California Proposition 45, Public Notice Required for Insurance Company Rates Initiative (2014)

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Proposition 45
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California Proposition 45, the Public Notice Required for Insurance Company Rates Initiative, is on the November 4, 2014 ballot in California as an initiated state statute.

If approved by voters, the initiative would:[1]

  • Require changes to health insurance rates, or anything else affecting the charges associated with health insurance, to be approved by the California Insurance Commissioner before taking effect.
  • Provide for public notice, disclosure, and hearing on health insurance rate changes, and subsequent judicial review.
  • Require sworn statement by health insurer as to accuracy of information submitted to Insurance Commissioner to justify rate changes.
  • Exempt employer large group health plans under any circumstances.
  • Prohibit health, auto, and homeowners insurers from determining policy eligibility or rates based on lack of prior coverage or credit history.

The initiative, in general, would expand to health insurance rate regulation system to what Proposition 103 (1988) imposed on automobile and homeowners insurance.[2]

Supporters refer to the initiative as the Insurance Rate Public Justification and Accountability Act.[3]

Its sponsors originally hoped to qualify their measure for the November 6, 2012 ballot. They submitted over 800,000 signatures on May 18, 2012.[4] On June 28, it became evident that election officials would not have adequate time to scrutinize the signatures for validity in time for placement on the November 6, 2012 ballot. On August 23, 2012, it was announced that the measure had qualified for the 2014 ballot.[5]

Text of measure

See also: Ballot titles, summaries and fiscal statements for California's 2014 ballot propositions

Ballot title:

Healthcare Insurance. Rate Changes. Initiative Statute.

Official summary:

"Requires Insurance Commissioner’s approval before health insurer can change its rates or anything else affecting the charges associated with health insurance. Provides for public notice, disclosure, and hearing, and subsequent judicial review. Exempts employer large group health plans."

Fiscal impact statement:

(Note: The fiscal impact statement for a California ballot initiative authorized for circulation is jointly prepared by the state's Legislative Analyst and its Director of Finance.)

"Increased state administrative costs to regulate health insurance, likely not exceeding the low millions of dollars annually in most years, funded from fees paid by health insurance companies."


CW Yes on 45 2014.png

The campaign in support of Proposition 45 is being led by Consumer Watchdog.[6]




  • California Democratic Party[9]
  • Courage Campaign[8]
  • California Industrial Areas Foundation (IAF)
  • California National Organization for Women (NOW)
  • Consumer Federation of California
  • Consumer Watchdog
  • Consumer Attorneys of California
  • California Alliance for Retired Americans
  • Congress of California Seniors (CCS)
  • San Diego Hunger Coalition
  • Coalition for Economic Survival (CES)
  • California Partnership
  • Campaign for a Healthy California
  • Coalition of California Welfare Rights Organizations, Inc.
  • Los Angeles Alliance for a New Economy (LAANE)
  • Actual Systems Web Services
  • AllCare Alliance
  • Physicians for a National Health Program (PNHP) - California




  • Harvey Rosenfield said, "Premiums are going through the roof. A lot of people can't get health insurance at any price. Benefits are going down. Company CEOs are getting rich."[11]
  • Jamie Court, the president of Consumer Watchdog, stated, "The public wants accountability and transparency for the skyrocketing rates being charged. Rates have been rising five times faster than the rate of inflation."[7]
  • Dr. Mohammad Gharavi, a heart and lung surgeon in Thousand Oaks, argued, "If I had a choice of insurance companies controlling it or the government controlling it, I'd rather have the government."[12]


Total campaign cash Campaign Finance Ballotpedia.png
as of August 21, 2014
Category:Ballot measure endorsements Support: $981,455
Circle thumbs down.png Opposition: $37,577,050

Two ballot measure campaign committees registered in support of the initiative as of August 21, 2014:[13]

Note: Consumer Watchdog Campaign - Yes on 45 and 46, A Coalition of Consumer Advocates, Attorneys and Nurses is supporting Proposition 45 and Proposition 46.
Committee Amount raised Amount spent
Consumer Watchdog Campaign - Yes on 45 and 46, A Coalition of Consumer Advocates, Attorneys and Nurses $415,000 $356,373
Consumer Watchdog Campaign - Yes on 45, A Coalition of Consumer Advocates, Attorneys, Policyholders, and Nurses $497,779 $102,525
Jones for Passage 2014 Insurance Rate Public Justification & Accountability Act $68,676 $26,582
Total $981,455 $485,480

The following are the donors contributing $10,000 or more to the campaign in support of the initiative as of August 20, 2014:[13]

Note: Some of these donors gave their money to a committee that was simultaneously supporting more than one ballot measure. When that is the case, it is not generally possible to break down how much of that donor's money specifically was spent on the campaign for a particular proposition. Those contributions are listed below with shading; readers should not assume that all or even most of a donation to a multi-purpose committee was used for expenditures related to this particular proposition.
Donor Amount
Consumer Watchdog $570,178
Thomas Steyer $200,000
Greene Broillet & Wheeler, LLP $125,000
Committee for Corporate Accountability and Consumer Protection $105,121
CA Nurses Association Initiative PAC $75,000
California Federation of Teachers COPE Prop/Ballot Committee $25,000
CA Ambulatory Surgery Association PAC $15,000
Northern CA Carpenters Regional Council Issues PAC $10,000
Pace of California School Employees Association $10,000


Californians Against Higher Health Care Costs 2014.png

The organization leading the campaign in opposition to Proposition 45 is Californians Against Higher Health Care Costs.[14]


See also: A full list of opponents


  • California Chamber of Commerce
  • California Medical Association
  • California Hospital Association
  • California Orthopaedic Association
  • California Association of Health Plans
  • California Association of Health Underwriters
  • California Association of Marriage and Family Therapists
  • California Chapter of the American College of Cardiology
  • California Children's Hospital Association
  • American Academy of Pediatrics, California
  • American Congress of Obstetricians and Gynecologists District IX
  • American College of Physicians California Services Chapter
  • American Nurses Association California
  • Association of Northern California Oncologists
  • Association of California Healthcare Districts
  • Association of California Life and Health Insurance Companies
  • California Association of Rural Health Clinics
  • California Society of Plastic Surgeons
  • California State Oriental Medical Association
  • California Urological Association
  • CAPG
  • Employer Health Coalition
  • NAACP California
  • California Citizens Against Lawsuit Abuse
  • Civil Justice Association of California
  • William Jefferson Clinton Democrats
  • California Taxpayer Protection Committee


  • State Building and Construction Trades Council of California
  • Imperial County Building and Construction Trades Council
  • Los Angeles/Orange County Building and Construction Trades Council
  • California-Nevada Conference of Operating Engineers
  • United Contractors
  • International Brotherhood of Boilermakers
  • International Brotherhood Of Electrical Workers - 9th District
  • Sailors’ Union of the Pacific


Californians Against Higher Health Care Costs issued a "Get the Facts" sheet detailing their reasons for opposing Proposition 45. The sheet reads:


A special interest group is sponsoring an initiative on the November 2014 ballot that gives ONE POLITICIAN new power over our health care – including our co-pays, deductibles and even the treatment options our health insurance covers.

We all want to control health care costs – that’s why California has a new independent commission with the authority to negotiate rates with health plans and reject them if they’re too expensive. We should give this commission a chance to work, NOT give more power to a politician who can take campaign contributions from special interests.

This flawed, deceptive measure will just increase costs for consumers and harm the quality of our health care.

1. Gives One Politician Too Much Power
  • Gives one politician new power over what treatment options your health insurance covers. Treatment decisions should be made by doctors and patients, not someone with a political agenda.
  • Grants the insurance commissioner more power over health care while allowing millions in campaign contributions from special interests – with no safeguards against corruption.
  • Gives one politician sweeping new power over rates, co-pays, and benefits for millions of small business employees and could force many small businesses to lay off workers, drop coverage, or even go out of business.
2. Creates More Costly Bureaucracy
  • Creates ANOTHER expensive state bureaucracy when we can least afford it, ultimately paid for with higher health insurance premiums.
  • Costs tens of millions of dollars for bureaucracy, bureaucrats, and salaries, but doesn’t do anything to control the costs that are driving health care premiums.
  • Duplicates existing bureaucracy and regulation with a new program, creating costly confusion and overlap with other state and federal laws and regulations.
3. Sponsored by Special Interests Who Stand to Make Millions Under the Measure
  • Sponsored by special interest lawyers who included a hidden provision allowing them to charge up to $675/hour and make tens of millions in fees off costly health care lawsuits.
  • The proponents have made more than $11 million off a similar provision in the last ballot measure they bankrolled – costs that were ultimately paid by consumers.
  • Proposes special interest reforms of a large and complicated health system without the input of patients, doctors, hospitals, or health plans.
4. Interferes With Your Treatment Options
  • Gives one politician power over co-pays, deductibles, benefits, and even what treatment options your health insurance covers.
  • Treatment decisions should be made by doctors and patients — not someone with a political agenda.


—Californians Against Higher Health Care Costs, [16]

Other arguments in opposition to the initiative include:

  • Patrick Johnston, president of the California Association of Health Plans, said the initiative would create "misguided, onerous rate regulation" that would harm consumers.[7]
  • James T. Hay, president of the California Medical Association, stated, "This misguided measure will cause higher rates and lessen access to care, which is why doctors, hospitals and healthcare providers oppose this measure."[17]
  • Dr. Paul Phinney, a Sacramento pediatrician, said, "They're gambling that people will submit a knee-jerk vote and create a program that will be a cash cow for consumer attorneys."[12]
  • Supporters of Covered California argued that the initiative is unnecessary because the Affordable Care Act, also known as "Obamacare," already imposes new rules to protect consumers. Susan Kennedy, a board member, said the initiative could damage healthcare reform in California "permanently, perhaps fatally." She continued, "Even under the best-case scenario, enactment of this measure significantly complicates Covered California's ability to enact healthcare reform. I just think it's the wrong time to add an entire layer of complication and risk to what we are attempting to achieve." Diana Dooley, chairwoman of Covered California, said, "I feel very mother-bearish on protecting the investment we have made in implementing the Affordable Care Act."[18]


Two ballot measure campaign committees registered in opposition to the initiative as of August 21, 2014:[13]

Committee Amount raised Amount spent
No On 45 - Californians Against Higher Healthcare Costs $37,278,550 $2,552,676
No On 45: California Association of Health Underwriters Issues Committee $298,500 $0
Total $37,577,050 $2,552,676
Note: Of the $37,278,550 raised by No On 45 - Californians Against Higher Healthcare Costs, $11,916,775 or 32 percent is held as unpaid or unforgiven loans.

The following are the donors to the campaign against the initiative as of August 20, 2014:[13]

Donor Amount
Kaiser Foundation Health Plan, Inc. / KP Financial Services $14,590,350
Wellpoint, Inc. and Affiliated Entities $12,770,000
Blue Shield of California $9,693,200
Anthem Blue Cross $270,000
Health Net, Inc. $135,000
WarnerPacific Insurance Services $50,000
National Association of Health Underwriters $50,000
Word & Brown Insurance Administrators, Inc. $50,000
United Healthcare Insurance Company $30,000
Beere & Purves, Inc. $25,000
California Association of Health Plans $15,000


See also: Polls, 2014 ballot measures
  • The Field Poll conducted a survey related to ballot initiatives between June 26, 2014 and July 19, 2014. They found that about 69 percent of total registered voters supported Proposition 45. Democrats supported the proposal by 75 percent, while Republicans approved of it by 58 percent. Voters not affiliated with either party supported it by 73 percent.[19]
California Proposition 45 (2014)
Poll Support OpposeUndecidedMargin of ErrorSample Size
The Field Poll
6/26/2014 - 7/19/2014
Note: The polls above may not reflect all polls that have been conducted in this race. Those displayed are a random sampling chosen by Ballotpedia staff. If you would like to nominate another poll for inclusion in the table, send an email to

Path to the ballot

See also: Signature requirements for ballot measures in California

Two different versions of the initiative - #11-0070 and #11-0072 - were submitted to election officials. Initiative #11-0070 is the one that qualified for the ballot.

In the wake of the extended signature verification process that led to the initiative qualifying for the 2014 ballot, rather than the intended 2012 ballot, Consumer Watchdog released a statement arguing that the state's signature verification process should be changed. They said, "A flawed signature verification process wasted hundreds of thousands of taxpayer dollars on an unnecessary full signature count, and Californians now have to wait two extra years to vote to get outrageous health insurance prices under control. Citizens usually take to the initiative process only when legislative reform has proved impossible, meaning ballot measures address problems for which a fix is long overdue. It's time to lower the random sample threshold to ensure that measures like this one make the ballot they are intended for, and save the counties the significant time and expense of a full count."[21]

Cost of signature collection:

The cost of collecting the signatures to qualify the initiative for the ballot came to $1,728,998.

The signature vendor was Kimball Petition Management.

See also: California ballot initiative petition signature costs

See also

External links

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Basic information



Additional reading


  1. California Secretary of State, "Proposition 45 Ballot Title and Summary," July 3, 2014
  2. Home Insurance, "Groups working to expand California's Proposition 103," November 15, 2011
  3. California Attorney General, "Insurance Rate Public Justification and Accountability Act Petition," accessed August 4, 2014
  4. 4.0 4.1 Los Angeles Business Journal, "Signatures Submitted for Health Insurance Rate Initiative," May 18, 2012
  5. 5.0 5.1 Sacramento Bee, "Initiative on health insurance rates won't make November ballot," June 28, 2012
  6. Consumer Watchdog - Vote Yes on Prop 45, "Homepage," accessed July 11, 2014
  7. 7.0 7.1 7.2 Los Angeles Times, "Sen. Feinstein backs health insurance rate controls," February 1, 2012
  8. 8.0 8.1 8.2 Consumer Watchdog, "Endorsers," accessed July 11, 2014
  9. Post-Periodical, "State Democrats Vote to Support Ballot Measures," July 14, 2014
  10. Consumer Watchdog, "Dennis Quaid Calls On Californians To Support Pack Patient Safety Act," January 16, 2014
  11. Los Angeles Times, "Consumer advocate Harvey Rosenfield takes on health insurers," November 26, 2011
  12. 12.0 12.1 Ventura County Star, "Initiative to regulate health insurance hikes sparks big debate," April 14, 2012
  13. 13.0 13.1 13.2 13.3 California Secretary of State, "Campaign Finance: Proposition 45," accessed April 17, 2014
  14. Californians Against Higher Health Care Costs, "Homepage," accessed July 9, 2014
  15. Note: This text is quoted verbatim from the original source. Any inconsistencies are attributed to the original source.
  16. Californians Against Higher Health Care Costs, "Get the Facts," accessed July 10, 2014
  17. Los Angeles Times, "Battle escalates over ballot measure on health premiums," March 12, 2012
  18. Los Angeles Times, "Covered California officials, insurance chief clash over Prop. 45," August 22, 2014
  19. The Field Poll, "2014 TCWF-Field Health Policy Poll - Part 2," August 20, 2014
  20. California Healthline, "SEIU-UHW Says Ballot Initiatives Seek To Stop 'Hospital Price Gouging'," February 15, 2012
  21. Herald Online, "Ballot Initiative to Make Health Insurance Companies Justify Rates Should Have Qualified for 2012 Ballot According to Official Signature Count Released Today, says Consumer Watchdog Campaign," August 27, 2012