Managed Care Bill Gets Senate OK

After getting a favorable signal from Gov. Pete Wilson, the state Senate on Thursday approved a managed care reform bill that would give more women direct access to obstetricians and gynecologists.

The bill, virtually identical to one Wilson vetoed last summer, was passed on a bipartisan 30-3 vote and moves to the Assembly. The lower chamber is expected to send it to Wilson in the next week or so.

Wilson’s spokeswoman said the governor “favors the concept” of the bill by Assemblywoman Susan A. Davis (D-San Diego), but stopped short of saying he would sign it.

Senate approval of the Davis measure (AB 12) marked the first significant action this session to reform California’s multibillion-dollar managed health care industry.

The reform drive was brought to a temporary halt last summer when Wilson vowed to veto more than 80 managed care bills he considered “uncoordinated, reactive [and] piecemeal” solutions to complex problems.

The governor demanded that the Legislature delay further reform efforts until a special task force he appointed had studied the issues and reported its findings in January.

At the time, Wilson said he had vetoed the original Davis bill because it violated his warning to the lawmakers, not because of the measure’s merits.

In its recommendations, the task force called for support of legislation that would give women in managed care plans direct access to obstetricians and gynecologists without first receiving approval from primary care physicians.

Most managed health programs require consent of a primary care physician before patients can visit specialists, such as OB-GYNs. But backers of the legislation said that for most women in California, OB-GYNs are primary care doctors.

Sen. Bruce McPherson (R-Santa Cruz), who managed the bill on the Senate floor, argued Thursday that care by an OB-GYN “is basic care for women.”

Davis said women enrolled in some managed care plans have direct access to an OB-GYN and that her bill would extend the same benefits to others, provided that the OB-GYNs are included in the plan’s network of physicians.

Davis said she worked closely with Wilson’s staff on her latest bill and expects him to sign it. Senate Republicans also indicated they were told Wilson supports it.

However, Lisa Kalustian, a Wilson spokeswoman, stopped short of saying he would sign it. She said the governor “favors the concept,” had so informed the Legislature, but that no one now knows what his decision will be.

Jamie Court, director of Los Angeles-based Consumers for Quality Care, said his group supports Davis’ bill and that Wilson should sign it.

Court said his group is concerned that the governor will accept relatively limited reform bills, such as the Davis measure, but will reject more far-reaching proposals.

These include, he said, giving patients the power to sue health maintenance organizations for medical malpractice and putting the HMO industry under the regulation of a state commission, whose members would include consumers.