VETO OR AMEND AB 72 (Bonta)

This memo was sent as a personal message to Governor Brown re AB 72 (Bonta) earlier this month just after the bill was enrolled and sent to his desk. Now we make it public:

"Because AB 72 leaves 'network contraction' as a viable business method, eliminating only the 'surprise billing' element,  if you let AB 72 slip into law, you might want to add a memo of your own that there should be follow-up legislation to make sure that the medical networks are fully staffed. 'Fully staffed' means that they include a complete range of medical and surgical specialists. 

Meantime, we recommend a veto."

Robert L. Weinmann, MD, Editor

Robert L. Weinmann, MD, Editor, The Weinmann Report (www.politicsofhealthcare.com) 

Reference for our readers:

Our original piece was posted on-line at www.politicsofhealthcare.com on 12 August 2016.  The title was "Assembly Bill 72 (Bonta): Oppose Unless Amended, a pending bait and switch bill," in other words, a bill to disallow "surprise billing" while leaving the underlying mechanism enabling appointment of out-of-network doctors intact. The mechanism is called "network contraction" and is also  known as "in-network cost sharing." It allows networks to understaff by purposefully not carrying enough network doctors to cover all medical and surgical specialties. It's a profitable network move at the expense of services to network subscribers or customers who don't know their insurance plan is not required by law to retain a full network of physicians and surgeons. So here is the amendment we recommended as of 8/12/16:

Health-care plans should be required to maintain full provider lists covering all specialties. The plans should provide these lists to their in-network providers and to all of their subscribers and customers. Networks that fail in this requirement should be penalized by fines and disciplinary action against their managers and officers.

9/23/2016 -- flash! Governor Brown signed AB 72 into law. There are no provisions in the bill to prevent corporate greed, e.g., "network contraction." The bill is aimed squarely between the eyes of "out-of-network" providers.

INVESTIGATING WORKERS COMP DENIALS OF CARE ON TELEVISION AND RADIO

The undersigned recently participated in two investigative stories, one on television, NBC Bay Area, the other on radio, KPFA, 94.1 Wednesday, 8/31/16.

The NBC Bay Area story was a three-part investigation of workers comp. The focus was bureaucratic delay and denial of care to injured workers in California. Here are the links: Dozens of Injured San Jose Firefighters Denied Workers' Comp Treatment; Workers' Comp Drags Out Medical Care, Injured Workers and their Doctors Say; and Injured Workers Face Stacked Deck During Workers' Comp Appeals Process, Critics Say.

The KPFA 94.1 story was broadcast on WorkWeek Radio. This program addressed "the growing crisis for injured workers" in California and revealed that Maximus, which does so-called "independent medical review," was paid $40 million in a "no bid contract to make determinations of whether workers were entitled to medical care." The story is a production of Work Week Radio, workweek@kpfa.org

The undersigned commented on SB 1160 (Mendoza) and on the continuing travesty that allows Utilization Review (UR) and Independent Medical Review (IMR) doctors to determine California-based cases even though these doctors may not be licensed in California and aren't subject to the state medical board. While SB 1160 may actually improve UR somewhat, its lien provisions harm access to care for injured workers.