Health Care Issues on California's November Ballot Get Early Jump Start

by George Lauer, California Healthline Features Editor

TOPIC ALERT:

A couple of health care issues on the November ballot got early bursts of attention last week, seven months before California voters have their say.

A Berkeley research organization issued a report detailing early financial contributions in what is widely expected to be this year's most-watched and most-expensive ballot measure -- a proposal to give the state government regulatory authority over health insurance premium rates. The report offered no big surprise: Health insurers appear willing to spend lots of money to defeat the initiative.

Proponents of another ballot measure aimed at increasing public accountability for California physicians jumped on CMS' recent release of detailed Medicare physician payment data. Proponents said the payment disclosure -- CMS' first since 1979 -- undermines the stance of the California Medical Association. CMA opposes the ballot initiative.

The early political salvoes suggest California voters are in for long, heated campaigns on at least two health care fronts over the coming months.

Insurers Invest in Campaign Against Rate Regulation

So far, health insurers -- led by WellPoint -- have contributed $13.4 million to the campaign to defeat rate regulation in California. WellPoint, based in Indiana, contributed $12.5 million in December.

MapLight, a Berkeley research organization, issued a report last week detailing campaign information from the Secretary of State's office. The report showed proponents had accumulated $425,521 as of April 2.

Other contributors to the opposition campaign include Kaiser Permanente and Anthem Blue Cross, which each donated $270,000. Blue Shield of California gave $180,000, Health Net gave $135,000, and the California Association of Health Plans and United Healthcare each gave $30,000.

"And we really haven't even started yet," said Jamie Court, president of Consumer Watchdog.

"We fully expect the opposition to have between $50 million and $100 million and we don't think it matters," Court said. "Maybe it's naïve to think this way, but I really think the voters are going to see this one for what it is -- a move in their best self-interest," Court said.

Requests for comment from WellPoint and Kaiser were referred to Robin Swanson in Sacramento, who is handling inquiries for a coalition of the measure's opponents called Californians Against Higher Health Care Costs.

"Our coalition of doctors, hospitals, small businesses and health care providers is opposed to the measure because the new bureaucracy created by this initiative would be headed by a single elected politician who would have broad new power over our health care, including what treatment options health insurance covers. Treatment decisions should be made by doctors and patients -- not someone with a political agenda," Swanson said in a written response.

CMS Data Sparks Political Jab

Proponents of an initiative seeking more public accountability for California physicians said the federal government's posting online of Medicare payments to specific physicians puts California Medical Association leaders in an uncomfortable position.

"The California Medical Association is standing in the way of public accountability for dangerous doctors by organizing against basic patient safety measures and yet its leaders are taking millions from the very taxpayers they refuse to protect," said Carmen Balber of Consumer Watchdog in a prepared release.

Consumer Watchdog, a leading proponent of an initiative seeking tighter regulation of physicians prescribing controlled substances, as well as drug and alcohol testing for physicians, said government data shows 34 of 54 members of the CMA Board of Trustees were paid almost $5 million by Medicare in 2012.

Molly Weedn, associate vice president at CMA, did not give credence to the criticism.

"Drawing major conclusions from raw data is always misleading, but it's hardly a surprise, since these are the same proponents of medical lawsuits who are attempting to mislead California voters with a deceptive, expensive ballot measure that will increase health costs and reduce health access," Weedn said.

Health Care Issues on November Ballot

So far, only one health care measure -- rate regulation -- has qualified for the November ballot. Several others are in various stages of signature gathering and checking. For those measures that pass bureaucratic muster, the California Secretary of State will assign proposition numbers and release final language this summer.

Here's a quick look at what voters can expect:

  • State approval of health insurance rate increases: The measure requires the state insurance commissioner to approve premium increases for health insurance in the individual and small group markets. Proponents include Consumer Watchdog and California Insurance Commissioner Dave Jones. Health insurers are opposed.
  • Controlled substance prescription regulation; drug and alcohol testing of physicians and new regulations governing medical negligence lawsuits: Known as the Troy and Alana Pack Patient Safety Act, the measure would require physicians to check a state database before writing a controlled substance prescription for a patient for the first time. It also would reform the Medical Injury Compensation Reform Act to increase the current $250,000 cap on non-economic damages to about $1.1 million. The measure also would require random drug and alcohol testing of physicians as well as testing following an adverse event to a patient. Proponents include Consumer Watchdog. Opponents include CMA.
  • Tobacco tax: Known as the California Healthcare, Research, and Prevention Tobacco Tax Act of 2014, the measure would add a dime to the cost of each cigarette sold in California -- or $2 per pack. Proponents say money would be used to offset the cost of providing health care to individuals with tobacco-related diseases, cancer research, and prevention. Proponents include cancer and health organizations. Opponents include tobacco industry.
  • Pay limits at not-for-profit hospitals, physician groups: The initiative would require not-for-profit hospitals and physicians groups to limit executive compensation to the same salary and expense allowance of the president of the United States -- currently $450,000. The measure also would require annual public disclosure of the state's 10 highest-paid not-for-profit health organization executives. Proponents include Service International Employees Union. Opponents include hospitals and physician groups.
  • Hospital charge limitations: This measure would prohibit most California hospitals from charging more than 25% above the estimated cost of goods and services provided to patients. Public, children's and veterans hospitals would be exempt. Hospitals also would have to provide annual patient care expense and revenue reports. Proponents include SEIU. Opponents include hospitals and hospital organizations.
  • Medi-Cal funding for hospitals: Known as the Medi-Cal Funding and Accountability Act of 2014, this measure would extend a hospital quality assurance fee program for two additional years and would prohibit the Legislature and the governor from imposing Medi-Cal fees or taxes on hospitals unless the funding and matching federal funds are used to pay for hospital care provided to Medi-Cal patients. Proponents include the California Hospital Association.

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