HMO REFORM: Two Figueroa Bills Move To Senate Floor
The state Senate Appropriations Committee yesterday unanimously passed two HMO reform bills, which now go to the Senate floor for consideration. Both are sponsored by state Assemblywoman Liz Figueroa (D-Fremont), who says the bills "are part of [her] commitment to reforming HMOs in California." AB 1621 prohibits HMOs from denying patients reconstructive surgery to correct birth defects or other medical abnormalities. "HMOs have tried to portray this bill as being about tummy-tucks and face lifts. It is not," said Figueroa. "This is about people whose appearance has been tragically disfigured through medical circumstances beyond their control. That is why people buy health insurance. This bill just assures they will get what they're paying for," she said (Figueroa release, 8/19). Maureen O' Haren of the California Association of Health Plans said her organization has no position on this bill (CHL sources, 8/20).
Figueroa's second bill, AB 332, guarantees that when an HMO overturns a medical professional's treatment or care decision, someone who is at least as qualified as the original doctor will be involved in the decision. According to Figueroa, nothing in current state law prohibits an HMO accountant from overturning a doctor's decision to provide a course of treatment that the HMO might view as too expensive. "Medical decisions should be made by medical professionals," Figueroa said. "If a doctor's decision must be overturned, it should be by an equally qualified doctor who is as responsible as the first doctor," she said (Figueroa release, 8/19). Consumers for Quality Care, which supported the legislation, noted that this bill falls within the recommendations made by Gov. Pete Wilson's managed care task force. Jamie Court, director of the group, said, "This reform protects patient access to high quality health care without increasing health care costs. In fact, by deterring avoidable injuries, AB 332 will save the health care system the multi-million dollar cost of caring for those injuries" (CFQC release, 8/19). O'Haren said her group opposes the bill because it would "significantly increase costs" and "greatly inconvenience patients" (CHL sources, 8/20).