Health Reform-California Medical Association

TO: Hillary Rodham Clinton FROM: Jennifer Klein DATE: 7/16/96 RE: Issues to be Raised by the California Medical Association We were told that the California Medical Association hopes to raise two issues during your meeting with them on Wednesday, July 17. Health Care Reform They are interested in talking about moving forward on health care reform in the next term. According to Barbara Woolley, they have some concerns about the Democratic initiative to cover children which is part of the Families First Agenda (unveiled by House and Senate Democrats). The Administration has not taken a position on the children's health initiative, and instead we continue to talk about the President's budget proposal to cover workers between jobs. We have said that, of course, we support efforts to expand coverage. In addition, as you know, both you and the President have made comments about the possibility of moving forward on health reform by covering children. The initiative has three parts: 1. To make "Kids Only" insurance available by requiring that all insurance companies and managed care plans that do business with the Federal government (through FEHBP, Medicare, Medicaid, etc.) offer policies for children up to age 13. 2. To make "Kids Only" insurance accessible by requiring these policies to include the protections in the Kassebaum-Kennedy bill (including guaranteed issue, guaranteed renewability, no discrimination based on health status, etc.). 3. To help make "Kids Only" insurance more affordable by covering part of the premium through tax relief and premium subsidies. Managed Care Regulation The California Medical Association would also like to talk about regulation of managed care. The Administration was criticized recently in an article by Bob Pear in The New York Times claiming that the Administration had "shelved" a regulation to ensure that HMOs that contract with Medicare or Medicaid do not reward doctors for withholding appropriate care. The article was misleading; we remain committed to implementing this regulation. The change that was reported by Pear was simply a change in the effective date for the regulation to January 1, 1997 in order to tie its implementation to the signing of contracts between Medicare/Medicaid and HMOs. More generally, we continue to support both private and public efforts to promote quality managed care and to protect against denial of necessary care. For example, we have implemented tracking systems to monitor and improve quality of care in Medicare and Medicaid HMOs and created new materials SO that beneficiaries can make informed choices about managed care plans.