Sea of vetoes engulfs health care legislation

Gov. Arnold Schwarzenegger vetoed three of the most closely-watched pieces of health-care legislation this year, capping even what his top advisers called a failed year on health reform.

“To try to portray this as a successful or significant year on health-care reform, it just wasn’t,” said Schwarzenegger adviser Daniel Zingale. “We did some good things, but overall, it was just like last year.”

Among the bills rejected by the governor was legislation that would have forced health plans to seek an okay from a third-party before revoking a customer’s health insurance, a bill that would require health plans to spend a certain percentage of health-care premiums on patient care, and a bill that sought to ensure that doctors were reimbursed for health-care costs, even when HMOs refused to pay certain bills.

Those were just the highest profile vetoes on a range of health care bills that many advocates say they were surprised to see rejected. Bills that would have provided health insurance to about 1,000 sick, uninsurable Californians, and one that would have prevented dentists from obtaining credit card billing signatures from patients who are under anesthetic were also rejected.

The rescission bill, AB 1945 by Assemblyman Hector De La Torre, D-South Gate, was sponsored by the California Medical Association. It had received substantial bipartisan support in the Assembly, but passed with just one Republican vote in the Senate.
De La Torre was clearly angry at the veto.

 “Having the governor not engage in any discussions or negotiations for months, and then just veto the bill is astonishing,” he said. “The issue was good enough to use as an applause line in his State of the State Address in January, but not to sign a good piece of legislation that would protect insured people in the individual market.”

But the veto was hailed by health plans, which vigorously opposed the measure.

“We are pleased that Governor Schwarzenegger recognized that AB 1945 was a bill that missed its mark.  Rather than offer consumers real legal protections from unfair rescission or cancellation, it would have invited dishonesty on applications and lead to price increases and reduced coverage in the individual market,” said Christopher Ohman, president of the California Association of Health Plans.  

“Health plans support improved clarity in applications, ensuring consumers receive timely notice about questions of coverage and have the chance to work with the health plan, and health plans support using an independent third party to review rescission decisions and plans are willing to abide by those decisions.”

Sen. Shiela Kuehl’s SB 1440 would have required health plans to spend at least 85 percent of premiums on health-care benefits for patients, a concept the governor supported in his health care overhaul, AB 1x, which died in Senate Health back in January.
Zingale said the breakdown of comprehensive health reform discussions, and the embrace of piecemeal changes in the health-care system, were responsible for the governor’s vetoes.

“There’s a problem with just picking off the easy pieces and avoiding the hard, real work of changing the health-care delivery system,” he said. “It’s easy to spend more money. It’s harder to enact the cost-saving measures and the prevention measures we need. Those are the most important pieces. Those build the foundation for change.”

But Kuehl suggested the veto of SB 1440 may have been a bit more personal. She said she and her staff met repeatedly with the governor’s senior health care staff, and that they had assurances that the governor would sign the bill.

“We took their language up until the very end,” said Kuehl. But the governor’s health care reform bill, AB 1X, died in Kuehl’s Senate Health Committee earlier this year, a fact that the outgoing Senator says may not have been entirely forgotten.  

“I do think that he was particularly angry at me,” said Kuehl. “Last year he signed nine of my bills and vetoed three. This year, he vetoed 13, including little ones that were not related in any way to health.”

On the Kuehl bill, Zingale said the governor supports the idea that HMOs should be required to spend 85 percent of their revenues on patient care. “But they should be forced to spend a big portion on prevention. I think the lack of prevention was the main obstacle to getting the market reforms done this year.”

In his veto of SB 1440, Schwarzenegger said “this bill represents exactly what I did not want to see this year – a one-sided, piecemeal approach to health care reform.” While he expressed support for the concept, he said, “taken in its isolated and singular fashion, this bill may weaken our already-broken system.”

On the rescission issue, Schwarzenegger’s health-care proposal would have ruled rescissions moot, since health insurers would not be allowed to reject any patient for health-care coverage. But he said a number of provisions should have been in the bill, including additional protections for patients and standardized health-care applications.

“This bill was written by the attorneys that stand to benefit from its provisions. In rushing to protect a right to litigate, the proponents failed to consider the real consumer protections that are needed,” the governor wrote.

But De La Torre dismissed the governor’s reasoning, saying “I think that’s just cover.”  De La  Torre accused the governor of doing the bidding of health plans that opposed the measure, saying, “I don’t think he ever intended to reign in rescissions.”

Within hours of the governor’s veto on AB 1945, and a host of other health-care measures, a Schwarzenegger coalition of health-care reform advocates who supported the governor’s health-care proposal earlier this year put forward a message echoing the governor’s call for more comprehensive health care reform.

“A comprehensive solution to the healthcare crisis in California is needed to truly reach our collective goals: to reverse rising health-care costs, solve the problem of the uninsured, and dramatically improve the quality of care for every resident of this state,” said Cassie Gilson, legislative advocate for the Coalition To Advance Healthcare Reform just after the veto was announced. “We urge the governor and the Legislature to act quickly in the next legislative session to come to agreement on a comprehensive plan that accomplishes these goals.

De La Torre said that was wishful thinking. “In the meantime are all these people being screwed,” said De La Torre. ”What are they supposed to do?”

When asked if the issue could be handled as part of a more comprehensive approach to health-care reform, De La Torre said, “the governor tried that and it didn’t work. I’m sorry but I don’t think he’s going to be able to deliver on that in the next two years. In the meantime, let’s fix what’s yelling for a remedy in the system.”

Anthony Wright, executive director of Health Access, which supported the governor’s health-care plan, described the governor as “actively hostile” to health-care bills this year, and said he was not sure what next year would hold for health-care legislation.
“With the governor being so stubborn and erratic, it makes it more difficult to plan,” he said.

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