Although several reform measures already have been signed into law, health maintenance organizations appear to have dodged the brunt of the assault launched upon them in Sacramento this year.
The bills that have been signed by Gov. Pete Wilson are AB 1181, which guarantees access to specialist care for chronically ill and disabled patients; AB 607, which forces more disclosure of treatment plans by HMOs; and AB 12, which allows women direct access to obstetricians and gynecologists without a referral from their primary care physician.
Among the bills that have stalled are AB 2436, which would expand the grounds under which HMOs could be sued, and AB 2638, which critics say would effectively dismantle the current managed care system by expanding the rights of patients to choose their own doctors.
Although the legislative session is not over, HMO reform advocates acknowledge that little else in the way of reform is likely to get through this year.
"While the three bills that were signed into law are good bills, none of them represent the major types of reform that are needed in the system," conceded Assemblyman Martin Gallegos, D-Baldwin Park, who chairs the Assembly Healthcare Committee. "I blame that on the strong influence of the HMO lobby against reform."
HMO representatives say they are simply working to contain health care costs.
"If there are legitimate reforms, we want to address those issues, but we don't want to implement reforms that raise the costs of premiums," said Bob Scarlett, vice president of state affairs for Wellpoint Heath Networks, the parent company of Blue Cross of California. "We want to keep the premiums low."
Consumer advocates claim that HMOs won not on merit, but on the strength of campaign contributions.
"The HMOs have more than doubled their lobbying efforts in Sacramento," said Jamie Court, director of Consumers for Quality Care. "But the crowds are going to get restless. The opposing candidates of HMO reform are going to have to pay attention. Significant reform will have to take place, it is just a matter of when."
Court said the HMO lobby spent about $1.4 million in 1997, up from about $400,000 in 1996.
So far, Scarlett said Wellpoint alone contributed $160,000 in campaign funds this year but said that's relatively low for companies of its size (nearly $6 billion in annual revenues).
"We are a big company," he said. "PG & E; gave $1 million. We don't give that much relative to other industries. Our influence is that we present good arguments."
Jennifer Fitzgerald, Republican caucus consultant for health care, agreed, saying that the "HMOs have been very proactive this year. I think we have a ton of comprehensive reform out there and both sides are trying to pass good reform."
Gallegos said the only other reform bill likely to be signed into law this year is AB 406, which would transfer jurisdiction over regulation of the HMO industry from the Department of Corporations to a new HMO board set up within the Department of Consumer Affairs.
That was among the recommendations of the Managed Health Care Improvement Taskforce, which Wilson created last year to sort through increasing demands for HMO reforms.
Dozens of other bills are expected to languish.
"The legislative process is slow and there are a lot of competing interests," said Fred Main, senior vice president of the California Chamber of Commerce. "There is a lot of focus on the election and people are trying to figure out if they will be here next year. It (health care reform) is really still being held in the balance."
At the same time, however, Scarlett suggested that even Democrats may not be anxious to see bills passed this year, given the likelihood that Wilson will veto legislation that hits HMOs too hard.
"They are just hoping they get a Democratic governor, and then they will be able to create more reform," he said.
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