California’s Workers, Employers and Families Can’t Afford Higher Health Care Premiums 83% of Californians say lowering health care costs should be a top priority for lawmakers. The state even created the Office of Health Care Affordability (OHCA) to rein in health care spending. Yet the proposed MCO Tax in the Governor’s May Revise is estimated to increase the cost of health care coverage by $1.5 billion each year.

California’s health plans provide health care coverage for more than 28 million people and are dedicated to ensuring that everyone has access to high quality, affordable health care services. In 2026, California lawmakers are considering many new health care mandate bills that, as proposed, would altogether drive up premiums by nearly $634 million. This push by the legislature for new, expensive health care mandates comes at a time when California is trying to improve health care affordability.

California has set targets on how fast health care costs grow. These health care cost targets are set by the Office of Health Care Affordability (OHCA)—and apply to hospitals, health plans, and providers. They are designed to slow rising costs and make care more affordable for Californians.

AB 298 Fails the Affordability Test

As currently written, Assembly Bill 298 (D Bonta) would drive up health care premiums by $711,200,000, according to the non-partisan California Health Benefits Review Program (CHBRP).

At a time when Californians are struggling with the cost of living, lawmakers should focus on lowering health care costs, not passing bills like AB 298 that drive premiums higher for families, workers, and employers statewide.

In California, a strict system is in place to make sure every health plan has the funds – called financial reserves – to cover their members’ care, no matter what happens.

Authorization for Care is a critical tool that ensures care aligns with the latest medical guidelines while protecting patients from unnecessary procedures, excessive costs, and harmful treatments.

The Office of Health Care Affordability (OHCA) in April 2024 adopted a statewide health care spending target, which will apply to health plans, providers and hospitals. The OHCA board adopted a phased-in target to gradually decrease health care system spending growth over time. The purpose of the spending target is to rein in health care costs and make health care more affordable, while also aiming to address inequities in the health care system.

VOTE NO ON AB 3275 – Health plans understand the important role hospitals play within our health care system and we continue to support and make every effort to ensure hospitals stay operational so they can continue to provide quality care to all patients in the communities we serve. Unfortunately, AB 3275 will drive up health care costs, harm the existing health care delivery system, and DO NOTHING to help financially distressed hospitals in California.

Hospitals are hiking the prices of hospital-administered drugs, making it even harder for patients to afford these often life-saving medications. A recent study found that hospitals markup drug costs by an average of 108%, which drives up the cost of patient hospital bills exponentially. Check out these hospital bill markups!

As California’s Office of Healthcare Affordability (OHCA) develops proposals to address health care affordability in California, health plans are actively engaged with the Office on efforts to manage health care costs and improve affordable health care coverage options. Californians deserve health care that is accessible, affordable, and high quality, and health plans are active participants in developing solutions.

Hospital-negotiated prices spiked from 2020 to 2022, with commercial insurer and health plan payments to hospitals amounting to 254% of Medicare rates on average, according to a new study published by RAND.

California’s health plans are fully dedicated to working with the hospital community to meet the needs of all patients in the communities we serve.

California’s Medi-Cal managed care plans are advancing health equity in communities across the state. Enacting change and promoting health equity will improve health care for Californians that need it the most.

California’s Health Plan premium costs in 2024 will be driven by several factors across the individual and small group marketplaces, particularly: continued inflation driving increased provider reimbursement rates, health plans taking on more of the costs of COVID-19 vaccines and tests, uncertainty around Medi-Cal “redetermination”, and the continued rise in drug prices especially from emerging weight loss drugs and other specialty drugs.

California’s health plans provide health care coverage for nearly 28 million people and are dedicated to ensuring that everyone has access to high quality, affordable health care services. In 2023, California lawmakers are considering many new mandate bills that, as proposed, would altogether drive up premiums by at least $943 million.

Big Pharma has a track record of raising insulin prices and there is no guarantee they will not decide to raise insulin prices again in the future. Big Pharma-backed co-pay cap legislation like Senate Bill 90 could lead to higher health care costs for all Californians by allowing big pharma to raise prices at will, without accountability.

Backed by pharmaceutical companies, SB 70 removes important health plan checks and balances, clearing the way for big pharma to push for higher usage of their costly specialty drugs – resulting in increased costs for all health plan enrollees.

California’s Medi-Cal Managed Care Plans are partnering with the Department of Health Care Services (DHCS) on CalAIM — a multiyear initiative to improve health equity, quality of life, and health outcomes by evolving the Medi-Cal program.

The vast majority of health plan spending in California goes to pay for medical services like hospital and doctor visits, prescription drugs, lab tests, x-ray, and medical supplies. In 2021, health plans spent nearly $207 billion, or 87 cents out of every health plan dollar, on medical care.

With more than 14.7 million enrollees, California’s Medicaid program (Medi-Cal) provides comprehensive medical, behavioral, and mental health care benefits and services to one in three Californians. Within Medi-Cal, an estimated 12.4 million members are enrolled in Medi-Cal Managed Care, providing some of California’s most vulnerable populations with well-rounded services for improved health outcomes.

Californians deserve safe, high quality, high-value health care. Yet SB 250 will derail the progress we have made in our health care system by lowering the value and safety that Californians should expect from their health care providers.

California’s Health Plan premium costs in 2023 will be driven by several factors across the individual and small group marketplaces, particularly the return of normal pre-pandemic medical trends, continued COVID-19 uncertainty, inflation, increased mental health and telehealth utilization, and other factors.

Californians deserve safe, high quality, high-value health care. Yet SB 250 will derail the progress we’ve made in our
health care system by lowering the value and safety that Californians should expect from their health care providers.

California health plans cover more than 26 million people and are dedicated to ensuring that everyone has access to high-quality, affordable health care services. This year, California lawmakers are considering many new health care mandates that, as proposed, would collectively drive up health care premiums by $1.5 billion – in the first year alone.

SB 958, sponsored by California hospitals, makes it even easier for them to markup the cost they charge patients for critical medications, causing higher health care premiums for all Californians.

The vast majority of health plan spending in California goes to pay for medical services like hospital and doctor visits, prescription drugs, lab tests, x-ray, and medical supplies. In 2020, health plans spent nearly $189 billion, or 87 cents out of every health plan dollar, on medical care.

SB 524 will raise health care costs for Californians by eliminating the vital tools health plans, employers, unions, and the state use to lower the cost of health insurance and prescription drugs.

Since the recent passage of the American Rescue Plan by the Biden Administration — which has made health care more affordable for thousands of Californians – California’s health plans have been hard at work finding ways to maximize the new law’s benefits on behalf of their members. These efforts are making health care more affordable, accessible, and flexible for thousands of Californians.

A new nationwide study released by AHIP shows that health plans play a vital role in supporting the economy and employees throughout the nation, including here in California. The AHIP study looked at state-by-state statistics such as how many people are covered by insurance from an employer, how many people are employed by the industry, and the percentage of premiums paid by employers, among other statistics.

California continues to make great progress toward closing the uninsured gap under the Affordable Care Act (ACA) and other programs. One example is the American Rescue Plan recently signed into law, which has helped make health care coverage more accessible than ever for those with health coverage and for uninsured Californians eligible for affordable health coverage.

Health Plans Ensuring the Highest Quality Care

Telehealth use has grown significantly as the COVID-19 pandemic has taken hold of daily life and is helping patients and providers alike.

Researchers at the Nicholas C. Petris Center at the University of California, Berkeley, School of Public Health this week released a new study finding that the COVID-19 pandemic has cost California’s public and private insurers an estimated $2.4 billion dollars in testing and treatment. This amounts to about six times the annual cost to treat seasonal influenza in California.

The individual health insurance market will see an average rate change of only 0.8% in 2020 — the lowest since Covered California launched in 2014 — and California’s health plans are proving to play a key role in providing affordable health care coverage, while supporting policies to help close the 7% remaining uninsured gap in the state.

CAHP Statement: Individual Health Coverage Premiums for 2020 Reflect California’s Bold Steps to Increase Affordability

As providers of health care coverage for more than 26 million Californians, health plans are dedicated to ensuring that everyone has access to high quality, affordable health care.

In 2017, California enacted into law SB 17, groundbreaking legislation that is helping to shine a light on pharmaceutical companies’ efforts to spike prescription drug prices.

With more than 13.3 million enrollees, California’s Medicaid program (Medi-Cal) provides comprehensive medical, behavioral, and mental health care benefits and services to one in three Californians.