MANAGED CARE REFORM: Second-Opinion Bill Passes Senate
The state Assembly yesterday passed a bill that would force HMOs to allow patients a second medical opinion under various circumstances. State Assemblyman Michael Sweeney (D-Hayward), "said he was surprised there was no debate on the measure, AB 341, which is opposed by the HMO industry." The bill mandates that an HMO pay for a second opinion by another plan doctor, or by a doctor outside the plan "if the expertise wasn't available in-house." The 60-13 vote sends the bill to Gov. Pete Wilson for his signature or veto, a decision Wilson spokesperson Sean Walsh says the governor has not yet made (Sacramento Bee, 8/27).
Denials Of Care
The state Senate also passed AB 332 yesterday. The bill, which has already passed the state Assembly, "prevents an HMO from denying a critically-ill patient doctor-recommended treatment unless another qualified doctor has examined the patient." The bill, sponsored by state Assemblywoman Liz Figueroa (D-Fremont), passed the Senate by a vote of 22-14. The legislation is a recast version of AB 794, also sponsored by Figueroa, which was vetoed by Wilson last fall so he could have time to hear back from his task force on managed care reform. Consumers for Quality Care notes that an analysis by the Health Policy Economics Group at Price Waterhouse found that premium increases under the bill would range from 0.1% to 0.4%. CQC's Jamie Court implored Wilson to sign the bill, saying, "If Governor Wilson refuses to allow patients to sue their HMO, he must at least assure Californians that decisions at HMOs are made by appropriately licenced doctors, not bureaucrats and accountants" (CFQC release, 8/26).
The San Francisco Chronicle reports that another health care-related bill was sent to Wilson, which "requires health plans to pay for the ambulance costs of taking someone to a hospital if that person called 911 seeking medical care." The bill, AB 984, passed the Senate 23-5 (Lucas, 8/27).
Docs, Kaiser Weigh In On Lawyers
The California Medical Association, the American Medical Group Association and Kaiser Permanente yesterday denounced a recent effort by trial attorneys to link bills that would establish an external review process for HMO patients with a much more controversial measure that would give HMO enrollees the right to sue their health plans -- a move that virtually guarantees a veto of the combined measures. "We are extremely disappointed that the trial attorneys and Consumers for Quality Care have betrayed the trust of their clients, and consumers in general, by leading efforts to defeat independent external review," said CMA President Dr. Robert Reid (joint release, 8/26).