CALIFORNIA HEALTH CAPITATION PLANS HAVE "SLIM CHANCE"

CALIFORNIA HEALTH CAPITATION PLANS HAVE "SLIM CHANCE" of passing the California state legislature this session, state Senator Diane Watson noted at a state govt. affairs breakfast at PMA's annual meeting. Asked if she envisioned a capitation program this year or next, Watson responded that there are four bills in the state legislature, one of which has passed the Senate and is in the Assembly's Health Cmte. "The chance of any capitation bill passing this session are slim, if none," she declared. Watson said the bills are "competing pieces of legislation" and the legislature has "not come to any agreement as to which will be the lead vehicle." Watson asserted that two issues need to be addressed in the pending capitation proposals: co-payment and access to health care. "We're dealing with a welfare-eligible group of participants and it is impractical to think that these people can come in with $25 to the emergency room," Watson stated. She maintained that co-payment for medical services should be eliminated. In addition, the capitation system should be designed to assure reasonable access, Watson said. "We want to be sure we can define what a region is so that we won't have voids in service as I have in my district, so people won't have to travel 45 miles to be admitted into a hospital." Under current California Medi-Cal reforms, the state is experiencing problems with access to care, she contended. Watson said providers are asked to package services and "give a set fee to the Medicaid authorities as their operational fees" for the prospective year. However, she observed, "we're getting feedback that there are all kinds of cost overruns" and "we're finding more doctors are opting out of the Medi-Cal business in the state of Caifornia." PMA's Woodrow Allen said the assn. "does not have a defined position pro or con on capitation." He said that PMA has a health care financing cmte. assessing the issue to determine what position the assn. should take.