By HOWARD FINE
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.
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