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If you are interested in this topic or have comments about this op-ed from SFMS President Peter Curran, MD in San Francisco Medicine, please join the online discussion by submitting your comments below. We welcome your feedback!

Not Quite as it Seems

Health insurance premiums for individuals in California increase, while incomes remain flat. Blue Cross Anthem attempts to raise individual premiums by 40 percent in 2011. Seven million Californians are without health insurance. Assembly Bill 52 (authored by Assemblyman Mike Feuer, D-LA) seeks to prohibit health insurance companies from increasing health care premiums without obtaining prior approval from the Department of Managed Health Care or the Department of Insurance.

The CMA would naturally be in favor of this, right? Wrong. AB 52 sailed past the CMA Council on Legislation in March and two CMA Board of Trustee (BOT) meetings, despite an “oppose” position from the CMA.

The CMA position is that any rate regulation is a bad idea, because what insurers lose from premium hikes they will simply make up with lower physician reimbursement. The CMA believes it should instead focus on enforcing rate review and “invest in meaningful ways to bring down health costs.”

A CMA staff member following the bill put it to me this way: “The reality is that insurers are going to get their Wall Street projections.” When I suggested that this oppose position perhaps gives the appearance of the CMA sleeping with unlikely bed fellows (that is, insurance companies), he quickly added that the CMA does not make policy; the House of Delegates (HOD) that meets each year to discuss and vote on numerous resolutions makes the policy. In other words, the physicians make the policy and the CMA functions to enforce that same policy.

A member of the CMA BOT said the same thing: It is understood that the CMA position on AB 52 is based on established CMA policy. In fact, a similar bill authored by former Assemblyman and current Insurance Commissioner Dave Jones was killed last year and did not have the support of the CMA. When I spoke with a representative from Mike Feuer’s office, she said that the CMA has been approached several times in the past on AB 52 and similar bills and has always been against anything related to rate regulation.

If CMA is against AB 52 and rate regulation, then I should be able to find a resolution from the HOD that supports that claim. The CMA lobbyist mentioned a resolution from HOD 2007, so I went to the archives. All I found from 2007 was adopted resolution 206a-07, Health Insurance Companies as Public Utilities, which resolved that the “CMA study and make recommendations regarding the establishment of a regulatory body . . . to regulate health insurance industry financing, compliance with state and federal laws, and the provision of mandatory health care coverage.”

I know from my experience with the CMA HOD that when a resolution is recommended for further study, it usually means there is less than a unanimous consensus of physician opinion at the House. It wasn’t until I spoke with Ruth Haskins, chairperson of the CMA Council on Legislation, that I learned CMA “policy” can be either real policy from the HOD or more like what the CMA has supported in the past. Regarding insurance regulation, Haskins believes there was no guiding CMA policy when it came to AB 52.

This is a complicated bill with many ramifications, including not knowing what ultimate effect it would have on patient care or physician well-being. Instead of changing CMA’s position on this bill late in the year (perhaps to a neutral position) and risk losing face with our allies in the legislature, the decision of the BOT in July, with advice from government relations at CMA, was to maintain the oppose position and hope for the opportunity of further study with a two-year bill. This is in fact what happened when the author of the bill decided he lacked the necessary votes in the Senate and determined to try again next year.

When the BOT reconvenes in January 2012 and AB 52 is presented for discussion, the important next step may not be whether the official CMA position remains oppose or becomes neutral, but rather this: Will the CMA support alternative legislation that promotes its own ideals to address the problem of escalating health insurance costs?

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