San Jose Mercury News Examines ‘Controversial’ Health Proposals in California Performance Review

The San Jose Mercury News on Thursday examined some of the most "controversial health and human services proposals" in the recently released California Performance Review (Feder Ostrov, San Jose Mercury News, 8/5). The 2,500-page review, released Tuesday by Gov. Arnold Schwarzenegger (R), proposes eliminating or consolidating more than 100 boards and commissions and modifying state business practices in an effort to save $32 billion over five years. The report aims to save almost $5 billion over five years by making changes to Health and Human Services Agency. Some proposals in the review include: establishing a new Public Health Department; reducing the amount of oversight of HMOs; reorganizing some the Department of Managed Health Care activities and placing all licensing boards under DMHC's authority; eliminating 17,000 county jobs and hiring private contractors to determine Medi-Cal beneficiaries' eligibility and administer many of the applications online; changing the HIV reporting system to use patient names rather than alphanumeric codes; and consolidating the Mental Health Department and alcohol and drug programs (California Healthline, 8/4).

Forming the new Public Health Department "super agenc[y]" -- which would manage Medi-Cal, public health, disability services, mental health and substance abuse programs -- could save the state money "by coordinating crucial health care data now stored in 60 different information systems," the Mercury News reports. However, dismantling DMHC, "an activist HMO watchdog agency," and moving some of its responsibilities to the quality assurance division of the new Public Health Department is one of the "most contentious proposals" in the review, according to the Mercury News. In the past, DMHC has advocated for state residents in HMO disputes, closed down HMOs for financial instability and fined others for providing inadequate care, according to the Mercury News. Anthony Wright, executive director of Health Access, said, "We're very concerned that these proposals would undermine California's HMO-patient protections," adding, "You'd no longer have an HMO czar, a person whose focus is to protect consumers."

The Mercury News reports that the HIV name-reporting proposal would eliminate a "painstaking compromise" between state officials and HIV/AIDS activists. Unlike the alphanumeric codes for HIV-positive residents, residents with AIDS are reported by name. Fred Dillon of the San Francisco AIDS Foundation said that the federal government supports HIV name reporting and could eventually require the practice as a prerequisite for federal funding for HIV/AIDS services. However, he noted that the practice could discourage some residents from getting tested and might not reduce costs. Senate Health and Human Services Committee Chair Deborah Ortiz (D-Sacramento) said, "I fear unless we provide more money to the system, efficiencies are not going to result in more favorable outcomes for Californians." She added, "These needs don't go away" (San Jose Mercury News, 8/5).