CALIFORNIA: MANAGED CARE REGULATION FIGHT LIES AHEAD
Consumer groups and state legislators vowed to push forThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
stronger regulation of managed care in California yesterday as
the California Managed Care Improvement Task Force met for the
last time to release its executive summary of "modest managed
care reforms," the San Francisco Chronicle reports. The panel,
which released its preliminary recommendations in December, was
appointed by Gov. Pete Wilson (R) (Russell, 1/6). The New York
Times reports that consumer groups complained that the panel's
recommendations did not go far enough, while industry groups said
the "recommendations amounted to costly micromanagement."
THE RECOMMENDATIONS
The centerpiece of the "panel's recommendations is the
creation of a state entity to oversee managed-care plans,
replacing the California Department of Corporations," but the
task force did not make specific recommendations on whether the
agency should be headed by a gubernatorial appointee or a board
appointed by the governor and the Legislature. Other
recommendations included the establishment of a third-party
review process for claims denial appeals and a risk-adjustment
process for health plans. It was also recommended that health
plans be required "to collect and publish more detailed
information on consumer complaints" and be required to
"standardize their plan descriptions to make it easier for
patients to comparison shop." The New York Times reports that
the task force did not rank its recommendations in order of
priority or estimate the costs (Purdum, 1/6).
STILL A WAY TO GO?
State Rep. Martin Gallegos (D), chair of the Assembly Health
Committee, called the 100 recommendations "industry-friendly,
weak and rather soft," and vowed to introduce a constitutional
amendment to give consumers the right to sue HMOs. Although the
proposal was discussed at length by the task force, they
ultimately decided not to endorse it. In addition, the Chronicle
reports that a coalition of health advocates urged the state
Legislature to override Wilson's "October 10 vetoes of five
health care reform measures," including bills that "would have
required HMOs to disclose the rules by which they deny medical
care, require coverage of medical supplies used by diabetics and
cover bone marrow transplants for women with breast cancer and
annual prostate screening tests for men" (1/6). Although the
Legislature has not voted to override a gubernatorial veto for 20
years, some legislators are hoping that because many of the bills
received two-thirds support during the regular votes, override
attempts would be successful (Geissinger,
AP/Contra Costa Times, 1/6).
MORE ACTION
"The immediate practical effect" of the recommendations
"will be to give renewed impetus to some 70 pending bills ...
that would guarantee patients easier access to care, including
wider access to specialists and prescription drugs without
administrative hurdles." Gallegos did say he believes the
recommendations would result in a "push on the part of the
Legislature for stronger reforms" (New York Times, 1/6). Some
consumer advocates expressed limited support for the proposed
package of reforms. Jeanne Finberg, senior attorney for
Consumers Union, said, "It's definitely wimpy, but taken on the
whole, it will improve managed care for Californians" (Chronicle,
1/6).
PROS AND CONS
The California Medical Association voiced support for the
recommendations. CMA President Rolland Lowe said, "While some of
the recommendations could be stronger, we feel that, if fully
implemented, they will make significant contributions to
restoring patients' trust in the health care system, and to
improving the quality of health care services received by
enrollees in managed care plans" (CMA release, 1/5). Myra
Snyder, president of the California Association of Health Plans,
was not as supportive. She was "disappointed that the task force
didn't take a systemic approach to the health plans and review
what works and what doesn't." The New York Times reports that
she expressed concern that the "grab-bag of proposals" would lead
to "extreme micromanagement of health plans." She said, "By the
sheer volume of recommendations, we anticipate that this
legislative session will see another flood of bills."
NATIONAL IMPLICATIONS
Philip Romero, executive director of the task force, said
that the group was "very aware of the national implications" of
their recommendations. He said, "More than 70-plus percent of
Californians are in managed care, and nationally it's more like
40 to 45%. Eventually the nation will catch up, but we're
probably four to five years ahead of the rest of the country
right now" (1/6).