If Education Is 1st, 2nd and 3rd, Where’s Health Care?

Where does health care reform fit on the agenda of a governor who has vowed to make education his first, second and third priorities?

“I guess that says it ranks fourth,” joked one Democratic legislator.

The future of health care in California is one of the great unknowns about the Gray Davis administration. What is certain is that many legislators, lobbyists and consumer advocates are raring to resolve long-simmering debates that his predecessor, Pete Wilson, left on the burner.

Davis, who does not have an extensive track record on health issues, has offered few signals on his health care agenda. And some he has offered appear contradictory, or at least confusing.

During a visit to Washington last week, while he said he “definitely” wants to move oversight of HMOs out of the Department of Corporations--an agency critics call toothless--he also suggested that he’d like to give managed care the opportunity to reform itself before the government steps in.

“If it’s clear that HMOs will not get ahead of the curve, and act in a way that shows considerable interest in the patients . . . then we will respond,” he said. “My preference is that they meet with patients, consumer groups and various providers and see if as a coalition they can’t achieve a new consensus.”

Davis’ press secretary, Michael Bustamante, said Friday that his boss was only trying to warn HMOs that the government should not have to “embarrass” them into doing the right thing.

But consumer advocates and HMO critics thought the governor was going soft on managed care.

“I was definitely surprised,” said state Sen. Liz Figueroa (D-Fremont), chairwoman of the Senate Business and Professions Committee. “It appears that the governor does not understand the severity of the concerns consumers have.”

Some reform advocates are openly nervous about one of Davis’ imminent decisions: whether to put the Business, Transportation and Housing secretary or someone else in charge of HMO regulation. Consumer activists and the California Medical Assn. consider the Health and Human Services Agency and its secretary more inclined to focus on patient protection.

Other advocates worry that Davis’ overwhelming focus on education may divert attention from such issues as obtaining coverage for the state’s 7 million uninsured people, 1.6 million of whom are children.

“In pronouncing his priorities as education, education and education, many of us are wondering, ‘Is health care again on the back burner?’ ” said Arnoldo Torres, executive director of the California Hispanic Health Care Assn.

Still, many lobbyists and legislators are optimistic that Davis ultimately will act on a host of matters that hopelessly divided former Gov. Pete Wilson and his opponents--from expanding mental health coverage to requiring doctors to report all cases of HIV infection.

Walter Zelman, president of the California Assn. of Health Plans, said he appreciates Davis’ “thoughtful” approach as legislation on managed care reform--some of the bills conflicting with others--pile up.

Assemblyman Martin Gallegos (D-Baldwin Park), chairman of the Health Committee, said he was encouraged that Davis last week dispatched state Health and Human Services Secretary Grantland Johnson and Business, Transportation and Housing Secretary Maria Contreras-Sweet to meet with his committee. Davis has instructed the two secretaries to come up with recommendations on HMO reform by early this month.

The committee’s Republican vice chairman, Scott Baugh, said tensions that characterized the last legislative session have eased, and the “environment is ripe” for progress on managed care reform--though he disputed critics’ complaints that Wilson “did nothing” on managed care.

Davis supporters say the new governor already has taken speedy and decisive action on several health issues--endorsing family planning and prenatal care for illegal immigrants, for example.

Johnson said Davis’ focus on education by no means shoves health care aside because the two issues are strongly linked.

“If a child is not healthy or is chronically ill, it’s much more difficult for him to succeed,” he said. “[Davis] has . . . a firm commitment to expand the accessibility of coverage to them and their family members.”

Davis has said he wants to ensure that uninsured children who are eligible for government-supported insurance programs are enrolled. That is no small challenge. In California, about 788,000 children who are eligible for Medi-Cal are not signed up, according to estimates by the UCLA Center for Health Policy. Critics complain that the program suffers the stigma of welfare and that outreach efforts have been anemic.

The new federally subsidized Healthy Families program, designed for children whose families are too poor to buy insurance and too well off for Medi-Cal, hasn’t met its enrollment goals either. About 73,000 of the 328,000 eligible kids are enrolled--a shortfall that has children’s advocates alarmed.

Yet Davis pledged in January that he will support a modest expansion of Healthy Families and, if the budget permits, may widen eligibility still more in May. Johnson suggested that the administration is exploring efforts to extend coverage to uninsured working adults, as well.

Lawmakers have introduced several bills to expand Healthy Families, and substantial federal dollars might be leveraged for the effort. But some critics say improving access to the existing program must come first.

“We should not be enhancing and expanding the program when . . . we’re doing such a lousy job” getting it started, Torres said.

Some health care experts believe Medi-Cal ought to be entirely revamped, as well. To simplify matters, others support a melding of all insurance programs serving California’s poor families.

Baugh said Republicans prefer to address the insurance crisis through the private sector, by offering incentives for expanded employer-based coverage. “Otherwise we’re marching down the path toward socialized medicine,” Baugh said.

Other health issues likely to command the governor’s attention are:

* HMO accountability. Besides oversight of HMOs, the big issue is how to hold them accountable to consumers. Davis, like many other Democrats, has said he favors giving consumers timely access to review by independent physicians as well an expanded right to sue their HMOs. Baugh said Republicans might go along, provided consumers first take complaints through an independent review before filing suit. Zelman drew the line at more liability, saying external review is sufficient.

* Medical malpractice reform. Should plaintiffs in malpractice suits be limited to $250,000 in pain and suffering damages?

Essentially, consumer advocates and trial lawyers argue that the pain and suffering cap, which hasn’t been raised since it was first imposed 24 years ago, should at least be adjusted for inflation. They say its paltry level is interfering with the ability of some clients to find lawyers. The California Medical Assn. argues that lifting the cap will cause health care costs to soar.

Davis has said he will not eliminate the cap but has hinted he might be open to some “adjustments.”

* HIV tracking. Should the government track cases by name or by code? AIDS groups and some in the medical community believe that reporting cases by patients’ names will deter people with privacy concerns from testing and treatment. But some Republican legislators and doctors believe codes hamper notification of potentially infected partners.

Calling privacy worries “irrational,” Wilson last year vetoed a tracking-by-code bill. This session, advocates of reporting by name have introduced rival legislation of their own.

Davis has not taken a public position, though Johnson said “we are very much aware of concerns about confidentiality.”

* Mental health coverage. Mental health advocates have dusted off legislation, vetoed by Wilson last year, requiring insurers to offer patients with major biological illnesses coverage on par with that of other organic diseases.

Davis said during his campaign that he would “like to” have increased mental health insurance but that he’d “have to keep in mind overall economic impacts.”

Marquis reported from Los Angeles, Lesher from Washington and Sacramento.