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Andrew LaMar

Sacramento - As the U.S. Senate begins debating sweeping health care legislation, California physicians called for changes to the bill today to ensure reform delivers on its promise of providing patients access to a doctor when they need it.

The California Medical Association has encouraged lawmakers all year long to craft a workable plan that provides universal access to health care. While CMA supports the general thrust of legislation passed last month by the House of Representatives, it opposes the Senate bill as currently written.

“There is no way health care reform can work if patients can’t get access to a doctor,” said Brennan Cassidy, M.D., CMA president. “The Senate bill fails to fix major problems in Medicare and Medicaid, which currently suffer from chronic underfunding that undermines access and continues to undermine the success of these government programs.

“As physicians, we remain committed to meaningful reform that best serves our patients. Building reform on the foundation of Medicare and Medicaid can only work if that foundation is sound, and unfortunately both programs need major improvements and better funding to function properly.”

What is meaningful health reform? Meaningful reform would truly build on what works and fix what’s broken by ensuring people have affordable access to a doctor and ensuring health care decisions are made by doctors and patients, not insurance companies or government bureaucrats. It would rein in the health insurance industry to increase competition and choice for consumers; protect the needs of patients; prohibit exclusion to coverage due to pre-existing conditions and protect from policy cancellation due to need for health care; and provide sufficient resources for public programs to deliver on their promise of health care.

CMA is working with senators to draft amended legislation that meets these goals. California’s physicians remain hopeful that Congress can craft and pass meaningful health care reform in coming months. Should the Senate pass health care reform, then a two-house conference committee would convene to merge the bills approved by the House and Senate into a final plan.

“California’s physicians appreciate the support of senators and their sensitivity to critical issues affecting the well being of patients and the doctors serving them,” Cassidy said. “It’s essential that the Senate’s leadership adopt changes to help California and protect patients.”

CMA supports several provisions in the Senate bill, including:

• An individual mandate to purchase health care insurance that will cover 94 percent of the uninsured.
• Insurance industry reforms, such as prohibiting rescissions and mandating coverage of people who have pre-existing medical conditions.
• Helping low-income families afford health care by expanding Medicaid eligibility to 133 percent of the Federal Poverty Line.
• Creating a health insurance exchange that offers competition and a choice of plans and doctors.
• Boosting Medicare reimbursement rates for primary care physicians by 10 percent and reinvesting in primary care, an essential part of preventive care that saves taxpayers money.

However, CMA is calling for significant improvements to the Senate bill, including:

• Provide a permanent fix to Medicare’s flawed payment formula known as the Sustainable Growth Rate (SGR). In coming years, the SGR mandates cuts of 40 percent that would hurt physician participation and therefore hurt seniors’ access to care. Unlike the House bill, the Senate legislation does not replace the SGR with a more reasonable schedule.
• Eliminate or restrict the authority of an Independent Medicare Commission that would give away congressional accountability for the Medicare program.
• Increase Medicaid reimbursement rates. In California, Medi-Cal patients currently have serious access problems because only about one-third of the state’s doctors participate due to unbelievably low rates.
• Do away with the Value Index provision, which would end up shifting Medicare funding away from urban areas, such as Los Angeles and New York, where high numbers of poor and minorities spend their lives uninsured and with limited or no access to health care before entering the program. When they age into Medicare, they have greater health care needs that drive up the cost of providing care. In contrast, the House bill calls for a study of geographic differences in Medicare spending before making any changes in funding. Because the Value Index does not factor in high practice costs – rent and staff wages are much higher in California – and demographic/socioeconomic factors, it shifts funding to rural states.
• Correct reporting requirements for physicians. By expanding the currently flawed, non-scientific and untested requirements, the bill exacerbates rather than solves the problem of inaccurate information about physicians that will mislead patients and policymakers.

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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.