HEALTH ACCESS UPDATE
Wednesday, June 8th, 2005

SACRAMENTO UPDATE: SPECIAL ELECTION; HMO REGULATIONS

  • Special Election Looms with 8 Pending Measures, Several with Major Health Impacts
  • Gov’s DMHC Proposal Would Put CA HMO Patient Protections at Risk, Reduce HMO Audits

SPECIAL ELECTION UPDATE: GROUPS PROTEST $80 MILLION COST

Despite many efforts to convince him otherwise, Governor Arnold Schwarzenegger is widely expected to announce, by next Monday, June 13th, that he will call a special election for this November 2005. For a list of the initiatives slated for the ballot, go to the Health Access Special Election Scorecard, at:
http://www.health-access.org/advocating/special_election.htm

THE $80 MILLION COST: In a press conference this afternoon, several health, education, service, and constituency organizations announced their opposition to this special election, and highlighted what $80 million–the estimated cost of the election–could buy instead for Californians. The health-oriented groups, including Health Access California, California Nurses Association, and United Nurses Association of California, pointed out that $80 million could pay for a year’s prescription drug costs for 88,954 seniors–enough to fill the Rose Bowl. With the money for a special election (instead of waiting seven months until the June 2006 primary), California could also pay for 1804 more nurses, or pay for health coverage for 64,725 uninsured twentysomething adults.

BUDGET PROPOSAL: The groups pointed out the special election’s double impact on health care: not only would this election divert money that could go for prescription drugs, trauma centers, child health coverage, or other vital needs, but the powers the Governor is seeking through this special election would allow him to unilaterally cut these services even more. The Governor’s main purpose in calling this election is to get voters to approve his budget-related measure that would place a spending cap on health, education, and other vital services, and give the Governor unilateral power to make cuts, without legislative approval.

OTHER PROPOSALS: In addition to this budget proposal, the Governor is also seeking two other measures, on teacher tenure and redistricting. Allies of the Governor are also sponsoring a measure to restrict the political activities of public employee unions.

If a special election is called, there will be eight proposals on the ballot altogether. The first to qualify was a measure to restrict abortions without parental notification.

Other measures on the ballot include two measures sponsored by consumer advocacy groups: an initiative to repeal electric deregulation and provide some consumer protections to energy ratepayers, sponsored by TURN, and an initiative to have the state bargain for better prescription drug prices for the 10 million Californians without drug coverage, sponsored by the Health Access California. In response, the prescription drug industry has filed a counter-measure, which would also provide a drug discount card, but the discounts would be entirely voluntary.

For the official title and summary of these measures, and relevant links, visit the Health Access website:
http://www.health-access.org/advocating/special_election.htm

To get more information about the prescription drug initiative, and join the effort to pass the Cheaper Prescription Drugs for California Act, go to:
http://www.health-access.org/providing/ourx.htm

GOVERNOR’S DMHC PROPOSAL TO SCALE BACK HMO AUDITS & CA PATIENT PROTECTIONS

In a public hearing this morning, the Schwarzenegger Administration’s Department of Managed Health Care (DMHC) considered a proposal to scale back California’s auditing and monitoring of HMOs and enforcement of California standards and replace it with audits by a private entity, the National Commission for Quality Assurance (NCQA). Information on the hearing is available at the DMHC website, at:
http://www.dmhc.ca.gov/library/reports/news/pcompn.pdf

Opposed by consumer, community, and provider groups, the proposal was first floated by the Governor’s California Performance Review study last year. At the hearing, the Department revealed they has been researching this proposal for several months, to allow HMOs that meet the NCQA standards to be “deemed” to have met California standards. It does not say how DMHC intends to continue to enforce California standards, even when those are different or better than NCQA standards.

Groups testifying in opposition included Health Access California, the consumer advocacy coalition that was the legislative sponsor of the bills that became the Patient’s Bill of Rights, as well as the California Pan-Ethnic Health Network, and the California Medical Association. The groups were concerned about the use of a private, unaccountable, industry-funded national group to monitor and enforce these key patient protections, one that keep some of its data secret, and that charges $695 for a copy of its survey.

With the proposal’s stated intent is to prevent duplication, California provides a broad range of protections that exceed the standards of NCQA or that exceeded NCQA protections when they were adopted. These include:

  • A maximum of 30 days to resolve a non-urgent grievance. NCQA allowed HMOs to delay resolving grievances for up to 60 days.
  • Timely access to care standards: the Department of Managed Health Care has proposed that consumers be offered non-urgent appointments within 7 days and urgent appointments within 24 hours of a consumer request for care.
  • Emergency care: California has a standard that is better than the standard in most other states: in California, an HMO must pay for emergency care if a “reasonable” person would have sought care. Other states uses the “prudent layperson” standard, a standard that allows HMOs to deny care if a consumer is not fully educated about the symptoms of a heart attack.
  • Culturally and linguistically appropriate care: California is in the process of developing standards for care that reflects the diversity of California. No other state has comparable standards for HMO consumers.

    While no action was taken today, the DMHC was clear that they were moving forward in researching and crafting this proposal.

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