SGA Update 031707

State Government Affairs Update

By Shannon Udovic-Constant, MD, FAAP

I. Health Care Reform (the below is excerpted from an AAP-CA email update from Marc Lerner, SGA chair, and Kris Calvin, AAP-CA Executive Director)

The AAP-CA is actively engaged at a high level in the health care policy reform discussions occurring in Sacramento. We are in conversations with the authors’ offices of all of the major proposals on the table, including the Governor, Assembly Speaker Nunez, Senate President Pro Tem Don Perata, the Republican Caucus, and Senator Kuehl. We have conveyed our strong support for health care reform, while at the same time asserting that any reform must occur in a thoughtful way that produces an efficient, effective and fair outcome for enrollees and providers alike.

The Proposals and AAP-CA Principles

There are five major proposals on the table: the Governor’s, Senator Perata’s, Speaker Nunez’, Senator Kuehl’s and the Senate Republicans. The proposals are complex, and differ significantly. For example, the Governor’s is built on an individual mandate, where all Californians must carry health insurance, while Senator Kuehl’s is a single payer system. The Governor’s also has a mandate on business to “pay or play” for health insurance, as do the proposals by Speaker Nunez and Senator Perata. Further, the Governor’s proposes a 2% and 4% fee on physician and hospital revenues respectively, as well as an increase in Medi-Cal reimbursement to near-parity with Medicare. The Republican proposal centers on health savings accounts and tax credits. A full analysis of the proposals is beyond the scope of a brief email.

As the proposals are in the very early stages we have not taken a formal position (support, neutral or oppose) on any of them. Rather, AAP-CA has developed a set of core principles to guide us in this process as we advocate with Sacramento policymakers on what is best for children and pediatrics. The following are principles that we have communicated as essential in any health care reform for California:

AAP-CA Principles for California Health Care Reform

- Insuring ALL California children and adolescents (including the undocumented)

- Using the medical home model of care

- Coverage must equate to true access - including adequate reimbursement for comprehensive services

- Focus on prevention and public health - especially vaccines

- Maintain CCS

- Adequate availability geographically and overall of pediatric primary care and subspecialists

- Build on programs and models that work based on the evidence

Issues that greatly concern us in the Governor’s proposal include the proposed fees on physicians and hospitals, and the shifting of funds away from the safety net in counties. The California Medical Association has taken the lead on this issue and others that relate to all of medicine. We are working in cooperation with them and other partners to learn more about the details of these proposals and to oppose those that are inappropriate. (It is worth noting that without CMA's leadership and resources in this area, AAP-CA would not be able to focus on pediatrics)

II. Other legislation of interest. This is a busy time of year as bills are introduced. AAP-CA reviews all bills affecting children and pediatricians. Here are a few highlights:

SB 24 (Torlakson): taxes: cigarette and tobacco products – support

This bill imposes an additional tax on the distribution of cigarettes at the rate of $0.095 for each cigarette distributed. The revenues would be put into the General Fund to be used for children’s health related purposes and smoking cessation programs. This bill is similar to the cigarette tax proposition that was on the November 2006 ballot that was narrowly defeated.

SB 137 (Torlakson): increasing CCS eligibility - support

This bill would change CCS eligibility so that the annual adjusted gross income allowing eligibility is $80,000 or less (up from the current $40,000) or for a family with an annual or monthly income equal to or less than 300 percent of the federal poverty level.

SB 676 (Ridley-Thomas): vaccine requirement for middle school entry

AAP-CA is co-sponsoring a bill to establish a middle school entry requirement for vaccines including diphtheria, Hib, measles, mumps, rubella, pertussis, poliomyelitis, tetanus, hepatitis B and varicella.

AB 34 (Portantino): Umbilical Cord Blood Collection Program – support

This bill establishes the California Umbilical Cord Blood Collection Program within the Department of Public Health by July 1, 2009 for the purpose of collecting and storing umbilical cord blood for public use.

AB 90 (Huffman): pupil nutrition: trans fat - support

This bill prohibits any school or school district from having food available to pupils during school hours that contains artificial trans fat.

AB 93 (Garcia): food: trans fat - support

This bill prohibits any food containing artificial trans fat from being stored, distributed, or served by, or used in the preparation of any food within a food facility. Exempts food sold or served in a manufacturer’s original, sealed package. A similar measure was enacted in New York City.

III. Medi-Cal reimbursement rates – AAP-CA has maintained as one of its top priorities trying to obtain a Medi-Cal reimbursement rate increase. To meet this goal the AAP-CA is an active participant of the Alliance for Patient Care, a coalition whose goal is to increase Medi-Cal reimbursement rates. The Governor’s health care reform proposal includes an increase in Medi-Cal rates but the Alliance for Patient Care will be actively working through the budget process to try to accomplish this important goal.

Please note that this information can change rapidly as bills may be amended. So anyone wanting to act on behalf of a bill for the AAP should contact me to be sure that the bill and our AAP-CA position has not changed since the posting. As always you are free to act as an individual at any time.

Please contact me at sudovic@hotmail.com about any state legislative issues of interest.