“”The Changing Face of Health Care,”” a presentation and discussion of the ramifications of the Affordable Care Act (ACA) and several proposals to help implement it in California, drew about 300 people to the Health Education Center at Western University of Health Sciences on Friday, April 12, 2013.


The talk, led by state Sen. Ed Hernandez, D-24th District, was intended to help current and future health providers gain a better understanding of the immediate and future impact of the ACA, and about how new laws and proposed laws in California will augment the federal ACA.

After opening remarks by Gary Gugelchuk, PhD, WesternU’s Provost and Chief Operating Officer, and an introduction by Dean Elizabeth Hoppe of the College of Optometry, Hernandez — himself an optometrist – said he appreciated how WesternU students are trained with an eye toward collaboration and with an understanding about health care needs to evolve.

“You are entering (health professions) at the absolute most exciting time in the history of our country for health care,” he said.

He also encouraged every student to join their respective student and professional associations to learn what they can do to influence health policy at local, state and national levels. “Voice your opinion. Engage in government. Then return to your community and share what you’ve learned,” Hernandez said.

Hernandez then reviewed the broad strokes of the ACA, including that:

• As of January 14, 2014, everyone over the age of 18 must have health insurance.

• Every citizen can keep their own insurance.

• Those who opt to not have insurance must pay a penalty of 1% of their annual income or $95, whichever is greater.

The senator said California is “leading the nation” in implementation of the ACA, a process recently enhanced by several Senate proposals to help the state comply with ACA requirements and also change the scope of practice for several health professions.


• SB X1-1 would implement the expansion of Medi-Cal coverage allowed under the ACA to currently ineligible low-income adults in California, including those with incomes at or below 133 percent of the federal poverty level, resulting in more than 1.6 million newly Medi-Cal eligible Californians. SB X1 1 also would establish a defined health benefits package for enrollees.

• SB X1-2 would implement the key consumer protections of the ACA in California’s individual insurance market, preventing insurance companies and health plans from denying coverage or charging excessive premiums on those who have pre-existing health conditions and requiring that insurance premiums be based solely on age, geography, and family size.

• SB X1-3 would authorize medical “bridge” plans to allow individuals who lost their Medi-Cal coverage to retain their plan, and allow families with children in Medi-Cal or CHIP and parents who are in the Exchange to enroll the entire family in the same plan and provider network. The goals are to provide continuity of care and coverage, as well as to assure coverage of the entire family in a single plan and provider network.

• SB 491, which would amend the Nurse Practice Act by deleting a requirement that certain acts be performed pursuant to a standardized procedure or in consultation with a physician and surgeon, and also authorizes a practitioner to perform specific additional acts, including, among others, diagnosing patients, performing therapeutic procedures, and prescribing drugs and devices.

• SB 492, which would designate optometrists as primary-care providers to diagnose and treat patients with chronic diseases, such as diabetes.

• SB 493, which would authorize pharmacists to administer drugs ordered by a prescriber, and would expand other functions, including furnishing prescription medications not requiring a diagnosis. It also would authorize pharmacists to order and interpret tests to monitor and manage drug therapies, and to independently initiate and administer routine vaccinations.

The latter three proposals are crucial as the ACA takes effect, Hernandez said, because the nation already has a shortage of primary care physicians. More health professionals are needed – quickly – to help carry out its mandates, and many of them already are qualified to do more than what the law allows them to do.

Pharmacists, for example, “are the most overtrained and underutilized health workforce in this country,” he said, which is why expanding the scope of what they can do (SB 493) makes sense as demand for health services grows under the ACA.

Hernandez cautioned that passage and implementation of the proposals won’t be easy, not least because of opposition from the California Medical Association, among other groups. “There’s tremendous opposition from organized medicine to the scope of practice bills,” he said.

A brief Q&A session followed the presentation.