Group to Propose Managed-Care Reform

Continuing the push for stricter regulation of the managed-care industry, a group of Democratic lawmakers, health-care advocates and labor unions today will unveil a package of California legislation that would give patients the right to second medical opinions, set 48-hour minimum stays for mastectomy patients and provide a host of other consumer protections.

The legislative package revisits some issues included in two ballot measures that California voters rejected in November. Sponsors of the bills say they hope to accomplish in the Legislature what they were unable to achieve by direct vote.

Despite the ballot turndown, “there’s a lot of unhappiness with the health plans on issues like access to care, choice [of physicians] and quality of care,” said state Assemblyman Martin Gallegos (D-Baldwin Park), author of several managed-care reform bills.

California legislators and HMO industry officials say they expect more than 100 managed-care bills to be put up for consideration this year. There was also a flurry of activity on managed-care issues in Sacramento--and in state legislatures across the country--in 1996.

The industry’s efforts to control health-care costs by emphasizing preventive care and restricting choice of doctors, hospitals and services deemed to be unnecessary have prompted a flood of complaints from consumers.

HMOs, the most restrictive type of managed-care plans, insist that they offer excellent care and that consumer surveys show the vast majority of members are happy.

“I think we’re going through a schizophrenic phase now,” said Myra Snyder, chief executive of the California Assn. of HMOs, a trade group. “The Legislature wants to decrease medical costs . . . but they also want everybody to have everything” in health benefits.

Supporters--led by Health Access California, a statewide health-care advocacy group--have dubbed the 11 bills being introduced today “the patient bill of rights.”

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Among the bills is a proposal to require health insurers to pay for a second opinion from a qualified physician if patients ask. The bill’s author is Assemblyman Michael Sweeney (D-Hayward).

Two bills by Assemblywomen Liz Figueroa (D-Fremont) and Valerie Brown (D-Santa Rosa) would require insurers to pay for a minimum 48-hour hospital stay and post-surgical home visits for patients undergoing mastectomies, lumpectomies and other breast cancer surgery.

The bills--similar to ones proposed in Congress and a number of other states--are a response to moves by some insurers to require that mastectomies be performed as an outpatient procedure without an overnight hospital stay.

Hoping to quell public outrage over the practice, the HMO industry’s national trade group--the American Assn. of Health Plans--recently took the position that mastectomy patients should not be rushed out of hospitals.