help get California's health plans to listen."

“Patients with inflammatory bowel disease have a limited number of treatment options,” said Michael Osso, President and CEO, Crohn’s & Colitis Foundation. “When renewal of a medication is denied, or not covered at the therapeutic dose, treatment can be disrupted, even when the prescription is ultimately approved on appeal. These disruptions can lead to severe, and sometimes irreversible, negative health outcomes in both adult and pediatric patients. Having access to the right medication, at the right time, and at the best dosage for that individual’s disease is essential. We appreciate Senator Wiener’s efforts to assure that patients have access to their needed medication during this brief, but critical, period.”