HMO REFORM: Wilson Vetoes HMO Oversight Board, Second-Opinion Bills
Gov. Pete Wilson Friday vetoed two managed care reform bills that the AP/Los Angeles Times reports "were among the most significant health care legislation of lawmakers' 1997-98 session." Wilson rejected AB 341, which "would have set up a powerful consumer commission to regulate HMOs," replacing the state Department of Corporations as the current regulator. He also rejected SB 406, which would have allowed "patients to get a second, outside opinion if they have been denied treatment."
It's Your Fault
In his veto message, the governor faulted the state Legislature for failing to follow his recommendation that the HMO regulatory agency be headed by "a single (gubernatorial) appointee," contending that the five-member commission stipulated in the bill would have created "a weak and unaccountable regulatory bureaucracy." Separately, Wilson called the second-opinion bill "flawed," saying, "There is no evidence that qualified physicians with the same medical group do not provide professional and unbiased second medical opinions" (9/26). Beth Capell of Health Access, a consumer group that sponsored the second-opinion legislation, "said it made sense to allow patients to go outside their doctor's group to avoid what she called a 'natural conflict of interest' among the physicians." She said, "If you want to try a second look at something, it's good to have someone who comes from a different perspective on the same problem" (Weintraub, Orange County Register, 9/26). Jamie Court of Consumers for Quality Care said Wilson's vetoes were "a parting favor" to the insurance industry. "This is cash register politics which leaves 19 million Californians in HMOs without even basic rights or recourse. Hurricane Pete has destroyed the foundation of a patient bill of rights that could have been built on next year" (CQC release, 9/26).
On Friday, "Wilson also signed two managed care measures, one requiring health care plans to pay for prostate cancer screenings [SB 2020] and the other mandating disclosure of financial incentives that affect decisions about care or referrals" (SB 750) (Orange County Register, 9/26). Wilson also signed SB 1766 which "would require HMOs to set up anti-fraud units and report their progress annually to the Legislature" (AP/Times, 9/26). According to CQC, one of the last HMO reform measures left on Wilson's desk is AB 332, which would require that managed care treatment decisions be made by California-licensed medical professionals and that an HMO can only deny treatment if the patient has been examined by a second, equally qualified doctor. This measure was recommended by Wilson's task force, but he has not yet indicated his position (release, 9/25). Another major health reform bill, the mental health parity bill (AB 1100), has not received a Wilson approval or veto.