A recent floor fight between the California Medical Association and Blue Cross became tangled in a cross-current of political forces involving the Assembly mod squad, some of the Capitol’s most powerful lobbyists and some good old-fashioned payback from a former Assembly speaker.
Among those responsible for the defeat of a CMA-backed bill were hired guns from the health insurance lobby, an increasingly influential cluster of moderate Democrats and former Speaker Fabian Nunez, D-Los Angeles, who still blames the CMA for helping to kill his health care proposal earlier this year.
Republicans also got into the act, when Assembly Republican Leader Mike Villines asked all Republicans to either vote against or stay off the bill, even though CMA lobbyists say they had assurances of support from some GOP lawmakers.
The bill was part of an ongoing feud between the health plans and the CMA that has been raging in the Legislature over the last couple of years on a wide variety of issues.
This particular bill, AB 2805 by Assemblywoman Fiona Ma, D-San Francisco, was a small skirmish in that larger war. But at the end of a marathon floor session last week, forces conspired to seal the bill’s fate.
The bill dealt with the practice known as direct billing – when PPOs bill patients directly for medical costs instead of seeking reimbursements from doctors of hospitals. Ma’s bill would have required PPOs to bill doctors or hospitals instead of billing patients directly.
“This is a consumer rights bill,” said Ma. “The current system turns patients into health care administrators, and doctors into collection agencies.”
But other factors were responsible for the bill’s demise.
“The bigger issue was the health plans against the doctors,” she said. “It was bigger than just me – it was really about who can exert their influence over the house.”
And in this round at least, the health plans scored a victory.
In the end, the bill only received 30 Yes votes, with a dozen moderate Democrats abstaining or voting against the measure. Among those not voting for the bill was Nunez, who is not a moderate, but had some alterior motives for not supporting the measure.
“That particular bill may have had the unintended consequence of leading to more balance billing,” said Assemblyman Jose Solorio, head of the New Democrats caucus in the Assembly. “People in this state are concerned with the cost and quality of their health care, and many of us have strong opinions on how we can best extend health care to our citizens.”
Assembly sources say some of the Capitol’s most powerful lobbyists, including Kevin Sloat and Joe Lang, became personally involved, and called in favors with Assembly Republican Leader Mike Villines to help kill the bill.
Also at issue, said some of the bill’s supporters, were moderate Democrats’ frustration Ma, who jammed several controversial bills off the Assembly floor – including mandated paid sick leave, and a bill limiting the use of lead in children’s products.
Solorio said the vote on this bill had nothing to do with Ma, or any of her other legislation. “We are very careful to select bills on their merits, not because of any author or anything personal,” he said.
Health plans have tangled with CMA over a number of high-profile issues this year. A number of major pieces of legislation, including millions in new mandates to cover various medical procedures, some of which are backed by CMA, continue to move through the Legislature over the objections from insurers.
Nicole Kasabian Evans, a spokeswoman for the California Association of Health Plans, says her group has been effective at killing some of what her industry views as the most harmful pieces of legislation, but more work remains to be done.
“We’re doing our job by trying to ensure that bills that are going to drive up health care costs do not make it to the governor’s desk,” said Evans.
Among those voting against this bill was former Speaker Fabian Nunez, who still blames CMA in part for killing his comprehensive health care proposal earlier this year.
That proposal died in the Senate Health Committee in January after months of work by Nunez and his staff. CMA was officially neutral on the bill, but sources close to Nunez say the speaker says the blood of that bill is partially on CMA’s hands.
In the end, Nunez’s vote is not what killed Ma’s bill, but it does illustrate how politics in the Capitol can quickly get personal.
“It wasn’t the thing that killed it, but it was a way for him to get a little payback,” said one supporter of the bill.