A venerable player in California’s Capitol wars is the 35,000-member California Medical Association, which is known for flexing its muscle – such as donating more than $22 million to campaigns during the past decade or fighting the administration in court over forced furloughs.
It targets traditional issues of critical interest to physicians, including licensing improvements or better Medi-Cal reimbursements or caps on medical malpractice insurance or limiting the role of corporations in medical decision making.
But as the sea-change of federal health care reform is felt in California, new challenges emerge.
With its doctors on the front lines of health care reform, the CMA is ramping up its communication with members, providing analysis on how the new rules apply to physicians, recruiting new members and crafting strategies that reflect a widely diverse membership.
“The shift to federal health care reform is going to be monumental. It is going to have a bigger impact on the delivery of health care than Medicare when it was passed,” said the organization’s CEO, Dustin Corcoran. “This is a vast, cataclysmic shift.”
“There is so much uncertainty, so much anxiety about all these changes, we have to provide background to our members,” he added.
CMA has always been a major player, and something of an anomaly in Sacramento’s political landscape. Simple ideological labels don’t easily fit the organization – they are seen as uber-liberal on some issues, borderline reactionary on others. The late Steve Thompson, a former aide to Assembly Speaker Willie Brown, headed CMA’s political strategy unit for years and acquired near legendary status in the Capitol as a canny advocate.
Corcoran, who has been at the CMA for 12 years, was hired and mentored by Thompson, an unvarnished liberal who “used to get in fist fights with his brother over who was more liberal,” former Senate Leader John Burton once said.
The CMA, which for decades had been seen as a stodgy, politically conservative organization allied closely with the Chamber of Commerce, was pushed into the political center under Thompson’s leadership, ultimately driving 2004 legislation that would have extended health-care coverage to a million California workers. Ultimately, after a $16 million opposition campaign financed by business interests, voters rejected the plan in the culmination of one of the decade’s major political fights.
But Thompson’s ghost remains in the CMA’s J Street headquarters.
“Steve Thompson and Jack Lewin were pushing the envelope over there. But even so, they had their own self-interest at stake, they had to,” said one health-care observer. “They (CMA) members are all over the map. They are well-educated and independent. In terms of ideology, you have the single-payers alongside the voucher advocates. So they have their work cut out for them.”
The group’s centrist position is no accident. The CMA political action committee supports both Democrats and Republicans in elections. Their bills are sponsored by members of both parties. Corcoran has vowed to keep the organization in the political center as much as possible, continuing the work of Thompson, his political mentor.
But other challenges abound – not the least of which is maintaining membership in an ever-changing health-care world and a sluggish economy (yes, it even affects doctors). To help bolster and nurture CMA’s own membership, Corcoran’s hired Jay Hansen, formerly of the Building and Construction Trades Union, as his new senior strategist – in effect the No. 2 position in CMA’s HQ.
The CMA’s new communications director is Rosanna Westmoreland, formerly with the California Farm Bureau Federation.
Hansen and Corcoran have known each other for years – Hansen also provided political mentoring to Corocoran – and Westmoreland has significant communications expertise, having headed the Farm Bureau’s vast communications operation, which includes print, broadcast and everything in between.
Corcoran said their charge will be to help CMA reach out to new doctors as the health-care world undergoes tectonic shifts.
Nearly one-third of California doctors are over the age of 60 – a higher percentage than any other state. Two-thirds of the state’s doctors are over the age of 45. Like many other organizations, CMA is working to reach out to younger potential members amid increasing competition from other medical organizations.
As older doctors retire and young doctors replace them, the nature of the practice of medicine and the needs of doctors are changing dramatically. Meanwhile, economic pressures are leading more doctors to become specialists, in part to pay off massive debts incurred during years of medical school. Specialists typically make more money than general practitioners.
According to a report by the California Health Care Almanac, “California barely meets the nationally recognized standard for supply of primary-care physicians. Only the Orange, Sacramento, and Greater Bay Area regions meet the recommended supply.”
For one, new doctors typically begin practice with hundreds of thousands of dollars in medical school debt. For another, the costs of setting up a new practice are heavy. Urban areas typically pay more for the medical arts than rural areas, which means new doctors typically head to the cities. By one estimate, the average salary of an established L.A.-area doctor is about $200,000, depending on practice and specialty, and sharply lower in rural areas. Across the country, the average pay is $157,000.
Indeed, the 154-year-old CMA is in transition, reflecting the dramatic changes in California physicians themselves. This is not your father’s CMA.
There are other demographic changes that present challenges for CMA. Latinos account for 37 percent of California’s population, but only 5 percent of the state’s 100,000 physicians are Latino. While family and general practitioner compensation has been rising, they earned only about 88 percent of the national average. A substantial number of California doctors come from foreign and out-of-state medical schools.
Younger doctors are more prone to work for set salaries at an institution – such as Kaiser, for example – a departure from the classic role of the physician who sets up a private practice after leaving medical school.
“The CMA, with the passage of the federal health law, is facing a new set of challenges and opportunities,” said Anthony Wright of Health Access, a labor-backed advocacy group that seeks expanding health care to low- and middle income Californians.
“There will be an influx of new patients, new funds into our health care system, and a new demand for medical professionals. At the same time there is a desire and a need for standards and oversight,” said Wright, who, like just about every other health care advocate in Sacramento, has both joined with and done battle against the CMA, depending on the issue, over the years.
The opportunities may be abundant, but so are the problems.
An increasing demand for doctors and patients puts strain on an already strained system. And new federal health-care rules are changing the way doctors do their jobs, and creating new challenges for CMA as an organization.
For example, the federal health care reforms include so-called Accountable Care Organizations – entities that would “force hospitals and doctors to have greater coope
ration with each other,” is the way one health care analyst described it. In essence, it would organize groups of doctors and hospitals – two groups often at loggerheads – to pool expenses and cut costs. Although largely unknown to the public, within the health-care industry the role of ACOs is capturing attention. “People are scrambling to set them up,” the analyst said.
And there’s always competition: The other major doctors’ group in the state is the 60,000-member California Association of Physician Groups, or “CAP- G” as it’s known in the Capitol. These include doctors who work for the HMOs, and while many CAP-G doctors also are members of the CMA, the strategic interests of the two organizations differ.
In the end, nobody really knows what’s in store for California’s medical profession.
“Right now, so much is moving so quickly. Regulations are happening and changing on a daily basis, and there are changes in the marketplace,” Corcoran said.
“But this will dominate the next decade. It (federal health care reform) is so difficult and time-consuming to implement. I don’t anticipate something getting all wrapped up with a bow on it within the next five years.”