CALIFORNIA: HMO TASK FORCE TO FINALIZE PROPOSALS TODAY
The California Managed Health Care Improvement Task Force isThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
scheduled to adopt its executive summary today at its final
meeting. Stanford University health economist Dr. Alain
Enthoven, who chairs the panel, said, "These recommendations go
too far for some, not far enough for others. ... However I
believe that taken together, they represent a very significant
and valuable reform package" (release, 12/31). Among the
recommendations for managed care reform are: the creation of a
new managed care regulatory agency; the establishment of "'an
unbiased, expert-based, independent, third-party review process'
for complaints about denial of coverage for medical treatments";
the development of "risk adjustment" for health plans; and
extended referrals to specialists for people with serious or
chronic illnesses (San Jose Mercury News, 1/5). Click here for
past American Health Line coverage of the task force's
The managed care recommendations have come under attack from
a variety of groups, including consumer advocates and industry
supporters. According to the San Jose Mercury News, consumer
advocates charge that the panel's reforms "are weak" in part
because it failed to recommend that consumers be allowed to sue
their health plans for malpractice. Critics also note that the
panel was dominated by industry representatives. Assemblyman
Martin Gallegos (D) said, "I think the task force had a
tremendous opportunity to really reform managed care, and I think
they blew it ... and a lot of it had to do with the fact that
two-thirds of the appointees were very industry-friendly." The
panel also "[l]eft unheeded ... the even thornier issue of
whether managed care plans should be subject to a state law that
limits malpractice awards against physicians to $250,000." Other
critics contend that the task force was created by Gov. Pete
Wilson (R) to "stall managed care reform for at least a year."
Managed care industry groups charge that the panel
recommended changes without considering likely costs. In
particular, industry officials oppose risk-adjustment of health
plans and new regulatory oversight for HMOs. Noting these
criticisms, Enthoven said, "If you counted the score, you
wouldn't find that the managed care industry had its way."
According to the San Jose Mercury News, some observers say the
task force has accomplished its mission by "[crafting] a modest
set of reforms that would improve managed care by increasing
government oversight and making the industry more friendly to
consumers" (Puzzanghera, 1/5). Center for Health Care Rights
director Peter Lee said, "I really think there is a lot of very
positive recommendations that can make a huge difference for
individual consumers" (Olmos, Los Angeles Times, 12/31).
The San Jose Mercury News notes that the task force
recommendations "will not be subjected to the political swirl of
an election year." Sean Walsh, a spokesperson for Wilson said,
"Will we take some of their recommendations? Most likely. Will
we reject some of their recommendations? Most certainly."
Several initiatives are expected to be introduced by state
legislators this year, including a ballot initiative that would
allow consumers to sue HMOs for malpractice (1/5).
An editorial in today's Los Angeles Times contends that the
"task force proposes some sensible solutions." The editorial
concludes, "Health care policy experts from groups as far apart
as the conservative Heritage Foundation and the liberal Urban
Institute are reaching agreement that more stringent HMO
oversight is needed. The question is whether lawmakers can stop
sniffing the political winds long enough to respond usefully.
The Wilson task force has given state legislators a solid
framework for action. Congress would do well to order a copy of
those proposals and give up the dueling news conferences" (1/5).