Medi-Cal lawsuit on the horizon, a financial policy one

This past week, SFGate announced that San Francisco’s Mayor Gavin Newsom’s administration and coalition are outraged by the 10% Medi-Cal physician reimbursement implemented by Governor Schwarzenegger’s Medi-Cal wonks (article 1 and article 2). This desperate $600 million savings attempt by the State government is plan B after Governor Schwarzeneggar’s Medi-Cal reform failed to come to fruition.

Being in the Medicaid field, I have no idea how Mayor Newsom’s lawsuit can stand legal grounds. Burden of health care access? By cutting reimbursement, physicians who can forgo the slim Medi-Cal reimbursement margins will bar medical services to existing or new Medi-Cal patients. If this financial barrier to health care access can be shown, then the new decreased reimbursement is not actuarially sound. If this cut had to be approved by the Center for Medicare and Medicaid Services (CMS), then an actuary’s signature must have certified the rates to be sustainable for the current level of access or greater. Obstruction to access is difficult to prove because of the intangible definition for the highly fluid Medi-Cal population. In addition this is only arguable for managed care but not for the fee-for-service system. The testy lawsuit stands weak legal grounds.

Can anyone with more policy and legal field experience enlighten me on the legal argument of this lawsuit?

In my mind, if Mayor Newsom wants to become Governor Newsom, this lawsuit is more of a political platform building opportunity for the 2010 election. I really hate seeing charismatic politicians that have the power to do wonders but then become a disservice to the American public, and I think Mayor Newsom thinks so too. So I nailed my opportunity yesterday to put in a plug. I really did not want to seem like every other San Francisco business person in line to shamelessly plug their business and that is it. I wanted to tell him how I could be part of his A-team of civil servants to make his health care policy progressive, hospitable, and vastly improved. So what did I do?

I am very gracious that my firm participated in the city planning team for San Francisco Earth Hour. In exchange for volunteering for the event by handing out energy conservation incandescent light, I earned an invite to the kick-off event at MarketBar where I knew that the Mayor had a public appearance.

I sealed the deal by thinking of two main points to capture his coveted attention. Point one was to get him engaged: Do you recall a few months ago when you rode the N-Judah Muni Metro to work?

My witness to his N-Judah presence provoked his outrage on the city’s MUNI issues. His knowledge of the issues and detailed ridership numbers impressed my friend whose husband has a MUNI love and hate relationship. As he pointed out the electric MUNI car parked outside of MarketBar, I took a jab that Austin long had these buses, and the vehicles are cleaner, wider, and more comfortable. That comment sparked Mayor Newsom’s competitive sportsmanship. San Francisco can do much better than Austin!

Point two was to hit his health care policy interest dead-on. I had a little trouble plugging myself because I am very shy, too polite, and passive. So my friend helped me out by shouting that I had health care policy interests. That grabbed his attention and he asked, “Did you know that we are suing the governor for their Medi-Cal cuts?” I thought, “Duh!?” Which health care policy wonk did not. So I put in my plug for what my team did for the current Governor’s administration on Medi-Cal redesign. He asked for my business card, and I sincerely hope his administration follows up.

If Mayor Newsom is going to be the next Governor, I want my hand at health care reform done right the first time his administration proposes it. I am sick and tired of living through stale iterations of reform, issue attrition, and waning political momentum. I am also sick of complaining. While young and capable, I have the time, patience, and aptitude, and I hope I get in on the action.

On a separate note, the Governor learned from former First Lady’s Hillary Rodham Clinton’s political debacle at health care reform. Since 2004, the Governor had various task forces to gather genuine buy-in, extensive input, and productive discussions. PR wise, “redesign” appears to be a more salient policy term than “reform.” This was one of my first health care policy field work assignments. I will save this story for another day but feel free to browse through one sliver of the redesign planning at the California Health Care Foundation. I am just sad that with all the effort, blood, sweat, and tears, plan A failed, hence this slapped together Plan B to help salvage the State’s budget. Not surprising, a lawsuit abounds.

Five A’s of Health Care Access

There are many catch-22’s in the health care system. A managed care company reimburses providers and hospitals for services rendered to beneficiaries at a certain payment level. The payment is just enough for hospitals and providers to maintain a contractual relationship with the managed care company and just enough for the insurance company to expense the least possible reimbursement to maximize profits. This reimbursement amount is a major factor in maintaining a large and stable network of providers that beneficiaries can choose from and can easily obtain care. The catch? Only if the payment is enough!

Access to health care is important. If you were taught under the same school of thought, the Five A’s of ACCESS are affordability, availability, accessibility, accommodation, and acceptability.

Health Policy Institute for Continuing Education Units

Sponsored by George Mason University, the College of Health and Human Services Center for Health Policy Research and Ethics, the Washington Health Policy Institute hosts its 16th annual meeting from June 3rd through 6th of 2008.At the meeting, “academics and health professionals interested in health policy research can learn firsthand about current policy issues and how policy is made through lectures and discussion with some of the nation’s leading policy makers. Students can also earn graduate credit through the Institute by attending morning didactic sessions and completing an analytic policy paper. An additional Institute option is the Policy Leadership Training Program for post-baccalaureate students and health professionals with a desire to enhance leadership capacity and skills in policymaking, research, and advocacy.”

Here’s a list of invited speakers –

BILL FINERFROCK
Vice President, Health Policy
Capitol Associates Inc.PATRICK FINNERTY
Director, Virginia Department
of Medical Assistance Services

PAULA HOLLINGER, RN
Associate Director, Health Workforce
Maryland Department of Health and
Mental Hygiene, and Former Senator,
Maryland General Assembly

DIANA MASON, PhD, RN, FAAN
Editor in Chief, American Journal of Nursing

ERIN McKEON
Associate Director, Government Affairs
American Nurses Association

ALAN MORGAN, MPA
Executive Director
National Rural Health Association

FRANK PURCELL
Director, Federal Government Affairs
American Association of Nurse Anesthetists

CATHY RICK, RN, CNAA, FACHE
Chief Nursing Offi cer
Veterans Health Administration

ALLISON WEBER SHUREN, MSN, JD
Arent Fox Kintner Plotkin & Kahn, PLLC

PEGEEN TOWNSEND, JD
Senior Vice President, Legislative Policy
Maryland Hospital Association

Since this meeting is slanted towards eligible graduate credit or CEU’s, I encourage students and policy practitioners with a few days in Washington D.C. to spare to attend.

After this affair, you may piggy back off the 25th annual AcademyHealth Annual Research Meeting, which follows soon after George Mason University’s affair.