HMO lobbyists say the report's recommendations, if implemented, would result in micromanagement of health care delivery and simply increase health care costs.

Some consumer groups, on the other hand, contend the recommendations do not go far enough. In response, those groups are drafting even more sweeping reforms. They have also drafted two initiatives that would remove existing liability caps on HMOs, among other things.

"Without the pressure from these initiatives, the Legislature and the governor will proceed with their business-as-usual attitude," said Jamie Court, executive director of Consumers for Quality Care, an L.A.-based consumer group.

With this much activity, "HMOs will not come out of this legislative session unscathed," said Dwyer. "They will not be able to ward off the legislation. There is just too much attention on HMOs right now."

Even the HMOs admit they are fighting a largely defensive battle.

"We anticipate an onslaught of legislation, on everything from utilization review to requiring coverage for mastectomy," said Snyder of the HMO trade group. "We are very concerned about the volume of legislation this year."

But HMO advocates say they, too, are scouring the task force recommendations. The aim, they say, is to forestall legislation that would be even more onerous and expensive than the task force recommendations.

Meanwhile in Washington, President Clinton's "Health Care Bill of Rights" has put patient care back in the spotlight.

Among its provisions: requiring health plans to give direct access to specialists; banning so-called "gag clauses" in which providers are forbidden from disclosing certain non-covered treatment options; and allowing patients to appeal treatment denials to independent medical boards.

Many of the provisions including a ban on "gag clauses" are already in effect in California. Other provisions, such as increasing access to specialists, are also being proposed in state reforms.

However, consumer advocates say that even though many of these provisions are already on the books, many cannot be enforced against employer-sponsored plans. Those plans, which include major companies (typically with at least 10,000 employees) that self-insure for health care, fall under the federal Employee Retirement and Income Security Act (ERISA), which pre-empts state laws.

Consumer advocates in California, including Consumers for Quality Care, are pushing for ERISA reform in Congress. Employer groups, insurers and HMOs oppose efforts to change ERISA and have mounted their own lobbying campaigns.

This legislative pressure comes at a time when HMOs are facing severe pressure from Wall Street.

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