HMO REFORM: Changes Likely, No Matter Who Wins Gubernatorial Bid
Today's Los Angeles Times reports that the state's two leading gubernatorial candidates -- state Attorney General Dan Lungren (R) and Lt. Gov. Gray Davis (D) -- "endorse moderate but significant HMO reform." While both men will likely use the issue "to tap into bubbling public frustration with the HMO industry," the Times notes that Lungren could use it additionally "as a way to distinguish himself from the Pete Wilson administration." Dr. Robert Reid, president of the California Medical Association, agreed, saying, "We really think (these candidates) are going to be more willing to reform managed care than Mr. Wilson has been."
You Say Tomato...
As far as similarities between the two candidates' HMO reform ideas, the Times notes that "[b]oth pledge to protect doctors from retaliation by HMOs when they make costly but competent medical decisions." Further, both Lungren and Davis "support patients' rights to sue their HMOs for malpractice when the organizations' medical decisions result in harm." However, they "both would apply the current $250,000 cap on malpractice damage awards for pain and suffering to HMOs as well as individual hospitals and doctors," which "could tightly limit some patients' compensation." However, both candidates have suggested they might consider increasing the amount of the state's medical malpractice cap, which has not been changed since its creation in 1975.
...I Say Tomato
While Lungren and Davis might have similar ideas on HMO reform, the Times reports that "there are differences in the gubernatorial candidates' approach and emphasis." Like Wilson, Lungren says he "opposes bureaucratic requirements that add to health care costs." He said, "We have to keep in mind over-all economic impacts. Will it be so great that it exacerbates the existing problem" of general substandard coverage? Lungren shies away from specific coverage mandates, believing that what is "medically necessary" should be determined by physicians, not politicians. And on mental health parity -- which the governor is presently considering -- "Lungren is noncommittal," according to the Times. For his part, Davis says he supports "the concept" of parity. And as far as other HMO reforms, he said he "would rather work with the HMO industry than against it," although he has voiced support for legislative limits on "drive-through" mastectomies. He said, "I'm not going to stand by and allow California patients to be ... abused or ripped off. If I am convinced there is a genuine need to act, I will act." On family planning, Lungren says he does "not oppose" mandatory contraceptive coverage -- which the governor just vetoed -- as long as employers could opt out of it "as a matter of conscience." Davis supports mandated coverage.
The Times They Are A Changin'
The Times reports that the HMO industry is "cautiously" preparing for what appears to be inevitable change. "We will consider all ideas and are willing to work with the new governor and whoever he may be," said Maureen O'Haren of the California Association of Health Plans. On the issue of expanding access for the uninsured, Davis wants to extend eligibility for the Healthy Families program, but Lungren says he does not want to tamper with the program until he sees how it works over time (Marquis, 9/18).