Tough love from Jerry Brown

24th April, 2012

“Everybody has needs,” Governor Jerry Brown told the physicians and medical students who filled a Sacramento banquet room on April 17.  “But needs turn into rights, which turn into laws, which turn into lawsuits.”

The governor was breaking the news that physicians can look for little help from state government in raising payment rates for California’s Medicaid program, Medi-Cal, despite the fact that they are already among the lowest for any Medicaid program in the country. The budget deficit is severe, he said, even with drastic cuts that have already been made to schools, the state university system, and services for people in need.

Governor Brown addressed the physicians (myself included) who had made the trip to Sacramento as part of the California Medical Association’s 38^th Annual Legislative Leadership Conference.  For anyone who cares about incentives for physicians to see Medicare and Medicaid patients, nothing he said was good news.  If payments to physicians continue to decline, more of them will stop accepting these patients, and we can expect to see even more physicians leaving the profession in frustration.

The governor’s lunchtime remarks zeroed in on California’s current budget crisis, and the steps he thinks should be taken to remedy it.  The legislature and the governor must address a budget problem of $9.2 billion between now and the start of the 2012-13 fiscal year.  Governor Brown urged physicians and all California voters to approve a temporary increase in sales and income taxes through an initiative that he has proposed for the November ballot.  The initiative would hike the state sales tax by a quarter-cent per dollar for the next four years and create a graduated surcharge on incomes of more than $250,000 that would last seven years.

If voters don’t approve the tax increases, Governor Brown warned, $5.4 billion of “trigger cuts” will take effect in 2013, with funding for schools and community colleges taking 90% of the brunt.  Other cost-trimming measures would include deferring payments to Medi-Cal providers, according to the Legislative Analyst’s Office.

Earlier in the morning, the physicians posed questions to a political panel consisting of former Assembly Speaker Fabian Nunez, former Senate Minority Leader Jim Brulte, and LA Times political reporter Anthony York.  These are uncertain times both for Democrats and Republicans, the panel noted.  No one knows what the Supreme Court will decide about the Affordable Care Act.  Recent redistricting has changed boundaries, pitting two seasoned congressional Democrats, Brad Sherman and Howard Berman, in an expensive race against each other in Los Angeles.

The panel agreed that no one knows how the new “top two” primary system will work in practice.  It will be in effect for the June 5 primary elections for California state offices and congressional district offices, and voters will nominate the top two candidates to face each other in November regardless of party.  In a traditionally Republican district, for example, if there were seven Republican candidates and only two Democrats, it could theoretically be possible for the two Democrats to be the top two vote getters despite the majority of Republican voters in the district.

After lunch, the physicians dispersed into small groups to meet with individual legislators and aides in their offices.  Our mission was to advocate for several bills that the CMA is sponsoring, including two that were authored by Dr. Richard Pan, a pediatrician, U.C. Davis faculty member, and first-term member of the Assembly.

The Assembly Committee on Health approved one of Dr. Pan’s bills, AB 2109, last week.  This bill ensures that parents must receive information about immunizations from a licensed health care practitioner before they can sign a form that excludes their children from being vaccinated before they can start school.  Without this requirement, some parents are deciding to skip vaccinations based on limited knowledge about the risks of the targeted disease, or because of exaggerated fears of vaccine complications.

Another of Dr. Pan’s bills, AB 1742, would work on behalf of physicians and hospitals that provide care to out-of-network patients.  Currently, payments for these medical services are usually mailed to the patient.  This bill would provide for payments to be sent directly to the physicians, hospitals and clinics that delivered the care.

Other bills sponsored by the CMA include:

• SB 1483 (Steinberg):  The California Public Protection and Physician Health Act would develop and oversee a coordinated statewide system of confidential treatment for physicians suffering from mental, behavioral, or substance abuse issues.
• AB 1848 (Atkins): This “Medical Expert Witness” legislation would authorize the state to discipline or deny licensure to physicians who offer deceptive or fraudulent testimony related to the practice of medicine, and would require expert witnesses from outside the state to register and receive a certificate authorizing them to testify.
• AB 2064 (Perez):  This bill will ensure that medical providers are reimbursed for the entire cost of acquiring and administering vaccines, so that vaccines will remain available in all communities.

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