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Governor Newsom was busy signing bills into new laws recently and many effect the health care system. Some are more controversial than others.
In a prior column we discussed the new California rule requiring all citizens to have health insurance or pay a penalty. This is essentially the same as the rules under the Affordable Care Act (ACA) that required citizens to have coverage. In an effort to dismantle the ACA, the Trump administration eliminated the federal mandatel. Now CA has essentially reinstated it. To ease the burden a bit, CA is providing additional subsidies to those that purchase coverage on the Exchange.
This is an important time for individuals and families to check the “Shop and Compare” option at www.coveredca.com. Coverage must be purchased on the Exchange to qualify for any of the subsidies or “advance premium tax credit”. If an individual meets the income requirements, but purchases coverage off the Exchange, they do not get the subsidy. Be cautious when searching. Skip the sites that are ad related and go to the real website.
This new mandate is also causing some small employers to revisit the idea of offering group insurance for their employees. In addition, providing benefits give the employer an edge in recruiting and retaining quality employees.
SB-276 allows state public health officials authority to review and, in some cases, revoke questionable medical exemptions for childhood vaccinations. The CDC (Center for Disease Control) states that exemptions should be rare and only when severe complications are indicated.
New regulations require the state to investigate doctors who give out more than five exemptions in a year and schools with immunization rates under 95 percent. Locally Turtle Bay School showed one of the higher non-vaccination rates for kindergarteners at over 20% in the 2018 reporting period. Results are posted at the California Dept. of Public Health website: ShotsforKids.
This comes amid the largest outbreak of measles in our country in two decades, with over 1230 confirmed cases nationwide and 62 in California. Some argue that this law is government overreach. Scientists find it to be a public safety hazard because when the vaccination rates fall below certain levels, the concept of “herd immunity” is impaired and the entire population is put at risk. While well intentioned, these actions impact the entire community, not just the child who is unvaccinated.
There are other barriers to immunizations. Sometimes it is as simple as the inability to access health care during the week. Shasta Community Health Center has begun seeing families for well-child visits on the weekend in hopes of providing better preventive care. If the issue of immunization is raised, the goal is to fact-based education regarding the real risks of vaccinations vs. the risk of the effects of the disease.
AB824 is another attempt at controlling big pharma companies. It addresses the “pay for delay” scheme that so often keep lower cost generic drugs from coming to market. When drugs are first approved, the manufacturer may be granted patents that allowing a period of exclusivity as a means of allowing them to recoup the research and development cost of the drugs. This can be up to 20 years.
If a generic manufacturer challenges the patent early, the brand name drug company will often tie the process up in expensive litigation or offer the generic drug company financial incentives not to proceed. The Federal Trade Commission has estimated that these deals increase Rx costs for consumers by about $3.5 Billion each year!
California Watch reports: “The Federal Trade Commission has made it a “top priority” to investigate these deals, according to its website, and has filed a number of lawsuits since 2001 to stop them. The commission would not comment on the California bill.
Recently, the agency noticed a curious trend: Even though the number of patent settlements has gone up in recent years, the number of those that resulted in pay-for-delay arrangements has gone down. The commission credits the drop to a 2013 Supreme Court decision, FTC v. Actavis Inc., in which the court held that pay-for-delay settlements violate antitrust laws.” It will be quite interesting to see how further challenges are handled by the new conservative court.
California’s new law gives the Attorney General more tools with which to fight these schemes. Our state is the first in the nation to do so.
Of course there are more new laws that effect the industry such as further reporting by insurers, allowing some HIV preventive drugs to be purchased without a prescription, medical marijuana to be administered on school grounds for severe disabilities, outlawing vaping at state parks and beaches, and much more. It’s never dull in California!