CMA Praises Progress to Cover Uninsured, Calls for More Improvements to Protect Patients - Posted 12.24.09

Sacramento - After the Senate's passage of health care reform today, California physicians called on congressional leaders to continue improving the legislation as it moves to the next stage of development, a conference committee charged with drafting a final version of the bill.

“We have serious concerns with the Senate bill, which does not do enough to protect access to care for senior citizens and other California patients,” said Brennan Cassidy, M.D., president of the California Medical Association. “We hope congressional leaders recognize that more must be done, including providing long-term stability and funding needed in Medicare and Medicaid so patients can see a doctor when they need to.”

The Senate bill has changed significantly since last month, when CMA opposed the measure as it was drafted. Among the improvements are:
• The 10 percent increase for primary care and general surgery will not be paid for by cutting payment rates for specialists. Therefore, the specialist rate reduction of 0.5 percent has been eliminated.
• The 5 percent tax on cosmetic surgery and medical procedures has been eliminated.
• The Medicare physician enrollment fee of $350 has been eliminated.
• The comparative effectiveness research provision has been further clarified to ensure that the sole research focus is on clinical information and use by physicians, not coverage and payment.
• CMA medical liability protections have been included to ensure that physicians are not exposed to new liability as a result of the quality or payment provisions in the bill.
However, the Senate legislation still falls short in many important areas, and CMA will work to correct these shortcomings during the conference committee process. CMA supports the following provisions for the conference committee bill:
• Correcting Medicare’s flawed funding formula, known as the Sustainable Growth Rate (SGR). That formula would cut funding by 40 percent in future years if left in place and would hurt senior citizens’ ability to find a doctor to treat them. The House bill provided a fix, the Senate bill did not.
• Increasing Medicaid’s low reimbursement rates. As it is, patients covered by Medicaid in California, known as Medi-Cal, often struggle to find a doctor because rates are so low that only about one third of the states’ physicians participate in the program. The House bill substantially increased rates, the Senate bill did not.
• Keeping congressional authority over Medicare instead of delegating to a committee, such as the Senate's proposed Medicare Payment Advisory Board, which could slash spending and coverage options with little input from others. The House bill does not include such a board.
• Improving quality reporting requirements to track Medicare treatment. It’s crucial that those standards provide accurate and meaningful reporting.
• Scrapping public physician performance report cards, as proposed by the Senate. The guidelines must be overhauled to be accurate and useful or dumped altogether. The House bill does not include the requirements.
• Giving patients the ability to privately contract with doctors.
• Boosting Medicare payments in 14 high-cost California counties where many physicians are opting out of the program and seniors are having trouble accessing doctors.

The House bill provides $300 million to California to update rates in those counties, which are currently classified for rural rates under the federal government's Geographic Practice Cost Index (GPCI). The Senate does not provide the adjustment.

CMA is a strong supporter of reform that provides universal access to health care. The current versions of the House and Senate bills provide coverage to at least 94 percent of the nation’s uninsured.
In addition, the bills provide assistance to help make health insurance affordable for low-income families through tax credits and subsidies. In California, two-thirds of the uninsured are from low-income families.

CMA applauds the legislation’s reforms on the for-profit insurance industry. The bills prohibit insurers from canceling coverage for patients once they get seriously ill, an outrageous practice known as rescissions, and requires insurers to spend 85 percent of revenues on direct patient care and provide coverage to patients with pre-existing medical conditions.

CMA will continue to work closely with members of California's congressional delegation throughout the legislative process.

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The California Medical Association represents more than 35,000 physicians in all modes of practice and specialties. CMA is dedicated to the health of all patients in California.

Contact: (916) 384-8935
Andrew LaMar