Opinion: Misguided insurance rule would hinder patients’ access to care

As a physician, my biggest concern is making sure that people have access to the care they need. However, the California Legislature is trying to pass a harmful bill that could seriously reduce the access that patients have to physicians. AB 52 will reduce the number of available doctors, decrease the already limited access that some of our patients have and cut back on the time we can spend with the people we treat.

It is already a challenge for Medi-Cal patients to find a physician, so many turn to emergency rooms for routine care. They rely on emergency care more than any other group, causing Los Angeles to be the home to some of the most overcrowded emergency departments in a state that ranks last among all states in access to emergency care for all patients.

As doctors, we know that we’ll never recover the cost of seeing a patient who relies on Medi-Cal or Medicare for their insurance. These government health insurance programs pay so little that doctors and hospitals must rely on private insurance payments to offset the billions of dollars they lose treating the uninsured and those with government insurance.

AB 52 will seriously undermine the ability of health care providers like me to serve our patients or cover the cost of care. By setting arbitrary limits on health insurance premiums, this harmful legislation will lead to longer delays in getting emergency care, more emergency room closures and even fewer doctors willing to accept Medi-Cal or Medicare. The bottom line is patients will suffer.

AB 52 isn’t the answer to the problems we’re facing in health care. It won’t halt the rapidly rising costs associated with diseases that as physicians, we’re seeing more and more of each year, including higher rates of obesity, diabetes and other chronic illnesses. And it certainly will not drive down the increasing prices of labor, rent, taxes and other expenses for physicians, like me, in private practices.

Despite these rising costs, the state’s insurance market remains very competitive. California’s insurance premiums are around the national average, even though this is a high cost state. Only 3 cents out of every $1 in premiums go to insurance profits. The lion’s share is spent on health care: 87 cents out of every $1 go to hospitals, doctors, pharmacies and other providers of medical care.

Most insured Californians get coverage through their employers, who can bargain for the best deals. As a result, they’ve seen increases of only about 9.7% since 2000. A small percentage of insured Californians–about 7%–get their coverage through the individual market, where increases have been greater. But the state is moving forward to change this market so that prices will be lower and more people can get coverage.

As a result of the new federal health care law, the state is establishing the California Health Benefit Exchange, which will create an online marketplace for medical insurance for individuals and small business. Consumers will be able to compare the prices of similar plans and choose the one that fits their needs and pocketbooks. By offering coverage to a wider group of people, this Exchange is expected to great expand coverage and affordability.

The new federal health care law also requires 80 to 85 cents out of every $1 in premiums be spent on medical care. Insurers must pay rebates to policyholders if they violate that law. In addition, California has adopted its own law that requires unprecedented accountability for health plans.

We should give these new laws time to work before agreeing to spend up to $30 million more per year for the Department of Managed Health Care and the Department of Insurance to erect vast new bureaucracies to implement AB 52—especially now that California is slashing funding to schools and other vital programs.

I oppose AB 52 and am glad to be a part of the growing opposition—including the California Medical Association, Los Angeles Area Chamber of Commerce, California Hospital Association, Hospital Association of Southern California, Valley Industry & Commerce Association and more than 50 organizations—that understands the harm this measure will cause to patients.

As we often say in medicine: First do no harm. AB 52 will harm patients’ access to doctors, hospitals and emergency rooms, and it will drive up costs. Together we can increase access and heal California’s health care system.

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Ed’s Note: George W. Ma, MD, is a physician in private practice in Los Angeles and president of the Los Angeles County Medical Association.