April 09, 2018
Area(s) of Interest: Access to Care Advocacy
Today, Assemblymember Ash Kalra (D-San Jose) released new details on a radical new legislative proposal that would increase patient out-of-pocket costs and result in a dangerous government intrusion into the health care market by creating state-sanctioned rationing of health care for all Californians.
Assembly Bill 3087 would establish an undemocratic, government-run commission with nine political appointees who would unilaterally set the price for all medical services that are not already controlled by the government, essentially eliminating commercial health care markets in California. None of the political appointees are required to be patient-focused or have any tangible experience in the delivery of health care to patients.
“No state in America has ever attempted such an unproven policy of inflexible, government-managed price caps across every health care service,” said California Medical Association (CMA) President Theodore M. Mazer. “It threatens to reverse the historic gains for health coverage and access made in California since the passage of the Affordable Care Act.”
Despite fundamentally altering how health care services are provided in California, the bill explicitly prohibits health care professionals from participating on the commission. This commission—constructed to view patient care simply as a cost center—would have the unprecedented authority to ration the timing and quality of care California patients receive by fixing the prices of the commercial health care market.
This bill does nothing to ensure that patient out-of-pocket costs are decreased and moves California away from the goal of value-based care backwards to an antiquated fee-for-service model. It would also have the consequence of dramatically reducing consumer choices.
“AB 3087 is a poorly conceived, monumental threat to patient access to health care that goes against the Assembly’s own expert recommendations,” said Dr. Mazer. “This dangerously flawed legislation would result in government-sanctioned rationing of care and higher out-of-pocket costs for patients.”
The bill would also put additional cost pressure on the California health care delivery system by allowing lawyers and lobbyists to be reimbursed by the Commission for lobbying the Commission. This process mirrors existing intervenor fee models that have not reduced overall consumer cost—but have served as a means for special interests to, as one former State Insurance Commissioner alleged, get “fat off the public trough.” Brazenly, the bill also creates a direct funding mechanism that would financially benefit one of the bill's sponsors.
AB 3087 also ignores the recommendations from the University of California, San Francisco’s report—commissioned by the Assembly—to achieve universal access to health care, which includes implementing a comprehensive strategy to overcome the physician workforce shortage in the state by removing barriers that prevent physicians and other clinicians from specializing in primary care and practicing in underserved areas. Currently, six of nine California regions are already facing a primary care provider shortage, and 23 of California’s 58 counties fall below the minimum required primary care physician-to-population ratio. The state needs 8,243 additional primary care physicians by 2030 – a 32 percent increase.
“AB 3087 would cause an exodus of practicing physicians, which would exacerbate our physician shortage and make California unattractive to new physician recruits,” said Dr. Mazer. “The Legislature should reject AB 3087, and instead, focus on real solutions that further value-based care, ensure a patient can access a physician when they need one and tackle California’s physician shortage.”
Historically, policies of inflexible and arbitrary price caps are viewed as ineffective in controlling costs and detrimental to access to health care. During federal health reform discussions, both the Obama and Clinton Administration considered price-cap proposals but ultimately rejected them on the basis that they posed too many direct and indirect risks to the overall health care delivery system.
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The California Medical Association represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit Facebook, Twitter, LinkedIn and Instagram.