A major bill that sets a new national standard for breaking through rigid restrictions on patient choice of doctors, hospitals and other medical providers set by insurance companies won approval in the California Assembly. The bill, sponsored by the California Nurses Association/National Nurses United, passed by a majority vote in the Assembly late Wednesday afternoon and will now go to the California Senate.

AB 2533, introduced by Assembly member Tom Ammiano, protects the ability of Californians to seek medical care from the providers of their choice by restricting higher charges for patients who get medical care outside their insurance provider “network.”

"This is a historic vote that will make a huge difference in the lives of tens of thousands of patients who may no longer face financial ruin or bankruptcy for seeking the critical medical care they need from the provider of their choice,” said CNA Co-president Deborah Burger, RN.

AB 2533 also directly addresses a growing national scandal of insurers who while entering the new health exchanges established under the Affordable Care Act have set even tighter network restrictions than existed in non-exchange plans. Many Californians in particular have found that private insurance plans they signed up for through Covered California excluded major hospitals in the state.

A key component of the bill is to require health insurers to arrange for enrollees who go outside their “approved” network of doctors or hospitals to obtain needed medical care in a timely manner will be charged the same out-of-pocket costs as they would pay for getting care within their network.

“This bill corrects that gaping hole both in the ACA and the existing insurance-based system that limits patient choice, forces people to travel long distances to find a provider within their ‘network,’ or exposes patients and families to excessively high bills that can lead to financial disaster,” Burger said.

AB 2533 would also require health insurers to file annual reports on denials of care and complaints about timely access to care to the California Department of Insurance and Department of Managed Health Care and require the departments to post the information on their website for public review.

Campaign for a Healthy California, a statewide coalition, is a major co-sponsor of the bill.

Bill to help RNs, other staff, exposed to MRSA also wins Assembly approval

A separate CNA-sponsored bill to assure workplace compensation eligibility for RNs and other hospital staff who contract the dangerous MRSA skin infection also won approval by the California Assembly Wednesday. It also moves next to the California Senate.

AB 2616, introduced by Assembly member Nancy Skinner, would extend presumptive eligibility for worker’s comp for any hospital employees who contract the aggressive, virulent antibiotic resistance staph infection commonly known as MRSA.

An estimated 200,000 MRSA occur in California hospitals every year, of which 12,000 result in deaths, according to the State Department of Public Health. RNs are particularly vulnerable to exposure because of the personal nature of the care they provide.

Under current law, a number of workplace injuries qualify for presumption of eligibility for workers’ comp for public safety personnel, but only for police, firefighters and some other safety personnel who are predominantly male. AB 2616 would extend that eligibility to RNs and other hospital employees who are predominantly women.

Testifying for the bill last month, CNA Co-President Malinda Markowitz, RN cited what happened to staff at her San Jose hospital following a MRSA outbreak in December. Administrators directed all staff in the affected units to be tested, and told them if found positive, they would be sent home and forced to use vacation time or lose pay due their exposure.

Too often, Markowitz noted, RNs and other healthcare workers “face an enormous amount of pressure and intimidation from management to not file workers’ compensation claims and/or face claims rejections. When nurses do file claims there are often harassed and embarrassed to the point where they do not proceed with the claim or do not file an appeal if a case is rejected.”

“Nurses and other healthcare workers provide a vital community service and should be taken care of with a rebuttal presumption for MRSA infections. Just like other first responders such as firefighters and police officers, nurses do not discriminate in which patients they care for, which include those with MRSA and other infections.”