California Gubernatorial Candidates Discuss Uninsured, Managed Care Reform During Debate

The candidates in California's gubernatorial race on April 2 addressed a number of health issues -- including managed care reform, tax credits to help the uninsured purchase health insurance and physician reimbursements -- before members of the California Medical Association, the San Francisco Chronicle reports. The candidates, Gov. Gray Davis (D) and Los Angeles businessman Bill Simon (R), offered "widely disparate views of the state's health care system" (Gledhill, San Francisco Chronicle, 4/3). Simon, who spoke first for about 30 minutes, "decried" HMOs and recommended "less government involvement" to address what he called a "full-fledged crisis" in the state's health care system (Morain, Los Angeles Times, 4/3). He attributed California's nursing shortage, financial problems facing state hospitals and the closure of several emergency rooms statewide to the state's managed care system (Ainsworth, San Diego Union-Tribune, 4/3). Although Simon did not "specifically say he was embracing the old fee-for-service system," he did suggest that patients should pay more for routine physician visits (Los Angeles Times, 4/3). Simon said that his health care policies would provide "more individual freedom, less bureaucracy, greater options and flexibility and trust in people and in the market economy" (San Francisco Chronicle, 4/3). In addition, he said that he has considered proposals that would increase reimbursements for doctors who treat state residents enrolled in Medi-Cal, the state's Medicaid program, and would provide tax breaks for state doctors who treat low-income patients. "Medical providers must be paid fairly and adequately for the services they provide," Simon said. He also called for medical savings accounts for state residents with employer-sponsored health plans, tax credits for state residents who purchase individual health insurance and health care vouchers for low-income state employees not offered employer-sponsored health insurance (Los Angeles Times, 4/3).

No 'Wholesale Changes'
In a 15-minute address, Davis endorsed the state's existing health care system, suggested some improvements and cautioned against making broad reforms. "If you're talking about wholesale changes in the way health care is delivered in this state, patients better beware," Davis said. He added, "America left fee-for-service for HMOs because of the staggering cost. ... I'm not prepared to abandon the HMO model. I still believe it can be improved to provide good quality care and still be fair to the physicians providing the care." Davis called for a physicians' bill of rights that would require health insurance companies in the state to pay doctors promptly for care they provide and would protect physicians against "unilateral changes" in their contracts. Davis also touted his accomplishments in health care, including patients' rights legislation that established the state Department of Managed Health Care, which helps patients in disputes with health plans (Los Angeles Times, 4/3). Davis also said that he has expanded enrollment in Healthy Families, the state's CHIP program, from 51,000 to 500,000 low-income children and announced that he has "reversed course" on a decision earlier this year to eliminate the Child Health and Disability Prevention Program, which provides immunizations and screenings for low-income state children (see story 10) (San Diego Union-Tribune, 4/3). In addition, he promised to expand coverage for low-income children in the state (Delsohn, Sacramento Bee, 4/3). The Contra Costa Times reports that the doctors "applauded more vigorously for Simon and appeared receptive to his speech, while greeting Davis with markedly less enthusiasm" (LaMar, Contra Costa Times, 4/3).