Tuesday, September 18, 2018



Staying in touch with our Physicians.

Vaccination Talks Continue

Although SB277 has passed and the uproar around the bill has seemingly calmed, anti-vax forces apprehend a new goal in contention with the vaccination bill. 


By Dominic Tovar

Those opposing SB277, which removes the personal belief exemption from school vaccination requirements, have been gathering signatures to recall the role of Senator Richard Pan, M.D., author of the bill. The goal of this action would be to put the discourse around vaccinations on the radar of political attention again, possibly igniting a revamp of SB277.

This course of action makes sense for the anti-vaxxers because it would be cheaper compared to the large sum of money it would take to qualify the ballot measure. Voters in the Sacramento-area would be the only district to have the ability to cast a recall election.

In the Santa Cruz area, a large community of individuals opposing SB277 have been present as rallies in front of the county building have been organized earlier in the year. “Santa Cruz County has one of the lowest immunization rates in the state, according to the California Department of Public Health. In the county, 9.5 percent of kids have a personal belief exemption — nearly four times higher than the state average” (Via Santa Cruz Sentinel).

If the recall passes, the vaccination bill will definitely gain state-wide attention and those who are against SB277 may gain momentum in the coming months.



Governor Brown Signs and Passes Senate Bill 277

After passing the State Assembly and then the State Senate this past Monday, we have finally approved the law and made California safer for young children across the state.



By Dominic Tovar


With this approval by the Governor, elimination of the personal belief exemption that allowed children to go to school without being vaccinated has been removed from the current list in response to a wave of outbreaks that could have been prevented had individuals been vaccinated.

The bill gained momentum last December with “at least 136 confirmed cases of measles across more than a dozen counties. Nearly 20 percent of those cases have required hospitalization.” Read the full article from CMA here.

 In the time before the bill some views agreed that pulling children who are not vaccinated out of the public health system would result in them being home schooled or be sent to private schools – not really dealing with the issue of vaccination and public health head on. But as California rallied around this need for a better health policy, the state has also grown more united as shown by the organization of vaccination campaigns led by organizations and local communities. 

As the bill stands, children who are home-schooled or participate in independent study do not have to receive immunizations: “Thus, SB 277, while requiring that school children be vaccinated, explicitly provides an exception when a physician believes that circumstances – in the judgement and sound discretion of the physician – so warrant” – Governor Brown. Read the full bill here.

We would like to acknowledge the “I Heart Immunity Campaign” which reacted to the need of a healthier California and has grown with the aid of organizations from all counties and organizations in the state including Vaccinate California, Kaiser Permanente, Pasadena Public Health Department, and many more to advocate for the passing of SB 277 and create a discourse that addressed this issue.  


New Senate Bill Requiring Children to be Vaccinated Before Entering Public School Systems

As of Wednesday April 15, 2015, the Senate Education Committee decided to delay its vote on the bill regarding the end of all personal belief vaccination exemptions due to concerns from the opposing side.

by  Christina Yang

California law requires that children entering kindergarten are to obtain vaccinations for several diseases. However, parents are currently able to obtain exemptions if vaccinations are against personal or religious beliefs by providing documentation stating that the parents have been informed about the vaccine and disease.

Due to these exemptions, in 2014, 13,500 personal belief exemptions and 2,700 religious exemptions were granted in California. This was also the year that there were 123 confirmed cases of measles in California, read more. 

Because the potentially dangerous consequences of vaccination exemptions, Senators Richard Pan and Ben Allen have proposed a bill, SB-277 Public Health: Vaccinations, to end certain vaccination loopholes.

The bill would remove all personal belief exemptions of vaccinations in public school settings. The bill also mentions the vaccinations that are to be received before a child enters the public school system such as pertussis (whooping cough), varicella (chicken pox), measles, and mumps to name a few. The benefits of this bill would eradicate the entry of preventable diseases in the United States.

Some of the views state that pulling children who are not vaccinated out of the public health system would result in those children being home schooled or be sent to private schools which many people believe is not a real and long term solution to the problem. Others believe that the bill is a good starting point on addressing the issue but isn't fully developed. Despite the opposition, there is still support for the bill.  As of Wednesday April 15, 2015, the Senate Education Committee decided to delay its vote on the bill regarding the end of all personal belief vaccination exemptions due to concerns from the opposing side.


The SGR Reform and the Children's Health Insurance Reauthorization Act has finally crossed the U.S. Senate and passed after a decade of exhausting debates.

by Dominic Tovar and Elizabeth McNeil


The SGR Reform and the Children's Health Insurance Reauthorization Act has finally crossed the U.S. Senate and passed after a decade of exhausting debates. This extremely important passage disrupts the original SRG outline which has held back a plethora of issues including payment plans and physician involvement in regards to determining how much input they are able to contribute on quality. While the SGR repeal will stand as an example of the effect that group effort maintains, it will also allow for there to be new discourse on other healthcare issues. To view the full text of the bill, click here.  Following this introduction are excerpts from an update by Elizabeth McNeil, Vice President of the Federal Government Relations for CMA.

After a decade of battling, the U.S. Senate, in a whopping vote of 92-8,  passed H.R. 2, the monumental, bipartisan Medicare SGR Payment Reform and Children's Health Insurance Program (CHIP) Reauthorization Act.  Both Senators Feinstein and Boxer voted in the affirmative.  President Obama is expected to immediately sign it into law.  Two weeks earlier, the U.S. House of Representatives adopted the legislation in a landslide vote of 392-37.  The CMA applauds this rare, bipartisan achievement in a deeply divided Congress.  CMA, AMA and more than 780 state and national physician organizations supported the bill.  In 2013, the policy was jointly developed on a bipartisan basis by the three House and Senate health committees.  This year, U.S. House of Representatives Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) are credited with negotiating the final budget offsets to fund the SGR bill.  

CMA extends a sincere thank you to all physicians for the extraordinary campaign this last decade to end the SGR.  CMA physicians kept up the fight these last two years to hold Congress' feet to the fire to develop a comprehensive bill to reform Medicare physician payments.  The unity within organized medicine finally put this over the finish line.  Moreover, 52 out of 54 Members of the California Congressional delegation voted to support physicians.  This is an incredible achievement in one of the most dysfunctional Congresses in history.  Please be sure to contact your Representative and the California Senators to thank them for their support via the AMA's website, www.FixMedicareNow.org.  Click on physicians and click on email.
Below is a brief summary of the major provisions of H.R. 2:
·         Medicare SGR Payment Policy:
·         Repeals the SGR;
·         Provides automatic, stable 0.5% updates each year for 4 years;
·         In 2019, physicians can choose to participate in one of two payment track options:
·         1: Maintains a Fee-for-Service Track that simplifies and consolidates the existing quality reporting programs, reinstates large bonuses up to 9% and reduces current penalties; 2: The Alternative Payment Model Track provides 5% bonus payments and allows physicians to develop the new models, such as primary care/specialty medical homes.
·         Physicians are also required to be involved in defining quality;
·         $125 million in funding to help small practice physicians transition to the alternative models or quality reporting programs; 
·         Reinstates bundled payments for the 10-day and 90-day global surgical services;
·         Provides total cost of care data to help physicians better manage their practices;
·         Mandates interoperability of EHR systems;    
While H.R. 2 is far from perfect, it represents a significant improvement over the current Medicare program which mandates penalties up to 13% in the coming years with no opportunities for payment updates or bonuses.  This bill consolidates the burdensome reporting programs and reinstates significant bonus payments. By repealing the SGR and providing annual updates, it provides stability to physician practices that allows for longer term planning.  Significantly, it allows physicians to design new payment systems that work for physicians and patients instead of government bureaucrats.  And it mandates physician involvement in defining and developing quality measures.  Moreover, once the costly SGR is repealed, it will be much easier for physicians to work with Congress to make improvements to the payment system (such as increasing the annual update) at a lesser cost. The enormous cost of the SGR has been a barrier to making any improvements.
·         Extends the expiring Children's Health Insurance Program (CHIP) for 2 years at the higher ACA funding levels:  It covers nearly 1 million children in California who would otherwise lose their insurance.  CHIP was formerly known as Healthy Families in California before it was folded into the Medi-Cal program.  However, it still enjoys a 60% federal funding match.   
·         Extends the expiring Community Health Center funding.
·         Extends the important National Health Service Corps Program and the Teaching Health Centers Rural Primary Care Residency Training Programs (created in the ACA) through 2017. There are several teaching health center residency programs in California.
·         Makes permanent the Qualifying Individual Medicare program that helps low-income seniors pay for premiums and continues the Transitional Medical Assistance Program for Medicaid families transitioning from welfare to work.
·         Extends the moratorium on RAC audits of the hospital two-midnight rule which helps hospitals and physicians.
·         Delays the ACA cuts to Disproportionate Share Hospitals for one more year.
1.  ~$200 billion (non-partisan Congressional Budget Office cost estimate) will not be fully offset with funding sources.  The SGR repeal portion of the bill will not be offset.  For 12 years, Congress has stopped the SGR payment cuts and the SGR never takes effect.  Therefore, the SGR savings to the federal government are phony.  Speaker Boehner and Leader Pelosi have rightly concluded that the cost to repeal the SGR should be $0.  The Wall Street Journal and the Americans for Tax Reform agree. 
2.  The remaining $70 billion will come from the following:
-Deductibles for new MediGap policies starting in 2020;
-Increased premiums for the 2% of very high income seniors: 15% more for couples making $267-320,000 and 20% more for couples making more than $320,000 in retirement income. 
-$35 billion in payment cuts to hospitals and others providing post-acute care services.  This does not apply to physicians. 

PHYSICIANS: Please View and Share the "No On 46" Ads on Social Media

PHYSICIANS: Please View and Share the "No On 46" Ads on Social Media

By Sergio Klor de Alva

The "No On 46" campaign has begun releasing campaign videos and advertisements on the radio in both English and Spanish, such as "The Truth about Proposition 46," which features real practicing physicians and medical students from California discussing the costs and potential devastating effects that the passage of Prop. 46 would have on patients and the state's overall health care system.
Other ads include the television ad "Risk" and the radio ad "Real Story." For Spanish versions of the same ads, please click here and here, respectively.
The ads address many of Prop. 46's major flaws, such as:
* The initiative was authored and funded almost exclusively by trial lawyers who stand to personally profit from the passage of the measure;
* The initiative would cost taxpayers hundreds of millions of dollars annually by quadrupling the limit on medical malpractice awards in California;
* Medical professionals may be forced to reduce services or even move their practices out of state as a result of the increased costs the initiative's passage would generate
* Personal privacy would be jeopardized due to the massive expansion of the use of a government-run prescription drug database (CURES) without additional security safeguards.
The ads also note that the proposition is dishonest, as the physician drug testing provision was only "inserted as a sweetener" in order to make the initiative more attractive to voters and to mask the measure's true intent: increasing the cap on medical malpractice awards.
According to Gale Kaufman, Senior Strategist for the No on 46 campaign, "Californians have a long and well-documented history of rejecting ballot measures that are either dishonest to voters or too burdensome for taxpayers. Proposition 46 is a double whammy – it's both deceptive and costly. [The video entitled The Truth about Proposition 46] represents a powerful opening argument in the very strong case against this year's most reckless ballot measure."
For more information, please visit www.NoOn46.com.

PHYSICIANS: Support the "No On 46" Campaign to Preserve MICRA

 PHYSICIANS: Support the "No On 46" Campaign to Preserve MICRA

Myriad health providers, education groups, business organizations, labor unions, workers, and community clinics have announced their opposition to Proposition 46.

By Sergio Klor de Alva

The passage of Proposition 46 would have disastrous consequences for the state of health care in California. Health costs would increase, access to care would be reduced, and patient privacy would be jeopardized, while lawyers initiate lawsuits that would make it even more difficult for medical practices to stay afoot. According to CMA spokesperson Molly Weedon, it is estimated that the passage of this initiative would cost an average family of four over $1,000 per year.

Proposition 46 also includes a number of unrelated provisions that were likely added with the intention of being "sweeteners" to entice voters into supporting the measure. These provisions include drug testing for physicians and the mandatory use of the government-run CURES database, which third-party analysts believe cannot be properly implemented as currently written and will leave patient information vulnerable to breaches in privacy.

California's independent Legislative Analyst believes that the measures could increase state and local government health costs by "hundreds of millions of dollars annually," thus severely impacting the access and affordability of medical care in the state.

For a complete list of "No On 46" members and to learn more about the campaign, please visit www.noon46.com.

VOTERS: Two Important Health Care Measures on November Ballot

VOTERS: Two Important Health Care Measures on November Ballot

Of the six measures (Propositions 43-48) that have qualified for the upcoming November ballot, two of them are health-related.

By Sergio Klor de Alva

Of the six measures (Propositions 43-48) that have qualified for the upcoming November ballot, two of them are health-related:

* Proposition 45 is an initiative statute requiring that health insurance rate changes be approved by California's Insurance Commissioner before taking effect.

* Proposition 46 is an initiative statute seeking to increase the cap on non-economic damages in medical malpractice lawsuits, in addition to implementing other measures that will jeopardize health care access for individuals across the state and will severely impact physicians' abilities to care for patients.

Both of these propositions are sponsored by Consumer Watchdog, a not-for-profit advocacy group headquartered in Santa Monica.

In addition, two other health-related measures are awaiting signature verification and have been held by the Secretary of State's office. While these measures did not reach the necessary signature threshold of signatures to be included on the 2014 ballot, they may have enough signatures to qualify in 2016. These measures include:

* An initiative to make the Medi-Cal hospital quality assurance fee permanent. This money is used to pay hospitals for providing Medi-Cal health care services. California hospitals want to ensure that the state is not using this money for other purposes.

* A proposal that would automatically augment wages of home health workers in the In-Home Supportive Services program whenever there is an increase in the minimum wage. It would also mandate a specified amount of training for those workers

All qualified ballot measures can be viewed on California Secretary of State Debra Bowen's page. For more information about the potential consequences of Proposition 46, please visit www.noon46.com.


SB 1000 Stalls in Committee

SB 1000 Stalls in Committee

The bill would have required a warning label on all sugary beverages sold in California.

By Maria Jennings

SB 1000 (Monning-D, Carmel), the bill that would have required sugary beverages to carry a health warning, failed to pass out of the Assembly Health committee.

The bill, which was co-sponsored by the California Medical Association, would have warned consumers of the negative health effects of drinking sweetened beverages. The label, which was developed by a national team of nutrition and public health experts, would have read: STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributed to obesity, diabetes, and tooth decay.   

Despite public support and testimony t from public health organizations, health care providers, and non-profit organizations, the bill has strong opposition from the beverage industry and affiliated business interests. Some members of the Health committee questioned the effectiveness of warning labels, as well as the specific language used in the warning.

The bill successfully passed out of the Senate earlier this month, but only received seven out of the necessary ten votes needed to pass the Health committee.

While the failure of the bill is a setback for public health advocates, its introduction and consideration was groundbreaking. It was the first bill of its type to be proposed in the nation, and received national, and even international, media coverage. 

Read CMA's full coverage of SB 1000 here. Stay up to date on health legislation by following SCCMS on Twitter. Also stay up to date on the Cruz Med Foundation here.

California Teachers Association Joins Campaign to Defeat MICRA Ballot Initiative

California Teachers Association Joins Campaign to Defeat MICRA Ballot Initiative

The CTA is the largest statewide teacher organization.

By Maria Jennings

The California Teachers Association (CTA), the largest statewide teacher association, has joined the chorus of organizations that have come out against the MICRA ballot initiative. 

The CTA, one of the state's leading voices in education, is joining the growing list of public and private organizations, including the Santa Cruz County Medical Society, that have come out against the ballot initiative.  Other organizations against the initiative include the California Medical Association, Planned Parenthood of California, the SEIU of California, and the American Civil Liberties Union of California.

"At a time when California is finally getting school funding back on track and paying back students after years of drastic budget cuts, the last thing public education needs is to be forced to foot a brand new bill for unregulated health care costs,"  CTA President Dean Vogel said in a statement. "This is a costly and harmful initiative that our students and school can't afford."

The proposed ballot initiative would raise the limit on medical malpractice insurance to around 1.1 million. This has the potential to further drive up the cost of healthcare in California, as it would force doctors to spend more on medical malpractice insurance. According to California's nonpartisan Legislative Analyst Office, the proposed ballot initiative could increase state and local government health costs by "hundreds of millions of dollars annually."

Read CMA's full coverage of the statement here, as well as the full list of organizations against the ballot initiative here. As always, keep updated on the latest MICRA news by following us on Twitter.


Important Deadline: June 30th, 2014

By Sergio Klor de Alva

Physicians who do not wish to participate in Anthem Blue Cross’s individual/exchange network have until June 30, 2014, to opt out before the new contract addendum becomes effective on July 1, 2014. The addendum contains new regulatory requirements and certain provisions that are concerning to CMA.


For more information about the contract addendum and opting out, please read this notice and click here.


You may also contact the CMA reimbursement helpline at (888) 401-5911 or at economicservices@cmanet.org.


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