GOV. DAVIS: Details Some Specifics on HMO Reform

      Gov. Gray Davis, much "criticized for failing to get involved in the debate over HMO reform legislation," set his "terms of engagement" yesterday, outlining what he would accept at a morning press briefing. But Davis' framework leaves several issues unresolved, and many still wonder whether he can reach agreement with Democrats in the Legislature, who are prepared to send him as many as 70 bills in the coming months (Ingram/Gladstone, Los Angeles Times, 8/19). Some Democrats are angry that Davis did not brief them on his proposals before going to the press. "It would have been more productive if we had seen this before the press did," said Assembly Speaker Antonio Villaraigosa (D-Los Angeles). Senate Pro Tem John Burton (D-San Francisco) added, "It's rude and politically stupid. We had meetings with him, we were supposed to get this at 10:30, and then they go and brief the press, not us" (Gunnison/Lucas, San Francisco Chronicle, 8/19).

'Gray' Area
      Davis' principles include a requirement that doctors "be the ones who deny or change treatment," and that HMOs "base their clinical practice guidelines 'on sound science rather than fiscal considerations.'" He also favors expanded access to second medical opinions and the creation of a new department regulating managed care companies, to be housed in the Business, Transportation and Housing Agency. He said he would create a "financial solvency board" to ensure the financial security of health plans (Lindlaw, AP/Contra Costa Times, 8/19). The governor also favors establishing an independent review system to hear appeals from patients who believe they have been denied care unfairly. Should the reviewer -- whom the patient would be able to pick from a state-approved list of experts -- determine that the care in question is medically necessary, the HMO would be required to pay. And as a final recourse, Davis would support the right of patients to sue, but only in cases where "substantial physical harm" has occurred. Cabinet Secretary Susan Kennedy said such a definition would likely include death and loss of limb or bodily function, but a strict definition is still in the works (Smith/Capps, Sacramento Bee, 8/19). Business, Transportation and Housing Secretary Maria Contreras-Sweet said, "We think this is a very balanced, first-year-out approach to health care reforms. I'm sure there's something every group is going to object to, and probably something every group will like."

Reax
      Comments from various camps bore out Contreras-Sweet's assessment. Consumers for Quality Care's Jamie Court said, "It is written full of loopholes. It's obscene to only give civil justice remedies to those who have a loss of limb." Walter Zelman, president of the California Association of Health Plans, said while he was "concerned about" certain provisions of the outline, it "appears to place some limits on the right to sue and would seem to suggest that individuals need to go through the external review process before they sue" (AP/Contra Costa Times, 8/19). Beth Capell of Health Access said, "We are generally pleased. He's recognized that we need more consumer advocacy in the regulatory agency" (Ainsworth, San Diego Union-Tribune, 8/19). Legislators also were split. Burton said, "This doesn't give us a hell of a lot of direction, assuming we wanted to take it." But state Sen. Jackie Speier (D-Daly City) called it "bold and ambitious," saying, "It's going to be a welcome relief for the consumer patients of California." And Assembly Minority Leader Scott Baugh (R-Huntington Beach) said, "Republicans will support this. It's up to the governor to lobby Democrats and persuade them" (Los Angeles Times, 8/19).