MANAGED CARE REFORM: Legislature Sends Direct OB/GYN Access Bill To Governor
The California Assembly yesterday passed "a bill granting women in managed health care plans direct access to obstetricians and gynecologists." The Assembly's 70-3 approval of the measure sends it to the desk of Gov. Pete Wilson, who favors it "in concept," according to his spokesperson. The Los Angeles Times reports that AB 12, which allows women "to bypass their primary care physicians to receive care," is the " second within a week to reach Wilson as an HMO reform that is likely to be signed into law" (3/31). Wilson spokesperson Lisa Kalustian said "direct access is 'absolutely a concept the governor has supported'" (Vellinga, Scripps-McClatchy News Service/Contra Costa Times, 3/31). "(This bill) represents probably the single most important step we can take toward improving women's health in California this year. This is one component of HMO reform where California women, the Legislature and the governor concur," said Assemblywoman Susan Davis (D-San Diego), the bill's sponsor (Lucas, San Francisco Chronicle, 3/31). John Mahnke, a past president of the California Association of Obstetricians and Gynecologists, said, "Women want direct access to a physician who is best trained to care for the majority of their health needs" (Vellinga, Sacramento Bee, 3/31).
The San Francisco Chronicle reports that the bill would require "HMOs to do what some already do." Both the Kaiser Foundation Health Plan, with 5.3 million members, and Lifeguard, with 219,000 members, let women choose OB/GYNs as their primary doctors. The California Association of Health Plans opposes the bill on the grounds that 93% of Californians are in a plan where direct OB/GYN access is already possible. The CAHP also believes health plans should be permitted to charge more for an OB/GYN visit because it is a medical specialty. But the CAHP will not urge the governor to veto the measure as it did last year (3/31). "If Wilson signs the bill ... California will join 15 other states in giving women direct access" to OB/GYNs. However, consumer advocates "consider the OB/GYN measure a small step when compared with some of the more than 100 managed care bills now winding their way" through the California legislative process." Consumers for Quality Care Director Jamie Court said, "The tough bills are not these softballs that the HMOs agree on," (Scripps-McClatchy/Contra Costa Times, 3/31).
A Little Historical Context
The San Francisco Chronicle notes that Wilson vetoed a measure similar to AB 12 last year because he "wanted to wait for recommendations of a managed care task force he appointed." In January, that task force recommended direct OB/GYN access (3/31). According to the Sacramento Bee, a "survey conducted for Wilson's task force found that 42% of Californians had experienced a problem with their health plan during the previous 12 months." In particular, survey respondents "complained about being denied treatment, having to endure lengthy waits for approval of referrals to specialists and receiving what they considered inappropriate care" (3/31).