Democrats Unveil Rival HMO Plan

Saying that Gov. Pete Wilson has not gone far enough down the road of reform, Democrats in the state Assembly on Monday unveiled their own plan to regulate California’s managed health care industry.

At the center of the plan is the proposed five-point Family Health Care Rights Act. Assembly Speaker Cruz Bustamante (D-Fresno) said the plan, if enacted, would constitute “the bedrock of California’s health care system.”

Included in the plan is the right to retain one’s doctor even if the physician leaves the health plan; the right to medical treatment as recommended by a doctor; access to information about medical benefits; the right to emergency care on demand and assurances of medical records’ confidentiality.

The Democrats released their proposal only days after Wilson set forth his point-by-point HMO reform agenda, which is largely based on recommendations from a task force he appointed.

The competing proposals will now wend their way through the Legislature. Though there is mutual agreement on some issues--such as creation of a state agency to oversee the managed care industry, as proposed by the governor--there are disagreements on many others.

Democrats say Wilson’s proposal is too tied to the economics of health care and favors business. The governor says a comprehensive plan must take into account the economics of health care while also improving patient care.

The half-dozen Assembly members who gathered Monday to announce their proposed HMO reforms said the governor’s proposals fall short of the regulation the industry requires if fairness is to be restored to the system.

Assemblyman Martin Gallegos (D-Baldwin Park), chairman of the Assembly Health Committee, said Monday that Democrats have pursued meaningful HMO reforms for years. But, he said, “we have been stymied by a Republican governor who has vetoed significant bills and threatened others.”

Wilson vetoed half a dozen HMO reform measures last year, saying he would not enact legislation--with the exception of one bill on hospital stays for women--until his task force reported its findings.

Now that Wilson is no longer threatening to veto HMO bills, the Democrats said their major push for reform will take place this year.

Expanded rights to doctor choice and medical treatment form the basis of the Democratic plan. Included in the package of more than a dozen bills are new restrictions on HMOs that would prohibit the termination of a doctor from a health plan or physicians’ group without cause.

In addition, the reforms would make it easier for patients to see specialists and allow women to obtain obstetrical and gynecological care directly, without a referral from a primary care physician.

Gallegos and others said they are willing to work with Wilson to achieve common aims in HMO reform.

Steve Tatum, a Wilson spokesman, said, however, that the governor has “indicated that in order to gain his signature, [HMO] legislation must safeguard or improve care . . . and be fiscally prudent and not include costly mandates.”

Allan Zaremberg, incoming president of the California Chamber of Commerce and member of a business taxpayers group concerned with health costs, said at least one bill in the Democratic package causes him concern.

A bill by Gallegos (AB 434) that would require a review process before a doctor can be terminated from a health plan would have a “chilling impact” on medical industry employers, Zaremberg said. Being forced to show cause not to renew an employee’s contract, he said, would affect “not only health plans but everyone in California who enters into [an employment] contract.”