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ACP-ASIM Pressroom

Health Care Issues 2001: Legislative Report Card

Presented by the California Chapter, American College of Physicians-American Society of Internal Medicine (115,000 internists with 10,000 providing care for California)

February 6, 2001

ISSUE

SPECIFICS

Year 2000 GRADE

Comments

Access to care

1.Expanding Childrens

Health Initiative Program (CHIP)

C+

Attempts to simplify enrollment but well short of goal

Goal: All eligible children and their parents up to 250% of federal poverty level.

 

2.CHIP extended to parents

B

Plans to use surplus funds to expand eligibility

Goal: Subsidize enrollment in private non-MediCal plans

 

3. Prevent loss of federal funds for CHIP

A

Timely action preserves funds otherwise lost

Goal: Expand program by requiring the state to apply for the maximum amount of available federal funds.

 

4. MediCal physician fee schedule

B

First effort in a decade; but state still 44th lowest reimbursement rate in nation; physician participation in program remains threatened

Goal: 80% of Medicare fee schedule as floor. This will result in more physicians being willing to participate in program.

Public Health

1. Tobacco funds

B

For the 2001 budget, Davis proposed spending $468 million from the tobacco settlement against tobacco companies on health-related programs. Previously, Davis said the settlement money should simply be dumped into the state's general fund with no strings attached.

Goal: Use funds exclusively for healthcare programs.

 

2. Elder abuse reporting

D

Well intended but creates dangerous potential of physician criminal liability

Goal: Revise law to place physician reporting responsibility more in line with the role of the physician in patient care — e.g., reporting those instances of abuse involving the health status of the patient.

 

Managed care

1. Medical group viability

D

Epidemic of contracting group bankruptcies due to pervasive under funding; health plans not held responsible for services provided

Goal: Actuarially sound capitation; reasonable arbitration/negotiation ability (e.g. AB32 -Richman)

 

2. Actuarially sound capitation

D-

Market share allows health plans to offer capitation rates which are below the cost to provide services.

Goal: Legislation to require actuarially sound capitation rates.

 

3. Independent review of health plan denials of care

A

New law in effect 2001 allows patient access to review of care denial

Goal: Implement in patient-friendly way with desired results, consumer confidence.

 

4. Access to fee schedule information

D-

Continued widespread health plan abuse of providers, unfair contracting and fee changes

Goal: Enforceable legislation and/or regulations with teeth

 

5. Medical Director Liability

D-

Out of state medical directors of health plans doing business in California are not held liable for making treatment decisions.

Goal: Require licensure by the Medical Board of California for medical directors.

State Budget Priorities

1. Funding for healthcare programs

C

Increased spending proposed for FY 2001-need to maintain increased funding proposed by Governor of $468 million in tobacco settlement money earmarked to expand health care programs including prostate and breast cancer treatment for the uninsured. Increased spending for Medi-Cal, California's health care program for the poor, will increase by

$204 million to $9.5 billion.

Goal: Support Governor’s proposed budget for healthcare.

Note: Grades are assigned by Board of Trustees of the California Chapter, American College of Physicians-American Society of Internal Medicine January 2001

A: Excellent initiative with good prospects for productive implementation

B: Useful initiative but requires thoughtful implementation for success

C: Some progress but requires expansion, better focus or appropriate implementation

D: Shows lack of activity, inappropriate focus or lacks practicality, can’t be implemented

D-: In urgent need of being addressed

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