This Month in State Policy

NCSD’s This Month in State Policy is a corresponding series intended to complement state-specific policies outlined regularly in This Week in Congress. NSCD will post This Month in State Policy through early June to provide peak coverage and analysis of state legislative sessions. For more information about this summary or other state policy trends, please contact NCSD’s Policy Team at policyteam@NCSDDC.org 

This Month in State Policy: STI Insurance Coverage 

NCSD has been monitoring state policies on insurance coverage for STI services to analyze legislation that will lead to the creation of a toolkit reflecting best practices for replication in 2024. The latest bill analysis centering on this topic can be found below. 

Governor Gavin Newsom (D-CA) rejected California legislators’ effort to expand insurance coverage for STI services by vetoing AB1645 on Oct 7. The bill introduced by Assembly Member Rick Chavez Zbur (D-West Hollywood/Santa Monica) sought to reinforce provisions in existing California law by mandating insurance plans cover STI office visits and treatment services without cost-sharing. The bill would further require insurance plans to comply with CDC treatment guidelines and reimburse nonparticipating providers for STI services if they are considered an essential community provider.  

AB1645 was supported by a wide range of individuals and groups, including California Insurance Commissioner Ricardo Lara (D), the Los Angeles LGBT Center, and the San Francisco AIDS Foundation. 

However, despite this influential coalition and California’s history with expanding STI coverage through innovative policy mechanisms like at-home testing, AB1645 was ultimately vetoed by the governor for “depart[ing] from structures in federal and state law” and “exceed[ing] the cost-sharing provisions under the Affordable Care Act,” or ACA. 

Gov. Newsom’s decision represents the varying strategies of state legislatures across the U.S., as language in AB1645 differs from other states’ bills that were signed into law, which may have weakened its political viability.  

For example, both SB132 in New Mexico and SB189 in Colorado circumnavigated ACA defrayal rules, which require states to cover actuarial costs associated with new coverage requirements to negate premium increases. Both bills accomplished this by enforcing no cost-sharing on plans that already cover STI testing (instead of introducing new requirements).  

Conversely, Gov. Newsom rejected AB1645 on the grounds that it would increase premiums due to new mandated coverage for any plan. California’s Senate Committee on Appropriations’ analysis cited an “unknown general fund” cost due to increased health plan premiums in CalPERS, the state’s public employee retirement system. 

In comparison, Colorado’s fiscal analysis on SB189 determined that while premium impact would increase by $2 million, or .03% of total premium, the increases would be more related to growth in enrollment than new coverages.  

In the end, this key difference in bill language, coupled with New Mexico and Colorado’s bills’ limitation to in-network service providers, likely enabled their passage over California’s AB1645.