Oversight about oversight…

Victoria Colliver at the San Francisco Chronicle has a preview of today’s Senate Health Committee hearing–which is expected to be at least five hours of grilling on a range of meaty issues.

The Senate Health Committee, chaired by Senator Sheila Kuehl, will hold a hearing today on “Consumer Protection under the California Department of Managed Health Care: Adequacy of Implementation and Enforcement,” reviewing the DMHC’s oversight in five key areas: timely access, language access, so-called discount health plans, retroactive denials of coverage; and mental health.

In all these issues, they strike to the core of whether the coverage is meaningful, and whether the consumer is getting value for what they paid for. And on all these topics, there are pending decisions regarding regulations or implementation issues at the DMHC.

It won’t be a surprise to readers of this blog that health and consumer advocates will press for stronger standards and more aggressive oversight for the health insurance industry–and for good reason.

Consumers are increasingly concerned that their coverage won’t be there for them when they need it–that they won’t be able to get in to see a doctor or specialist, to get a translator if necessary, or even that their coverage will be retroactively rescinded.

In light of these HMO practices, the Department needs to be more–not less–aggressive in protecting patients and investigating the insurance industry.

Yet, the tendency by the Schwarzenegger Administration is to leave the decisions up to the insurers. Recent regulations would let insurers decide their own standards on timely access; to determine their own method of notifying patients about their rights to an interpreter. On new regulations of discount cards, the Department were shaped by the industry they were purporting to regulate-an industry that offers a product of dubious value to consumers.

The regulations to ensure timely access to care has been a particular subject of controversy–and focus for Health Access. For years, the Department of Managed Health Care has had numerous drafts of regulations to implement a 2002 law to establish and enforce standards to ensure access to care within clear timeframes. Yet the most recent draft let the insurers set their own standards. Senator Kuehl recently wrote a letter indicating this conflicted with the intent of the Legislature is passing the bill.

We hope this hearing provides much-needed legislative push to the Department to resolve these issues quickly, and the political cover to prioritize protecting patients, regardless of industry opposition. Consumers want and need more assurances that their coverage will provide the protection that they paid for.

If nothing else, the hearing brings additional *public* scrutiny to these issues–which is important, given the stakes for the average health consumer, but rare, given that DMHC regulations usually get attention from the industry and a handful of consumer advocates.

We have an ongoing interest–Health Access California, the statewide health care consumer advocacy coalition, was the sponsor of the HMO Patient’s Bill of Rights in the late 1990s that created the Department of Managed Health Care, to be a stand-alone department with a specific focus on consumer protection. Our group continues to advocate on behalf of consumers at the DMHC on a range of issues. More recently, Health Access was the sponsor of AB2179(Cohn) in 2002, which required the Department to establish and enforce standards for timely access to care; and a strong supporter of SB853(Escutia) to require language access to care.

So we’ll be continuing to do our own oversight, over the insurers–and their regulators.

We’ll have a report on the hearing later in the day.

Health Access California promotes quality, affordable health care for all Californians.

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