CMA defeats bill that would have transferred negotiating power to health plans at the expense of physicians

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Mon Sep 28 14:18:26 PDT 2015


       

 

September 21, 2015

 

CMA defeats bill that would have transferred negotiating power to health
plans at the expense of physicians

 

 

 <http://www.cmanet.org/cma-alert/archives/2015/september-21-2015/#1>
California Medical Association

 

 

The California Medical Association (CMA) has defeated a bill that would have
drastically changed the current health care marketplace by allowing a
massive transfer of negotiating power to the health plans at the expense of
physicians. Assembly Bill 533 was an attempt to shield patients from billing
disputes between providers and health plans and would have required
non-contracted physicians and dentists to accept Medicare rates as payment
in full when performing services in a contracted or "in-network" facility.

 

Although CMA is in favor of removing patients from billing disputes between
health plans and out-of-network physicians, this specific solution was
unacceptable and would have transferred far too much power to health plans.

 

If physicians were required to accept Medicare rates, the plans would have
no motivation to contract with physicians. This not only would have
eliminated physicians' abilities to negotiate fair contracts and payment
rates, but also would have incentivized plans to maintain narrower
networks-without any punishment for failing to maintain adequate networks.

 

In the late days of the session, the bill's author-Assembly member Rob Bonta
(AD 18, Alameda County) -transformed AB 533 from a bad bill into a hostile
act against the medical profession. Overnight, the bill became essentially a
health plan-sponsored bill, with the strong support of consumer groups and
organized labor.

 

AB 533 would have done more harm than good by giving massive market power
and profits to health plans and insurers, while placing unfair burdens on
the state's physicians and patients.

 

The measure would also have implemented a three-day delay for patients
accessing out-of-network physicians under a PPO plan and created
complications for physicians with an undefined dispute resolution process.

 

CMA fought the measure to the end, rallying physicians and lobbying against
it until a final vote was taken at midnight on the last day of the
legislative session. Ultimately, the bill did not receive enough votes to
advance.

 

 

 

Jeff Wells
Deputy Editor, CAL/AAEM News Service

 

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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