Stopgap bill to fund federal government includes 6-year CHIP extension Today, the U.S. Senate voted to end the federal shutdown and keep the government running temporarily for three weeks until February 8. This stopgap bill will give budget negotiators time to develop a final agreement on 2018 fiscal year spending. The House of Representatives is expected to adopt the Senate’s three-week stopgap bill. The bill also includes a six-year extension of the Children’s Health Insurance Program (CHIP) – an important program that serves nearly 2 million children and pregnant women in California, and more than 9 million nationwide. The California Medical Association (CMA) has been advocating vigorously for an extension of the CHIP program, which expired in October. Although the successful 20-year-old CHIP program has historically had bipartisan support, Congress had been unable until now to come to an agreement to extend the program. Over the past 20 years, CHIP has helped reduce the nation’s uninsured rate for children to a record low of 5 percent. It provides access to comprehensive coverage, mental health services and essential preventive services, such as immunizations and developmental screenings, to prevent more serious illnesses and disease. So far, CMA and the American Medical Association have also successfully fought-off the Medicare physician payment cut that was being contemplated as a funding source for extending some expiring Medicare programs. In return for Democratic votes on the stopgap funding bill, Senate Republican Leader McConnell has agreed to hold a Senate vote with open amendments on immigration issues, including the Deferred Action for Childhood Arrivals (DACA) program that expires in March. January 30, 2018 General Federal Legislation, Federal Legislative Advocacy, Maternal and Child Health, State Children's Health Insurance Program 0 0 Comment Read More »
California physicians condemn changes to Affordable Care Act birth control mandate The Trump Administration today announced an interim final rule that permits employers and insurers to claim a religious exemption to the Affordable Care Act’s (ACA) “Birth Control Mandate.” The California Medical Association (CMA), representing over 43,000 physicians in all specialties and modes of practice, issued the following statement, condemning this policy change on the grounds that it undermines the availability of preventative health care for California women. “Access to contraception is a basic preventative health care service that millions of Californians rely on,” said CMA President Ruth Haskins, M.D. “The Trump Administration’s decision puts the personal beliefs of employers and insurance companies above the fundamental right of women to make medical decisions aabout their own health and their future.” CMA policy supports access, without copays, to all FDA approved contraception as a basic preventative health service. “CMA strongly believes that medical decisions should be made by patients in consultation with their health care providers. This ensures that these decisions are made in the patient’s best interest,” said Dr. Haskins. “In addition to limiting the health options available to women, this policy would have an overall negative impact on public health in California.” # # # The California Medical Association represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit CMAnet.org, and follow CMA on Facebook, Twitter, LinkedIn and Instagram. October 13, 2017 General Affordable Care Act, ACA, Federal Legislation, Health Care Reform, Reproductive Issues, Women's Health 0 0 Comment Read More »
CMA, AMA and organized medicine were united in opposing Graham-Cassidy Last week, the latest effort to repeal the Affordable Care Act (ACA) collapsed, after three Republican Senators announced their opposition—Susan Collins (R-ME), Rand Paul (R-KY) and John McCain R-AZ). Further action is unlikely this year, as Senate Republican Leader Mitch McConnell (R-KY) said the Senate would now turn its focus to overhauling the tax code. However, several Republicans vowed to continue to work into next year to repeal the ACA. The California Medical Association (CMA), the American Medical Association (AMA) and all of organized medicine were united in opposing this harmful bill, which would have repealed the ACA’s insurance mandate, underfunded health insurance subsidies and made drastic cuts to the Medicaid program. The Graham-Cassidy block grant proposal would have been disproportionately harmful to states like California, which embraced Medicaid expansion and increased coverage under the ACA. Even states that initially came out ahead under the block grant framework would have experienced devastating funding cuts over time from the bill’s Medicaid funding caps on children, the elderly and the disabled. Millions of Californians would have lost their coverage, and many others would have been seriously underinsured. Patients without coverage seek more expensive care in overcrowded emergency rooms, passing costs onto states, counties, health care providers and taxpayers. These patients also put off treatment, ending up with more serious conditions that could have been prevented. These problems would be exacerbated by the reduction of subsidies currently provided to poor and middle class families. The Graham-Cassidy bill would also have allowed states to do away with pre-existing condition protections and other essential health benefits that keep Americans healthy. “Congress should engage with physicians and other medical experts on the front lines caring for patients to develop legislation that improves patient access to physicians, protects coverage for our most vulnerable populations and addresses affordability,” said CMA President Ruth Haskins, M.D. In the meantime, bipartisan negotiations have resumed in the Senate between Health Committee Chairman Alexander (R-TN) and lead Democrat Patty Murray (D-WA) to adopt reforms to stabilize the individual market, such as funding cost-sharing subsidies and reinsurance. CMA and AMA support this effort. It has been a long and difficult year for physicians who want to make constructive improvements to the health care system. While the ACA has its flaws, none of the House and Senate proposals thus far have met CMA’s principles for health care reform. CMA and the physicians of California will keep fighting for reforms that increase patient access to health care and maintain coverage for the millions of Californians insured through Medi-Cal and Covered California. October 13, 2017 CMA, General, Managed Care, Medi-Cal ACA, Affordable Care Act, Affordable Care Act (ACA) Repeal, Covered California, Federal Legislation, Federal Legislative Advocacy, Medicaid, Medi-Cal 0 0 Comment Read More »
California's physicians oppose Graham-Cassidy repeal bill The U.S. Senate is currently considering the Graham-Cassidy block grant bill, which would repeal the Affordable Care Act’s (ACA) insurance mandate, underfund health insurance subsidies and make drastic cuts to the Medicaid program. Under the bill, traditional Medicaid funding would be capped. Medicaid expansion and ACA subsidies for low- and middle-income families would be subject to an underfunded block grant and phased out in 2027. This bill would be disproportionately harmful to states like California, which embraced Medicaid expansion and increased coverage under the ACA. In response, the California Medical Association (CMA), representing over 43,000 physicians in all specialties and modes of practice, called on the California Congressional Delegation to oppose this bill. Congress should work with health care professionals to craft legislation that increases patient access to health care and maintains coverage for the more than 15 million Californians insured through Medi-Cal and Covered California. “This bill would significantly reduce Medicaid funding, which provides health coverage for more than 13 million Californians,” said CMA President Ruth Haskins, M.D. “A vote for this legislation is a vote to deteriorate public health in California – especially in areas like the Central Valley, where approximately half of the population relies on Medicaid for health care.” Patients without coverage seek more expensive care in overcrowded emergency rooms, passing costs on to states, counties, health care providers and taxpayers. These problems would be exacerbated by the reduction of subsidies currently provided to poor and middle class families. The Graham-Cassidy bill also allows states to do away with pre-existing condition protections and other essential health benefits that keep Americans healthy. “Congress should engage with physicians and other medical experts on the front lines caring for patients to develop legislation that improves patient access to physicians, protects coverage for our most vulnerable populations and addresses affordability,” said Dr. Haskins. # # # The California Medical Association represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit CMAnet.org, and follow CMA on Facebook, Twitter, LinkedIn and Instagram. September 27, 2017 CMA, Medi-Cal Affordable Care Act, Affordable Care Act (ACA) Repeal, Federal Legislation, Federal Legislative Advocacy, Health Care Reform 0 0 Comment Read More »
CMA urges swift action to renew Children's Health Insurance Program The California Medical Association (CMA) is urging Congress to reauthorize the successful Children’s Health Insurance Program (CHIP), which is set to expire on September 30, 2017. Although the 20-year-old program has historically had bipartisan support, there has been some concern that the CHIP reauthorization could get caught up in the partisan bickering surrounding other priority issues, including attempts to repeal the Affordable Care Act (ACA). CMA has urged Congress to reauthorize the program for at least five years at current funding levels to give states the stability to engage in long-term planning and innovation. The U.S. Senate Finance Committee last week agreed to a five-year funding extension for CHIP. The proposal would also maintain the ACA’s 23 percent increase in the federal matching rate to states for 2018 and 2019. In California, the CHIP program currently serves 5.6 million children. Since its inception, it has successfully provided children of low-income, working families access to physicians so they have a chance to grow up healthy and thrive. It provides access to comprehensive coverage, mental health services and essential preventive services, such as immunizations and developmental screenings, to prevent more serious illnesses and disease. “Your swift action is essential to continuing this important, cost-effective program,” CMA President Ruth Haskins, M.D., wrote in a letter to the California Congressional Delegation. “The health of California’s children depends on your immediate action.” September 27, 2017 General Federal Legislation, Federal Legislative Advocacy, Maternal and Child Health, State Children's Health Insurance Program 0 0 Comment Read More »
California congressmen introduce bills to address physician shortage Two important bills have been introduced in Congress to address our state’s serious physician shortage and improve access to care in California. The first bill, the Training the Next Generation of Primary Care Doctors Act of 2017 (HR 3394), would reauthorize for an additional three years the Teaching Health Center Graduate Medical Education (GME) program that was established by the Affordable Care Act (ACA). The Teaching Health Center program is a community-based primary care physician training program that has been extremely successful in expanding the physician workforce in underserved areas. This bill would also expand the number of residency positions available within existing teaching health centers and establish sustainable funding. This bill has bipartisan cosponsorship by California Congressmen Raul Ruiz, M.D. (D-Palm Springs), Jeff Denham (R-Modesto) and David Valadao (R-Fresno). The second bill, the Comprehensive Additional Residency Expansion Act (HR 3451), introduced by Congressman Jeff Denham (R-Modesto) and sponsored by the California Medical Association (CMA), would build on HR 3394. The Teaching Health Center GME program currently supports 742 residents at 59 teaching health centers. This bill would add an additional 240 residency slots to train new physicians and authorize 10 new teaching health centers. It would also require the new teaching health centers be located in areas with a disproportionate share of Medicaid patients to help alleviate physician shortages and access to care in underserved regions. These bills are critically important because California is experiencing a severe shortage of primary care physicians, particularly in the rural and Central Valley regions of the state. Our state has one of the lowest primary care physician to patient ratios in the nation. Only 10 percent of physicians practice in rural areas nationwide, although 25 percent of the population resides in these regions. Training more physicians to meet the growing demands of an aging population with multiple chronic conditions is a CMA priority. We support efforts to encourage more physicians to practice in underserved areas to improve access to care. The underserved Central Valley region of California in particular has experienced difficulty attracting and retaining physicians. Data shows that most physicians set down roots in the areas where they train and remain there after their training to care for their communities. These two bills will help to create a new generation of rural physicians and ensure that patients in those areas have access to essential preventive and primary care to diagnose and treat health problems early. These are important bills that represent a practical approach to improving the physician shortage crisis and access to care challenges in California’s underserved areas. August 9, 2017 General Federal Legislation, Federal Legislative Advocacy , Graduate Medical Education, Physician Workforce, Primary Care, Rural Health, Underserved Communities 0 0 Comment Read More »
CMA joins coalition to oppose Senate health care bill The California Medical Association (CMA) and a coalition of 9 other state medical associations have joined together to oppose the Republican Senate health care reform bill, the Better Care Reconciliation Act of 2017 (BCRA). CMA and the other associations are concerned that the Medicaid funding cap and inflation index would not keep pace with rising costs beyond physicians’ control. The California Department of Health Care Services estimates that the Senate bill would cut California’s Medi-Cal program by $114 billion. "The proposal places an untenable burden on state budgets and an uncompensated care burden on physicians who are on the frontlines caring for these patients every day," the coalition wrote in a letter to Senate leaders. "We need Congress' help to better care for our patients." The coalition has offered to work with Congress to improve our health care system and ensure access to high-quality, affordable care and coverage. The BCRA would convert federal Medicaid financing to a per-capita cap or a block grant beginning in 2020. It sets the total medical assistance expenditures for a state as the sum of the per-enrollee amounts for the elderly, people with disabilities, children and pregnant women. Under the proposed per-capita cap, the base-year expenditure amount is based on spending between January 2014 and September 2017. The per-enrollee per-capita amounts would increase by medical Consumer Price Index (CPI) for adults and children, and medical CPI plus 1 percent for the elderly and people with disabilities for 2020-24. In later years, the inflation index is reduced. This financing formula would result in a more than 3 percent cut to Medicaid every year. In only five years, the cumulative cut could total more than 15 percent. “These inflation-based Medicaid growth rates are unsustainable for states and physicians. States cannot absorb these tremendous costs," the coalition letter said. "They will be forced to reduce physician payment rates that already are 50 percent less than Medicare rates in many of our states. Access to care is a challenge for Medicaid patients now, and this proposal will only make it worse.” Rather than imposing across-the-board funding cuts, the coalition urges the Senate to consider alternatives to promote efficient Medicaid models of care, such as medical homes, that more effectively address rising health care costs and better address patient needs. Other cosigners of the letter include the state medical societies of Arizona, Florida, Louisiana, New Jersey, New York, North Carolina, Oklahoma, South Carolina and Texas. To read the letter, click here. July 24, 2017 Medi-Cal Advocacy, Health Care Reform, Better Care Reconciliation Act (BCRA), Federal Legislation, Medicaid, Medi-Cal 0 0 Comment Read More »
Bills introduced to stop IPAB California Congressman and physician Raul Ruiz, M.D., (D-Palm Springs) and Senate Finance Committee Ranking Member Ron Wyden (D-OR) recently introduced bills that that would prevent the Medicare Independent Payment Advisory Board (IPAB) from moving forward. IPAB was to be a 15-member federal agency with the task of achieving specified savings in Medicare without affecting coverage or quality. It was established by the Affordable Care Act and up until now has not been implemented. The board was charged with making recommendations to reduce per capita spending growth in Medicare if spending growth exceeds a specified target. The California Medical Association (CMA) has long advocated for the board’s elimination. CMA is concerned that strict budgetary targets and other limitations imposed on the panel would ultimately threaten the ability of the nation’s seniors and disabled to obtain health care because the cuts directed by IPAB would disproportionally fall on physicians and negatively impact access to care. “Given the Trump administration’s short but disturbing record of irresponsible and cruel executive actions, it would be a huge mistake to leave in place the authority to push through harmful cuts to Medicare with minimal input from Congress,” Wyden said. Senator John Cornyn (R-TX) and Representative Phil Roe, M.D., (R-TN) have introduced similar bills. CMA applauds the actions of these representatives, particularly our own physician Congressman, Dr. Ruiz, to eliminate the IPAB once and for all. March 2, 2017 Medicare Federal Legislation, Medicare 0 0 Comment Read More »
Congress approves $6.3 billion medical innovation legislation After several years of hearings and negotiations, Congress has passed a $6.3 billion medical innovation package intended to accelerate the discovery, development and delivery of new therapies, including $1 billion to help states address the opioid epidemic. It also provides important electronic health record (EHR) reforms for physicians and for the first time will penalize vendors for failing to have interoperable systems. The bill (HR 6), known as the "21st Century Cures Act," is intended to bridge the gap between medical science and legislative action and regulations that slow progress. It passed with strong bipartisan support. While the California Medical Association (CMA) and the American Medical Association (AMA) had concerns with some aspects of the legislation, CMA was pleased that it met two of our top federal legislative priorities – actual funding to address the opioid crisis and vendor accountability for EHR problems. Among other things, the legislation would speed up drug approvals, increase funding for disease research, address weaknesses in the nation’s mental health systems and alter the regulatory system for drugs and medical devices. It now heads to President Obama for his signature. Of the bill’s $6.3 billion in biomedical research funding, $4.8 billion will go to the National Institutes of Health, including $1.8 billion for Vice President Joe Biden’s Cancer Moonshot Task Force and $1.4 billion for President Obama’s Precision Medicine Initiative and brain research activities. The bill marks the first time Congress has approved funding to address the nation’s growing opioid epidemic. It provides $1 billion in funding to states over two years to supplement opioid abuse prevention and treatment activities, such as improving prescription drug monitoring programs, implementing prevention activities, providing training for health care providers and expanding access to opioid treatment programs. The bill also reinforces current laws that require insurers to treat mental illness as they do any other illness in terms of benefits. And, it creates a new position in the U.S. Department of Health and Human Services (HHS) called the Assistant Secretary for Mental Health and Substance Use as a focal point for coordinating mental health programs across the federal government. An entire section of the bill that CMA fought particularly hard to keep was related to the use of electronic health records. The bill includes provisions that will ease physicians' reporting burdens, including one that excludes providers who furnish most of their Medicare services at ambulatory surgical centers from penalties under the EHR meaningful use program and the new Medicare MACRA Quality Payment Program. Additionally, the bill allows physicians to delegate certain EHR documentation requirements to non-physician staff. Another key element of the EHR section is a focus on EHR interoperability. HHS will receive $15 million in funding to help push interoperability and fight information blocking by EHR vendors. For the first time, the Office of the Inspector General (OIG) can penalize vendors for not having interoperable systems. CMA aggressively advocated for more EHR vendor accountability and enforcement. In the past, physicians were penalized by the meaningful use program for problems caused by vendors. Now, EHR vendors will have to be more responsible and accountable to ensure that systems are working and interoperable. The bill also calls for the establishment of a national directory of health professionals so that physicians can easily contact each other. Finally, the bill provides $500 million to the Food and Drug Administration (FDA) to speed up the development and approval of new drugs and medical devices by putting less emphasis on randomized clinical trials in FDA reviews of new indications for a drug already on the market. Instead, the bill encourages the FDA to use "real-world evidence," such as data from observational trials and insurance claims. Click here for a summary of the legislative package. To read the full bill, click here. December 14, 2016 General Federal Legislative Advocacy, Federal Legislation 0 0 Comment Read More »
Opioid bill passes in Congress, but remains unfunded Congress broke a months-long stalemate this past week with the Senate’s passage of the Comprehensive Addiction and Recovery Act (CARA), which authorizes the federal government to award state grants for opioid-related initiatives around education, prevention, treatment and recovery efforts. However, the efforts will not be fully realized until there are resources applied to fund the bill. The legislation authorizes, but doesn't appropriate funding, for programs to combat opioid misuse, in addition to increasing the availability of naloxone, a drug to treat overdoses. The medical community and the American Medical Association (AMA) applauded the vote, but called on Congress to authorize funding for it. “This legislation represents an important step in addressing the public health epidemic of opioid misuse,” said Patrice Harris, M.D., chair of the AMA Board of Trustees and chair of the AMA Task Force to Reduce Opioid Abuse. “But it will not be fully realized without new resources to support these programs and policies.” CARA, which also incorporates elements of the 18 opioid-related bills passed by the House in May, includes provisions to do the following: Authorize grants for opioid-related initiatives around education, prevention, treatment and recovery Improve prescription drug monitoring programs Expand access to the opioid overdose reversal drug naloxone Create training programs for providers to test co-prescription for at-risk patients Establish an interagency task force that will examine best practices for pain management and pain medication prescription Raise awareness and education around the safe care of infants born affected by illegal substances Require the Government Accountability Office to track and report on the capacity for inpatient and outpatient treatment for opioid use disorders July 18, 2016 General Drug Prescribing, Federal Legislation, Opioids, Prescription Drugs, Drug Abuse 0 0 Comment Read More »
