California Health Benefit Exchange: Health Care Affordability Reserve Fund.

Existing federal law, the Patient Protection and Affordable Care Act (PPACA) , requires each state to establish an American Health Benefit Exchange to facilitate the purchase of qualified health benefit plans by qualified individuals and qualified small employers. Existing state law creates the California Health Benefit Exchange, also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under PPACA. Existing law requires the Exchange to administer a program of financial assistance to help low- and middle-income Californians, by providing financial assistance to residents with household incomes at or below 600% of the federal poverty level, including appropriate subsidies designed to make health care coverage more accessible and affordable for individuals and households. Existing law requires a premium assistance subsidy provided by the program to be able to be advanced to a program participant and remitted by the Exchange to a qualified health plan issuer, based on specified factors. Existing law establishes the Health Care Affordability Reserve Fund, and authorizes the Controller to use funds in the Health Care Affordability Reserve Fund for cashflow loans to the General Fund. Existing law requires the fund to be used, upon appropriation by the Legislature, for the purpose of health care affordability programs operated by the Exchange. Existing law requires the Exchange to consult with the Legislature and stakeholders to develop options to reduce cost sharing for low- and middle-income Californians, as specified. This bill would require the Exchange to annually update the proposed program design for cost-sharing reduction, as specified, and would require the Exchange, in developing benefit designs, to maximize the number of low- and middle-income Californians with zero deductibles. The bill would provide that the premium assistance subsidy program would not be operative in any year in which federal premium subsidies are equal to or greater than those provided for the 2023 program year, and would require the program to include subsidies for cost sharing and maximum out-of-pocket limits until January 1, 2029, if federal premium subsidies continue at the level for the 2023 coverage year. The bill would make related conforming changes and delete obsolete provisions.