HMO REFORM: GOP Support May Signal Action For 1998

      While most of the support for managed care reform legislation last year came from Democrats, "many Republicans have jumped aboard what appears to be an unstoppable political freight train," the Sacramento Bee reports. According to state Assembly Health Committee Chair Martin Gallegos (D-El Monte) the "arrival of Republicans at the table greatly boosts the chances that legislation strengthening protections for HMO patients will become law." He said, "I think there's an excellent possibility we're going to see some reform coming out of this year." There are currently "[m]ore than 100 bills dealing with HMOs" pending in the state Legislature. About half of the 50 bills introduced since January were authored by Republicans. Beth Capell, a lobbyist with the consumer advocacy group Health Access, said, "The fact that we see a flood of Republican bills means this is a very hot issue." And "GOP legislators also concede that a groundswell of voter sentiment is forcing them to act." According to state Assemblyman Scott Baugh (R-Huntington Beach), "scores of voters called his office last year after the local newspaper ran a story detailing how Republicans had voted on HMO measures."

Catch The Wave
      Myra Snyder, president and CEO of the California Association of HMOs, "concedes that the public has a serious problem with her industry." She said, "Whether it's true or not -- and I don't think it is -- the public believes health plans make their decisions on a purely financial basis." However, "[f]or the first time, Snyder's group has issued a list of reforms it can support." Among them are direct access to OB/GYNs, an external review process for denied patient claims and "allowing people with chronic conditions to obtain a standing referral to a specialist." The HMO association has also announced its support for a proposal to "impose greater state scrutiny on the managed care industry by shifting regulation of HMOs from the state Department of Corporations to a new entity that would be dedicated solely to supervising health care." However, "consumer advocates worry that HMOs are simply trying to pre-empt more substantial reforms." Jamie Court, director of Consumers for Quality Care, said, "By coming out with a purportedly proactive agenda, they (HMOs) are hoping to peel away legislators who feel they need to do something about HMOs, but don't want to cross the insurance companies."

Battle Time
      The Sacramento Bee reports that "[o]ne battle over the shape of reform could come in the next two weeks, when the state Senate is expected to send" Gov. Wilson a bill that "would require health plans to allow patients access to a second opinion whenever 'a reasonably prudent person' would want one." The HMO association said the bill "is too broad," and is backing a bill "that would require HMOs to provide second opinions under a narrower set of circumstances" (Vellinga, 3/15).