Doctors Take No Stance on Props. 214, 216

The California Medical Assn., a frequent opponent of the HMO industry, has decided to remain on the sidelines in the battle over two November ballot initiatives designed to reform the powerful managed care industry.

After a heated debate, the CMA’s 48-member board of directors voted late Friday to adopt a neutral position on Propositions 214 and 216, two similar but competing health reform initiatives backed by labor unions and consumer groups.

The decision reflects the sharp split within the state’s largest physician group between doctors who support and are deeply involved in managed care, and those who believe that HMOs are jeopardizing the quality of medical care and doctor-patient relationships.

Backers of the initiatives said Saturday that they were disappointed but not surprised by the CMA’s decision. They noted that the CMA membership includes a large number of doctors who work for Kaiser Permanente, the state’s largest HMO, and for medical groups that depend on HMO contracts for their financial survival.

“We were pleased they stayed neutral,” said Maureen Anderson, spokeswoman for the Yes on 214 campaign. “The CMA had tremendous pressure from the HMOs to go negative on the initiative.”

Doctors “are far more tied into the managed care industry from a financial point of view,” said Rose Ann DeMoro, executive director of the California Nurses Assn., the principal backer of Proposition 216 along with consumer activist Ralph Nader. “I think [the neutral vote] really reflects the weakened power of the state’s doctors.”

The CMA, in an effort to counter the growing influence of managed care, recently created its own medical plan, California Advantage. The doctors’ group has said it may seek a state license to form its own HMO, presumably making it subject to any of the regulations enacted by passage of Propositions 214 or 216.

Indeed, the CMA has backed managed care reforms virtually identical to key provisions of the two initiatives, such as legislation to prohibit health plans from retaliating against doctors who advocate for their patients. The state medical group was largely responsible for bringing the issue of doctor “gag clauses” to national attention, sparking efforts in Congress and many states to outlaw such clauses in HMO contracts.

Dr. Jack Lewin, the CMA’s executive vice president, acknowledged that many doctors have questioned how, given the CMA’s closely aligned goals, it could not support the initiatives. But he contended that the decision to remain neutral was not a sign of weakness.

“It’s not a wimpy stand for us to take,” Lewin said. “The pain in the room was that we couldn’t support the very patient protections that we believe so strongly in.”

Lewin said the measures, which contain a laundry list of provisions, were “severely flawed” by provisions that “look more like labor union issues than patient protections.”

Proposition 214’s principal sponsor is the Service Employees International Union, which represents many health care workers.

Both initiatives would require the state to ensure “safe and adequate staffing levels” at hospitals and other health care facilities. Lewin said those provisions seem largely aimed at preserving union jobs.

The two rival measures are the result of a falling out between the nurses union/Ralph Nader group and the SEIU, which prevented an agreement to endorse a single initiative. The SEIU group has complained that certain business taxes in Proposition 216 make that measure more vulnerable to defeat.