Medi-Cal Rx to implement utilization management criteria for Code 1 diagnosis restricted drugs on April 30

October 02, 2017
Area(s) of Interest: Advocacy Health Care Reform 

Last week, the latest effort to repeal the Affordable Care Act (ACA) collapsed, after three Republican Senators announced their opposition—Susan Collins (R-ME), Rand Paul (R-KY) and John McCain R-AZ). Further action is unlikely this year, as Senate Republican Leader Mitch McConnell (R-KY) said the Senate would now turn its focus to overhauling the tax code. However, several Republicans vowed to continue to work into next year to repeal the ACA.

The California Medical Association (CMA), the American Medical Association (AMA) and all of organized medicine were united in opposing this harmful bill, which would have repealed the ACA’s insurance mandate, underfunded health insurance subsidies and made drastic cuts to the Medicaid program.

The Graham-Cassidy block grant proposal would have been disproportionately harmful to states like California, which embraced Medicaid expansion and increased coverage under the ACA. Even states that initially came out ahead under the block grant framework would have experienced devastating funding cuts over time from the bill’s Medicaid funding caps on children, the elderly and the disabled.

Millions of Californians would have lost their coverage, and many others would have been seriously underinsured.

Patients without coverage seek more expensive care in overcrowded emergency rooms, passing costs onto states, counties, health care providers and taxpayers. These patients also put off treatment, ending up with more serious conditions that could have been prevented. These problems would be exacerbated by the reduction of subsidies currently provided to poor and middle class families. The Graham-Cassidy bill would also have allowed states to do away with pre-existing condition protections and other essential health benefits that keep Americans healthy.

“Congress should engage with physicians and other medical experts on the front lines caring for patients to develop legislation that improves patient access to physicians, protects coverage for our most vulnerable populations and addresses affordability,” said CMA President Ruth Haskins, M.D.

In the meantime, bipartisan negotiations have resumed in the Senate between Health Committee Chairman Alexander (R-TN) and lead Democrat Patty Murray (D-WA) to adopt reforms to stabilize the individual market, such as funding cost-sharing subsidies and reinsurance. CMA and AMA support this effort.

It has been a long and difficult year for physicians who want to make constructive improvements to the health care system. While the ACA has its flaws, none of the House and Senate proposals thus far have met CMA’s principles for health care reform. CMA and the physicians of California will keep fighting for reforms that increase patient access to health care and maintain coverage for the millions of Californians insured through Medi-Cal and Covered California.


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