Wielding his pen, Gov. Jerry Brown has reinforced the Affordable Care Act, stood up to pharmaceutical companies and boosted testing for childhood lead poisoning.

Brown had until Sunday, Oct. 15, to approve or reject measures passed by the legislature this year, Brown weighed in on some key health care bills, including measures to protect Californians who buy insurance for themselves.

One law will ensure that consumers have three months to shop for health plans in future years, rebuffing a move by the Trump administration that cuts that time in half. Another law will help people keep their health care providers if insurers cancel their policy.

Health consumer advocates said Brown’s signatures on those and other bills will help maintain California’s role as a leader in protecting health care coverage in the face of federal threats. Last week, for instance, President Donald Trump ended an important Obamacare health insurance subsidy for consumers — a move that could destabilize insurance markets across the country.

Californians will stay “ahead of the curve, and ahead of the federal threats” because of lawmakers’ actions this year, said Betsy Imholz, director of special projects at Consumers Union in San Francisco.

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The governor’s health care actions and rhetoric have been particularly impassioned lately, especially in response to federal moves on health care policy, Imholz said.

“There’s a lot to be fiery about these days, and he’s using his bully pulpit well,” she said.

But Brown didn’t sign off on everything the legislature sent to his desk. He used his veto pen to kill some health care legislation, including a proposed statewide ban on smoking at state beaches and parks.

SIGNED BY THE GOVERNOR

Open Enrollment🖋

By codifying AB 156, by Assemblyman Jim Wood (D-Healdsburg), Brown agreed that Californians who buy insurance for themselves should continue to have a three-month open enrollment period, during which they can choose or switch health plans. The law exempts the Golden State from a Trump administration rule that shortens the sign-up period to 45 days, and applies to people who purchase individual market plans for 2019 and beyond. Californians already are assured a three-month open-enrollment period — Nov. 1 to Jan. 31 — for 2018 coverage.

Keeping Your Doctors🖋

Brown signed off on a measure to allow some seriously ill patients to continue seeing their current providers for a limited time if their insurer discontinues their plan. The bill, SB 133, was introduced by Sen. Ed Hernandez (D-West Covina) in response to the impending departures of Anthem Blue Cross and Cigna from portions of California’s individual insurance market next year. The law will continue an eligible patient’s coverage even if her doctors don’t contract with the new health plan, so long as the doctors are willing to accept the plan’s reimbursement rates.

Prescription Drug Costs🖋

The governor signed a hotly contested bill by Hernandez that will require drugmakers to report and explain big price hikes. SB 17 directs pharmaceutical companies to notify state agencies and insurers 60 days in advance if they plan to raise prices more than 16 percent over two years on drugs with a wholesale cost of at least $40.

The governor also approved AB 265 by Wood, which will ban pharmaceutical companies from giving consumers coupons for brand-name drugs when a generic equivalent is available, with some exceptions.

Childhood Lead Poisoning🖋

Brown signed AB 1316 by Assemblyman Bill Quirk (D-Hayward), which calls for all California kids to be evaluated by their doctor for lead poisoning, starting next year. Currently, children who receive government assistance such as Medi-Cal must be screened for lead, but that requirement doesn’t extend to other children. Doctors will also have to consider new factors when evaluating children, such as proximity to potential sources of lead contamination. A report published last month by the Environmental Working Group showed that one-third of infants who were at risk for lead poisoning had not been tested. “The current screening process is outdated and leaves many children vulnerable to lead poisoning,” Quirk said in a statement.

Unapproved Stem Cell Treatments🖋

Brown approved a bill that requires doctors to warn their patients before they undergo unapproved stem cell therapies. SB 512, also by Hernandez, says health care providers who offer such treatments must disclose to patients that the treatments have not been approved by the Food and Drug Administration, and urge them “to consult with your primary care physician prior to undergoing a stem cell therapy.” Health care providers may face fines for noncompliance.

VETOED BY THE GOVERNOR

Valley Fever🚫

Brown nixed AB 1279, which would have required the state Department of Public Health to develop additional outreach programs to educate people about Valley Fever, an infection caused by inhaling fungal spores often found in soil. The measure, by Assemblyman Rudy Salas (D-Bakersfield), had been watered down from its original form by the time it hit the governor’s desk. The original language called for a $2 million investment in research on the disease, which is common in dry regions, like Salas’ district. In his veto message, Brown said the department already provides fact sheets, brochures and other materials to educate the public about Valley Fever.

Smoking At State Parks🚫

Once again, Brown vetoed legislation that would have banned smoking at state beaches and parks. AB 725, by Assemblyman Marc Levine (D-San Rafael), would have established smoking areas at some parks and beaches. People caught smoking outside those designated spaces would have faced a $50 fine. A stricter bill by Sen. Steve Glazer (D-Orinda), SB 386, proposed a fine of up to $100. Lawmakers had previously sent similar legislation to Brown, but so far they have not won him over. In his veto message, Brown said a ban would be an overreach of government power. “If people can’t smoke even on a deserted beach, where can they?” he asked.

Reproductive Bias🚫

A bill that would have prohibited institutions with religious affiliations from firing employees because of their reproductive choices, such as having abortions, failed to make it past the governor’s desk. AB 569, by Assemblywoman Lorena Gonzalez Fletcher (D-San Diego), would have barred religion-based employers such as a Christian school, from requiring workers to sign a code of conduct that waived their reproductive health rights. In his veto message, Brown said that “these types of claims should remain within the jurisdiction of the Department of Fair Employment and Housing.”

SEE YOU NEXT YEAR?

(Some significant health bills that stalled in the legislature, but may be resurrected for another attempt in 2018)

Regulating Dialysis Clinics🤔

A proposal by Sen. Ricardo Lara (D-Bell Gardens) would have required minimum staff-to-patient ratios at dialysis centers, such as one nurse for every eight patients or one technician for every three. The stalled bill, SB 349, also would have mandated more time for staff to prepare between patient appointments. A bill by Assemblyman Rob Bonta (D-Oakland) would have required dialysis centers to spend at least 85 percent of their revenue primarily on direct patient care.

Both measures were backed by a large labor union, Service Employees International Union-United Healthcare Workers West (SEIU-UHW), which has threatened to take the issue directly to voters if the Legislature does not act.

Single-Payer Health Care🤔

The ambitious attempt to create one government-administered or “single-payer” health care system in California has been tabled until next year. SB 562 by Lara and Assemblywoman Toni Atkins (D-San Diego) would provide comprehensive health coverage to all Californians, regardless of immigration status. Private insurance companies would be barred from the system, and enrollees would not be charged copayments or premiums. A legislative committee estimated that the program would require $200 billion annually in additional tax revenue.

Supporters of universal health care hope to put a measure on the statewide ballot that would make it easier to fund a single-payer system.

Pediatric Dental Anesthesia 🤔

A bill that would have required oral surgeons to have a specially trained staff member with them to monitor a child under anesthesia stalled in committee. Current law allows an oral surgeon to perform surgery and monitor the unconscious child at the same time. AB 224, by Assemblyman Tony Thurmond (D-Richmond), would have built on last year’s “Caleb’s Law,” named after Caleb Sears, a 6-year-old boy who died in 2015 after oral surgery under anesthesia.

Containing Drug Costs🤔

A measure by Assemblyman David Chiu (D-San Francisco) would have brought together administrators from 17 state agencies to devise ways to reduce state drug costs. AB 587 would have expanded an existing state purchasing collaborative that buys drugs for a handful of public health programs, and directed the new group to develop cost controls, such as creating a uniform drug formulary for state agencies.

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SB 790 by Sen. Mike McGuire (D-North Coast/North Bay) sought to restrict the pharmaceutical industry’s marketing to doctors, limiting their spending to mostly educational or scientific purposes, which McGuire said could reduce unnecessary prescriptions of pricey drugs.

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Gov. Brown Signs Into Law Key Health Bills, But Nixes Others