CALIFORNIA: ASSEMBLY APPROVES HMO DECISIONMAKING MEASURE
The state Assembly approved yesterday a bill that "wouldThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
give doctors the responsibility of making decisions about
disputed patient care rather than bureaucrats in managed care
plans," LOS ANGELES TIMES reports. The bill (AB 794), sponsored
by state Assemblywoman Liz Figueroa (D), passed on a 43-19 vote,
with strong Democratic support. Figueroa "said medical treatment
should be solely the province of medical professionals and 'not a
business decision.'" TIMES reports that "in cases in which the
treating physician recommends care than an HMO or insurer refuses
to cover," the measure would "provide for the case to be referred
to a second doctor or other health care professional." Under the
measure, an HMO could still deny care, "but its liability for
malpractice would skyrocket if both doctors agreed on a
prescribed course of treatment."
COMMENTARY: Jamie Court, with Consumers for Quality Care,
which co-sponsored the bill, "hailed Thursday's vote," and called
the measure "the first in the nation to prevent HMO bureaucrats
from making life and death decisions." However, Mark Sektnan of
the California Association of Health Plans, said the measure
"will drive up health care costs in California three percent to
four percent." A spokesperson for Gov. Pete Wilson (R) said that
while the governor "has not taken a position" on the bill, some
provisions "appear problematic," including increased costs and
"seemingly unnecessary and overlapping procedures to resolve
disputes." TIMES reports that the measure, "along with several
others clamping down on HMO practices," now heads to the Senate
(Vanzi, 5/30).