LEGISLATIVE FLAME-OUTS RE MEDI-CAL, OPHTHALMOLOGY, AND FAIRNESS IN CONTRACTING

AB 1805 (Skinner & Pan), which would restore the 10% cut in Medi-Cal reimbursement for Medicaid patients in California, is bogged down, mired in the mud of the Assembly Appropriations Committee where it is being held hostage. The 10% cut was imposed by the state budget in 2011 and recently was denied restoration by Governor Brown's recently revealed budget for 2014. It is clear that the Governor isn't going to do much to help Medi-Cal recipients or their treating doctors. Even if the bill passes, it'll have to survive his Gubernatorial veto. Readers interested in the survival of this bill will be obliged to rely on the democratic process, i.e., they'll need to call their elected state reps.


AB 2400 (Ridley-Thomas), sponsored by the California Medical Association, which would have allowed providers the ability to negotiate changes unilaterally made by health plans and their insurance companies, or to terminate the contract if agreement could not be reached, has bitten the dust. The tilt of the current administration, like the one that preceded it, is towards big business and against hapless patients and their beleaguered providers. This bill was residing uncomfortably in Senate Health Committee. Now it rests in not so peaceful repose. Readers interested in this bill will need to try to restore interest and build a wider coalition in 2015 than they had this year.


SB 492 (Hernandez) which would allow optometrists to practice aspects of ophthalmology that they are not currently licensed for has had better success. This bill passed Assembly Business and Professions Committee. It is opposed  by the California Medical Association, the Union of American Physicians and Dentists, the California Neurology Society, and a host of professional organizations whose weight in this case is negligible since their combined opposition is regarded as turf protection. 


One success is the failure of SB 1215 (Hernandez) to clear the Senate Business and Professions Committee. This bill would have eliminated the in-office exception for specific procedures such as physical therapy and advanced imaging including CAT and MRI scanning, ultrasound, and other procedures, thereby sending patients on a perpetual run-around. Readers can learn  more about this bill on the Advocacy and Legislation sections of the California Neurology Society website. The CMA, UAPD, CNS, et al were opposed and were part of a wide coalition in opposition.


An aulde lesson in these bills is the importance of coalitions not all of whose members need necessarily have a stake in the outcome. Protection of public welfare still plays a role albeit not as much as many of us would like.

ALERT: The trial lawyers' malpractice initiative has now been officially designated as Proposition 46 while the campaign against it, which we support, will be known as the No on 46 Campaign. The idea is to add Proposition 46 to our list of flame-outs lest its carelessness and callousness burn irreparable damage into California's health care.

MED-CAL PATIENTS SNUBBED BY STATE BUDGET

The 10 percent pay cut for reimbursement for providing medical care to Medi-Cal patients was not restored by the state budget that was accepted this past Sunday. Reimbursement for California's Medicaid patients remains among the lowest in the United States.  Although the budget did not make the cut retroactive, it's bad enough as it is -- patients on Medi-Cal often cannot get care. Restoration of the 10 percent cut would have alleviated but not cured this problem. So why would the Governor leave his Medi-Cal constituency in the lurch?


This writer spoke to the Governor about this problem during his first years as Governor when he was often known as "Gov. Moonbeam." This writer can attest that Brown was never a moonbeamer, maybe a little tilted towards idealism, but always realistic and politically savvy.


I asked him then about the  pro and con arguments for supporting increased Medi-Cal benefits.  He said the pro argument was that the Medi-Cal population might need the support and even benefit from it. But to do it money would have to be poured into Medi-Cal that was also desired and equally needed by other programs, programs more popular with the voters, and more vital to the interests of tax-payers. Brown wryly pointed out that if he supported increased funding for Medi-Cal, he'd probably not hear a word of appreciation from the Medi-Cal patients but he sure as heck would hear about it from other agencies that got stiffed and miffed.


Needless to say, the Medi-Cal raise didn't happen then, just as it didn't happen now. This time, however, there is a consolation prize:  the budget now includes $41.3 million for technical assistance to Medi-Cal providers that will help set up electronic health records pursuant to the federal Electronic Health Records incentive program.  $3.75 million will come from state funds, 37.5 million from matching federal funds. Not a bad deal for the techies!


When it comes to governing, nobody holds a candle to our Gov. Brown.