California AFP Helps Refine Health Reform Proposal

Whatever health care reform system becomes reality in California, it must be built on a primary care system that provides personal medical homes. That's the message the California AFP and its primary care peers took to staff from Gov. Arnold Schwarzenegger's office and the leadership of the state legislature during a March 9 meeting.

The meeting focused on Schwarzenegger's health reform proposal (PDF file: 10 pages / 120 KB. More about PDFs.) and legislation introduced by state lawmakers. It continued discussions that began last year between Schwarzenegger, his staff and the Cognitive Coalition, which comprises the California AFP and state chapters of the American Academy of Pediatrics, the American College of Physicians and the American Psychiatric Association.

Schwarzenegger first turned to primary care physicians in November for help in honing his health care reform proposal. After announcing his plan in January, Schwarzenegger met with California AFP President Lyman "Bo" Greaves, M.D., of Santa Rosa, and other physician representatives to discuss the necessity of a medical home, a system that supports primary care physician training and a program that covers all state residents. Schwarzenegger's staff met with the coalition again in late January.

During the March 9 meeting, the coalition met with legislative staff for California Senate President pro tem Don Perata, state Assembly Speaker Fabian Nuñez, state Sen. Sheila Kuehl and the California Senate Health Committee, as well as with staff from the governor's office.

"This was built on a years-long relationship with the governor's staff," said Tom Riley, lobbyist for the California AFP. "In California, there are a lot more open doors to organizations that have a stake" in the legislative process.

Overall, conversations with the governor and his staff have been productive, according to Greaves.

"We applauded any move that expands coverage in the state, which is one of our goals," said Greaves. "But we also pointed out that, although expanding coverage is good, it doesn't equal universal access and it doesn't solve the crisis we have in our health care environment. If there are no new family physicians (to meet demand), patients will still go to the emergency room" for primary care.

Susan Hogeland, C.A.E., executive vice president of the California AFP, agreed. "We're working to convince the governor that insuring hundreds of thousands more people will put more pressure on a system that's already under pressure today," she said. "So we need to enhance primary care payment to keep family physicians in business and to keep the pipeline filled."

To that end, Greaves and his colleagues in the Cognitive Coalition called on the governor to build health system reform based on a medical home system that pays primary care physicians adequately, provides primary and preventive care, and coordinates health care services with other sectors of the community.

In addition, discussions focused on administrative access to care, said Riley. "We pointed out that the plan should not create utilization barriers for primary and preventive care, particularly for mental health care."

In January, Schwarzenegger announced a wide-ranging plan that would mandate health insurance for every resident of California. The state would reach that goal by requiring all people earning more than 250 percent of the federal poverty level to buy insurance either through their employers or on the individual market. It would allow children in families earning up to 300 percent of federal poverty levels to participate in Healthy Families, California's State Children's Health Insurance Program, and subsidize the cost of insurance for people who earn between 100 and 250 percent of federal poverty level through a special fund fed by fees paid by doctors and hospitals.

Meanwhile, the plan would prohibit insurance companies from denying coverage to anyone, regardless of pre-existing conditions, and from charging higher premiums based on age or health status. The governor's proposal also calls for legislation that would require hospitals and insurance companies to spend at least 85 percent of every dollar expended in premium and health care spending on patient care.

Schwarzenegger probably will not seek a single bill to implement his proposal, according to Riley. Instead, the governor's ideas likely will be attached to several proposals dealing with various related issues.

Other California lawmakers have put forth health-related bills addressing some of the same issues, as well. Among those bills are proposals for a single payer system, individual and employer mandates, and creation of a state insurance pool for children and the uninsured.

"What we're seeing now is the 'concept car' version" of what will become a final proposal, said Riley. "It's a great place to start, but it will go through many different permutations" before its final version is ready for a vote.

The process, said Greaves, "is likely to be a one- or two-year process, with all the negotiations going on." But the impetus for reform is strong, and the changes likely to be made in California may well offer a model for other states.

Whatever health care reform system becomes reality in California, it must be built on a primary care system that provides personal medical homes. That's the message the California AFP and its primary care peers took to staff from Gov. Arnold Schwarzenegger's office and the leadership of the state legislature during a March 9 meeting.

The meeting focused on Schwarzenegger's health reform proposal and legislation introduced by state lawmakers. It continued discussions that began last year between Schwarzenegger, his staff and the Cognitive Coalition, which comprises the California AFP and state chapters of the American Academy of Pediatrics, the American College of Physicians and the American Psychiatric Association.