HMO OVERSIGHT: CA COMMISSIONER DISCUSSES STATE EFFORTS
American Health Line's Bryan Courtright spoke withThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
California Department of Corporations Commissioner Keith Bishop.
Bishop and the department have come under fire from consumer
groups for what they label insufficient oversight of managed care
plans, saying the department has been slow to respond to consumer
complaints and lax in disciplining HMOs. Some have called for
the regulation of managed care to be transferred out of the
department's jurisdiction. An edited transcript follows.
AHL: Does the oversight of managed care belong with the
Department of Corporation?
BISHOP: I think that we do a good job of regulating managed care
in California so I don't see any reason why it should be changed
at this point. I think that we have been in the last few years
taxed by the fact that the number of plans and the number of
enrollees has increased and the complexity of the issues that we
are dealing with have grown and our resources have not kept pace
with the growth of managed care in California. This year we have
a substantial augmentation of our budget for oversight of managed
care plans, it's about a 73% increase. I think that will greatly
improve our responsiveness to consumers and to the industry and
allow us to increase our enforcement actions in the managed care
AHL: The department has come under fire for not being aggressive
enough in following up on consumer complaints about HMOs. How do
you respond to this charge?
BISHOP: I prefer to look at the facts. I was appointed
commissioner a little over one year ago and in my tenure I have
brought more enforcement actions against managed care plans than
any other commissioner. I have levied and collected more fines
than any other commissioner in the history of the administration
or the Knox Keene Act, which is our health care act. I brought
178 separate actions under the Knox Keene Act. I think the
highest number that was brought in before that in a single year
in the past ten years was 41. In the year-plus that I have been
here we have levied over $2.7 million in fines -- in the last ten
years the highest amount was $300,000.
AHL: What's your take on all the managed care bills currently
under consideration in the California Legislature, especially the
patient bill of rights?
BISHOP: This year there is a lot of legislation involving
managed care. I have a twofold concern about the direction of
some of the legislation that mandates specific types of treatment
or coverage. Under our law that regulates managed care plans,
the purpose of the law is to ensure the primacy of the health
care provider as the decisionmaker in terms of health care. When
we have the legislature defining care, then you are basically
politicizing the medical decision-making process. I have a big
concern with the thrust of bills that would politicize medical
decisionmaking. I think it's best left to the physicians. The
other concern I have is obviously there are some bills that would
increase the cost of health care and that would unwittingly
create problems of access to health care. In California we have
about 22% to 23% of our population that does not have health care
coverage. And cost is obviously a factor in terms of
accessibility. So I think that we need to be cognizant that cost
is important in ensuring that people have access to health care
coverage and that we have an efficient health care delivery
system that doesn't overburden the rest of our economy.