MANAGED CARE: Wilson Unveils Reform Proposal
"After halting all legislative attempts to overhaul state regulation of [HMOs] last year, Gov. Pete Wilson on Wednesday for the first time laid out his agenda for the managed care industry," the Sacramento Bee reports. Wilson outlined his "three broad principles by which he would judge ... HMO reform efforts" in a letter to state legislators. "He said any state changes to HMOs must be cost-effective, must not reduce access to health care and must improve the quality of care," the Bee reports. In addition, he "said he preferred that patients and employers be given broader HMO options so that free market competition, rather than government-imposed mandates, spurs improvement in the industry." Above all, Wilson said in an interview, the "cost to employers and health care consumers ... will be his primary concern." He said, "It would prove a bitter irony if we were to simply pile up one legislative mandate upon another so ... the cumulative total would drive (employers) out of business" (Smith, 1/29).
Among reforms proposed by Wilson is the creation of a new state agency responsible for regulating HMOs. The new agency would replace the state's Department of Corporations, "which Democrats have criticized for operating with a pro-business bias." Other recommendations include "easier consumer access to specialists and prescription drugs, minimum hospital stays offered for certain procedures and more information for the public on the quality of medical care -- which patients could use for 'comparison shopping,'" the Los Angeles Times reports. Wilson's proposal would also allow people to "keep their doctors when the doctors leave the patients' health plan," mandate contraceptive coverage, "[e]nsure that economic incentives rewarding doctors for limiting care are 'clearly and concisely disclosed' to consumers"; mandate coverage of second opinions and an improvement in arbitration processes and "the process for reviewing denial of treatment for serious conditions" (Vanzi/Morain/Lesher, 1/29).
Timing Is Everything
Wilson's recommendations for reform are the latest development in a party-line skirmish over managed care regulation. His 13-page press release outlining reform proposals and accompanying letter to legislators were issued on the same day Democrats in the state Assembly and Senate sought to push through four managed care bills that Wilson vetoed last summer. In the Senate, Democrats sought to override two vetoes of bills "that would have required HMOs to pay for insulin for diabetics and to pay for prostate screenings." In the Assembly, the two veto override attempts were for bills that would have required HMOs "to explain why they deny treatment and to offer an expensive but potentially life-prolonging treatment for breast cancer" (Lucas, San Francisco Chronicle, 1/29). Wilson had vetoed the bills "on the grounds that he was waiting for completion of a comprehensive study by a task force he appointed. ... The study was completed earlier this month, and Wilson's proposal adopted many of its key recommendations" (Los Angeles Times, 1/29). None of yesterday's veto override attempts succeeded.
Not So Wide A Gulf
Of the failed veto override attempts, Assemblyman Curt Pringle (R) said, "This is not about process. This is not about policy. This vote is pure and simply about politics," (Chronicle, 1/29). However, "[n]ow the task force has completed its work, and many of its recommendations are consistent with goals already outlined by Democratic lawmakers, doctors and consumer groups." The Orange County Register reports that "[w]ith polls showing wide support for some of those proposals, Republican legislators are jumping on board" (Weintraub, 1/28). "The Democratic actions and the GOP response served to show that ... health care could prove to be pivotal in this election year," the Chronicle reports (1/29).