The California Medical Association, which represents about 41,000 doctors, has been at the heart of health care deliberations in Sacramento for decades. This year, it has staked out strong and sometimes surprising positions on the legalization of marijuana, Medi-Cal provider rates and the role it believes nurse practitioners should play in patient care.
California Healthline discussed these positions with current CMA president, Steven Larson, a primary care and infectious disease physician who practices in Riverside. Larson is also CEO of Riverside Medical Clinic, a multispecialty medical group.
Among Larson’s points is that his organization — which has long battled the state over low Medi-Cal reimbursement rates for doctors — is now taking its fight to the people. Medi-Cal is the state’s Medicaid program for low-income residents. It provides coverage to more than 13 million people, and the rates California pays to participating physicians are among the lowest in the country.
Larson said the CMA is looking to the state’s initiative process for relief. Proposition 56, a proposed cigarette tax, and Proposition 55, an extension of the Proposition 30 income tax increases that voters approved in 2012, are both on the November ballot. If they pass, they’re expected to provide some money for Medi-Cal services.
“We have to do it on our own because the state government is not very sympathetic,” Larson said.
Q: With roughly 80 percent of Medi-Cal enrollees now in managed care and that number rising, shouldn’t your argument that payments to doctors are too low be addressed to private insurance companies instead of the state?
The managed care reimbursement to Medi-Cal providers is much lower than commercial rates. Just being in managed care doesn’t mean the rates are competitive with commercial rates. Not only are they not competitive, they are not sustainable for most practices.
Right now these patients are disadvantaged. If you have cancer in Medi-Cal, you do no better than if you have no insurance at all. That was in the Los Angeles Times recently. I think that’s true. They have no access.
California is 47th out of 50 states in Medicaid payments to physicians. That includes managed care.
What we’re doing now is hoping to create revenue through taxation that’s directed to Medi-Cal rates. The cigarette tax initiative and perhaps some of the Proposition 30 extension monies might go toward propping up Medi-Cal rates.
Q: You’re saying that the CMA is using the ballot process to try to increase payments to doctors because its efforts through the Legislature have failed?
Absolutely. We have decided we have to do it on our own because the state government is not very sympathetic. We’ve gone to them many times and it doesn’t seem to matter.