CMA Capitol Insight: Mea Culpa (Kinda)

March 17, 2014
Area(s) of Interest: Licensing & Regulatory Issues 

CMA Capitol Insight is a biweekly column by veteran journalist Greg Lucas, reporting on the inner workings of the state Legislature.

Mea Culpa (Kinda)

A spokesman for the California State Senate insists the upper house has only introduced 630 bills this year – despite all evidence to the contrary in the Senate’s own Daily File, which shows 1,404 bills in print since January 7, the first day of this year’s legislative session. Capitol Insight used the Daily File’s total in a March 3 item noting the sizable number of bills introduced this year, following a pretty sizable 2013. The Senate also wishes the world to know that 630 new bills this year – an average of 15.75 pieces of legislation per senator – is a record low for the 21st century, to which the only appropriate response would be “keep up the good work.”

Sugar-Sweetened Safety

Among the alleged 630 bills introduced this year by the senate is SB 1000 by Bill Monning, a Santa Cruz Democrat. Monning’s bill would require a “sugar-sweetened beverage” container to bear a boldface statement that says: “STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay.” The legislation, backed by the California Medical Association (CMA), first lays out a number of facts the medical community is already well aware of: The prevalence of obesity has grown from 8.9 percent in 1984 to 25 percent in 2012, while the single-largest source of added sugar in the American diet is sugar-sweetened drinks. If that’s not disturbing enough, the bill notes that the average American drinks nearly 45 gallons of sweetened beverages annually, the equivalent of 39 pounds of sugar. Doesn’t seem quite so lip-smacking yummy put that way. Last June, the American Medical Association declared obesity a disease. Monning says that in California, 19 percent of kids ages 2 to 5 drink at least one sugar-sweetened beverage each day, while 32 percent of those aged 6 through 11 do the same, as do 65 percent of 12- to 17-year-olds. Seventy-four percent of California’s African American adolescents drink at least one sugar-sweetened beverage each day, compared to 73 percent of Latinos, 63 percent of Asians and 56 percent of whites. Opponents of Monning’s bill will likely be the same as those who defeated a CMA-backed bill in 2012 that would have banned the sale at middle schools and high schools of sports drinks with more than 42 grams of added sweetener per 20 ounces. The listed opponents on that bill, AB 1746, were the California Chamber of Commerce and the California/Nevada Soft Drink Association, representing the makers of guess what. At its second hearing on April 18, 2012, the sports drink bill was sent to the Assembly Appropriations Committee “suspense file.” While Monning would impose labels rather than ban sales – an easier legislative sell – lawmakers differ on the efficacy of product labeling, not just on a party-line basis. While labeling legislation is least likely to win support from GOP lawmakers who view it as a curtailment on consumer freedom, some Democrats believe the proliferation of warning labels – think Prop. 65 – dulls their persuasiveness. Put another way: Those who know the perils of obesity don’t need the warning, and those who’d benefit from heeding the advice ignore it. Or, as The Grateful Dead say in one of their songs: “You ain’t gonna learn what you don’t wanna know.”


Here’s a CMA-backed bill that addresses an issue that seems like it shouldn’t even be an issue. Assemblyman Manny Perez’s AB 1771 says California’s health insurers need to pay doctors in their network for telehealth services, both electronic and telephonic. Hello? Telehealth improves continuity of care, cuts down on unnecessary office visits and offers faster, more convenient treatment. How often do reports appear discussing California‘s chronic physician shortage, the skewed distribution of the doctors the Golden State does have, and strategies to rein in spiraling health care costs? In each and every one of those reports, there are mention of telehealth as a sensible approach to expand the reach of care into less-served parts of the state, offer patients an alternative to face-to-face physician evaluations, and boost the utilization of a health care provider’s expertise. At the moment, the policies of the state’s health insurers vary. Some deny requests for coverage. Some reimburse telephone or electronic exchanges at a lower rate than in-person. Some treat them just like an office visit. But if all parties agree the practice is cost-effective, seems like old-fashioned common sense to encourage it.

Tempus Fugit

Seems like a few weeks ago that Covered California was touting its soon-to-be-unveiled website designed to help uncovered Californians purchase the health insurance they’d need after the federal Affordable Care Act became operative in January 2014. Now it’s just 14 days to the March 31 deadline to enroll in a Covered California plan that’ll start this year. A problem-free six months? No, but significantly less bollixed up than some other larger states and the federal government. California also voluntarily increased its chances at failure by making Covered California a player in the marketplace, establishing coverage minimums and other criteria rather than the hands-off approach of other states. And while the marketplace created by Covered California might not be a physician’s ideal, it did handle most of the stresses and strains of a major sea change in the delivery of health care in the nation’s most populous state. As of March 9, over 920,000 people had picked a health plan through Covered California. About 85 percent of them will get a government subsidy to lower the cost of coverage. Sign-ups slowed in February to 165,000, partly because the enrollment website was down for five days. In January, there were 220,000 sign-ups; in December, there were 400,000. Covered California says that 1.1 million applicants are expected to receive coverage through Medi-Cal, whose eligibility rules were expanded under the Affordable Care Act. Not bad for government work. Medi-Cal enrollment continues year-round. And, even if the March 31 open enrollment deadline is missed, exceptions are made for a major event like the birth of a child or loss of employer-provided health coverage.

Deadline Looming

March 24 is when backers of the initiative to remove the cap on noneconomic damages in malpractice awards must submit 504,760 valid signatures to place the measure on the November ballot. The qualification effort has been bankrolled primarily by a $1 million contribution by the Consumer Attorney issue Political Action Committee to the innocuous sounding “Your Neighbors for Patient Safety, a Coalition of Consumer Attorneys and Patient Safety Advocates committee, which is running the initiative campaign. Your Neighbors for Patient Safety has paid $800,000 from November 1 through January 31 to Kimball Petition Management, Inc., a Westlake signature-gathering firm used routinely by trial lawyers and unions. Based on payouts to the firm for previous petition drives, the $800,000 is just a down payment.

But Is It An Armani?

Former Assembly Speaker and San Francisco Mayor Willie Brown becomes an octogenarian on March 20. As if to punctuate that fact, the always-dapper Brown recently wrenched his back. Ever unflappable, he describes the incident this way in “Willie’s World,” his weekly San Francisco Chronicle column:

“I made a new addition to my wardrobe recently – a walker. I blew out my back while ascending the stairs at the Battery for a dinner following the opening of the Valentino boutique. It hurt like hell but by concentrating on actress Connie Nielsen, who was sitting in the front row, I managed to pull off my speaking responsibilities before heading off to the hospital for tests that seemed to check me for every condition known to humanity, including pregnancy. The medical technician doing the ultrasound took one look at my nametag and said, ‘It's amazing, you have the same name as the former mayor.’ With that, I ran out of the ultrasound room.”


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