Staff Reporter

As the HMO wars heat up in Sacramento this year, keeping track of who's who in the debate is almost as challenging as tracking the dozens of bills.

What follows is a score card spelling out the major players, and their agendas.

- The HMOs. At the center of the maelstrom are the health maintenance organizations, or HMOs. They are represented in Sacramento by the California Association of Health Plans, whose executive director is Myra Snyder.

The HMOs are primarily on the defensive against the scores of bills seeking to tighten controls over their operations. However, with the recent release of recommendations from Gov. Pete Wilson's health care task force, the HMOs are likely to push for limited reform in an attempt to head off more extensive and expensive changes.

- The consumer activists. There are two main groups involved in the health care debate: the Los Angeles-based Consumers for Quality Care and the Center for Health Care Rights, also based in L.A. Consumers for Quality Care is headed by Jamie Court and Harvey Rosenfield. It was Rosenfield who sponsored the successful Proposition 103 in 1988 that required insurers to roll back auto insurance rates.

The Center for Health Care Rights is a Medicare patient service and advisory group that also lobbies for health care consumers. Its funding comes from a mix of state and private sources. It is headed by Peter Lee, who recently served on the state Managed Health Care Improvement Task Force.

Both groups want to transfer HMO oversight from the Department of Corporations to a new agency that would be governed either by a board or an elected official. They also want to reform the HMO arbitration process, ensure access to specialists and require HMOs to justify limits on coverage.

Other consumer groups, such as Consumers Union, are also active in the debate, but to a lesser extent than these two groups.

- Health workers' unions. These are represented by a coalition called Health Access, which was originally formed to sponsor the unsuccessful Proposition 214 on the November 1996 ballot. (Among other provisions, the proposition would have prohibited health care companies from firing workers without just cause and banned bonuses for providers who withhold care.) The San Francisco group's chief lobbyist is Beth Capell.

The unions' interests generally are in accord with those of consumer activists, the only difference being an emphasis on preserving the jobs of health care workers in the face of consolidation. Health Access supports legislation that restricts the ability of HMOs to drop providers from their membership rosters and that would increase coverage for certain medical conditions.

- The employers. Several groups are involved here. There are the traditional employer lobbyists, such as the California Chamber of Commerce, whose health care point man is Executive Vice President Fred Main. Plus, there are trade associations like the California Manufacturers Association, with lobbyist Willie Washington taking the lead on health care issues.

Both the chamber and the CMA are key members of a new employer-centered health care lobbying group: Taxpayers Against Higher Health Costs. As its title suggests, the group opposes most of the HMO reforms, saying that new mandates would raise health care costs for employers and force some smaller employers to drop health coverage entirely.

- The physicians. There are two groups here: the California Medical Association and the California Medical Group Association. One of the most powerful lobbying organizations in the state, the CMA is headed by Dr. Jack McCleary and Dr. Jack Lewin. The CMA has long pushed for restraints on the HMOs' ability to drop providers and for higher payments to physicians.

The California chapter of the American Medical Group Association, which represents the ever-increasing number of physician groups, is represented in Sacramento by lobbyist Mary Griffen. In a sharp contrast to the CMA, the AMGA supports the right of HMOs to terminate contracts with physician providers.

- The Managed Health Care Improvement Task Force. This panel, composed of 20 appointees of Wilson and 10 legislative appointees, drafted more than 100 recommendations for HMO reform that are likely to set much of the framework for this year's debate. The group, which released its report this month, was chaired by Alain Enthoven, a professor at the Stanford University School of Business, who developed the managed care competition model for health care 20 years ago. Its executive director is Phil Romero, Wilson's chief economist.

- The Wilson administration. As the final arbiter of what legislation gets signed and what gets vetoed, Wilson wields considerable power in the HMO debate. Last year, he vetoed a half-dozen pieces of HMO reform legislation and threatened to veto virtually every one of the remaining 80 bills destined for his desk, saying he wanted to wait for the task force's recommendations.

Now that those recommendations are out, Wilson is under pressure from his natural allies in the employer community to limit the scope of HMO reform. But with the threat of far-reaching initiatives looming, and with the vagaries of election-year politics, it is far from certain what Wilson will sign.

- The legislators. While dozens of legislators have health care bills pending, two have emerged as the most powerful: State Sen. Herschel Rosenthal, chairman of the Senate Insurance Committee, and Assemblyman Martin Gallegos, chairman of the Assembly Health Committee. Both are activists pushing for tighter controls on HMOs.

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