The Republican Reform: Repeal?

Yesterday, President Obama’s bipartisan health reform White House summit reinforced the need and urgency for health reform, to provide security and stability for those with coverage, and to provide affordable choices for those lack it. We had specific reports and reactions on the Health Access Twitter feed, at

The systemic health care problems in California came up repeatedly, showing the need for reform in general, and for stronger oversight and regulation of insurers in particular. This should not be a partisan issue: we were pleased to work with Governor Schwarzenegger on health reform in 2007, especially after we got key protections on affordability and other issues.

So we were disappointed yesterday when so many Republican leaders wanted to delay reform and start from scratch, rather than move ahead with the reforms that Californians desperately need.

We are also dismayed that legislators here in California are seeking to remove existing consumer protections, or repeal regulations even before they are passed.

Two specific efforts were spotlighted in the last 48 hours:

* One bill introduced yesterday would prohibit California from implementing the pending health reform–or any other health reform. It’s clearly unconstitional. But on the day of a bipartisan summit to figure out areas of agreement, the amendment vividly portrays the GOP opposition to not just this reform, but any reform. The measure would prevent any regulation of the insurance industry–including preventing denials of coverage for pre-existing conditions.

* The major “reform” that Republicans pushed during the summit and through the year is the concept of selling health insurance across state lines. A California bill on the subject was defeated in committee earlier in the week.

Let’s be clear: Allowing insurers across state lines would eviscerate all California consumer protections, allowing insurers from other states with much weaker regulations to sell substandard products.

If an insurer or HMO is licensed in another state and a consumer needs recourse, how would the consumer complain? By calling the insurance commissioner in another state? How would the consumer even know where to call? This measure effectively eliminates all enforcement against health insurers and HMOs.

California provides many consumer protections because of a long history of abuses by HMOs and health insurers. Other states provide few or none. Here’s a list of the protections that Californians would likely lose by allowing plans licensed from out-of-state:

California Consumer Protections: Process/Financial

1. Fiscal Solvency Requirements (on Insurers, HMOs, medical groups, etc.)
2. Network Adequacy
3. Independent Medical Review
4. Grievance and Appeal Procedures, including urgent appeals
5. Right to Sue an HMO
6. Standards for Utilization Review
7. Reasonable person standard for emergency care
8. Right to a second opinion
9. Public disclosure of criteria for denial of care
10. Timely Access (48 hours for urgent care, doctor’s visit within 10 days, etc)
11. Language Access
12. Continuity of care
13. Protection against balance billing for out of network emergency care
14. HMO Help Line: 24/7, 365 days a year

Which consumer protection should Californians go without? Grievance and appeals procedures? Right to a second opinion? Language access?

California Consumer Protections: Benefit Mandates (partial list)

1. Mental Health Parity (1999)
2. Contraceptive Coverage (1999)
3. Diabetes supplies (1999)
4. Prescription drugs: cover medically necessary drugs if drugs covered
5. Cancer screening: “all generally medically accepted cancer screening tests”
6. Drive-through labor and delivery
7. Same-day mastectomy
8. Prostate screening
9. Cleft palate
10. Pap smears
11. Mammograms
12. Well child care

Which benefit mandate should Californians go without? Mammograms? Well child
care? Cleft palates? Diabetes supplies?

We wish those who support allowing out-of-state insurers to avoid these regulations would be explicit about what existing consumer protections they would like to effectively repeal. Their proposal would effectively eliminate all of them.

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

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