Conference report on California's employer mandate - SB2 (& AB 1528)
The Proposed Conference Report No.1 for SB 2, an employer mandate, is now available. AB 1528, which originally was a combined employer and individual mandate has been converted into a quality and cost containment bill that must be enacted for SB 2 to become operative. The links to both proposed conference reports are provided.
SB 2, Health Insurance Act of 2003:
http://info.sen.ca.gov/pub/bill/asm/ab_1501-1550/ab_1528_bill_20030909_proposed.html
PDF version:
http://info.sen.ca.gov/pub/bill/sen/sb_0001-0050/sb_2_bill_20030909_proposed.pdf
AB 1528, California Health Care Quality Cost Containment Commission:
http://info.sen.ca.gov/pub/bill/asm/ab_1501-1550/ab_1528_bill_20030909_proposed.html
PDF version:
http://info.sen.ca.gov/pub/bill/asm/ab_1501-1550/ab_1528_bill_20030909_proposed.pdf
Comment: These bills could pass before adjournment this week and be on Gov.Davis’ desk before the recall election to be held next month. We are beyond conceptual abstractions and into the real world of health care reform.
Message: 2
From: “Don McCanne”
To:
Date: Wed, 10 Sep 2003 19:48:13 -0700
Subject: qotd: M. Wacker responds on ER call coverage rules
Margaret Wacker, M.D. responds to the change in ER call coverage rules under EMTALA:
As a neurosurgeon who covers emergencies at county hospitals, I would like to make a few comments. The rule that has been in place has caused many private-practice neurosurgeons to restrict their hospital privileges especially at hospitals that require a service to provide 24/7 coverage regardless of the number of a given specialty. Though this has usually been interpreted to mean that if 3 or more neurosurgeons are on staff the hospital must provide 24/7 coverage, neurosurgeons have tended to reduce the number of hospitals at which they work, so that the call burden does not become onerous. That has tended to make it even worse for those of us who work in the public sector.
Many neurosurgeons have told me that they would be willing to take some call, but don’t want to take every other to every third, so limited where they would practice to avoid that situation. If some of these neurosurgeons were indeed willing to take 1 in 5 or 6 call at a hospital, they might actually help relieve the shortage. Unfortunately, the problem of specialist shortage with the rule change without central/regional planning might be no better than the current situation, or may even get worse. Or each outcome might happen in a different area depending on how the involved individuals choose to act.
The only real resolution to the specialist shortage problem is to have regional planning, and not try to provide all services at all hospitals.Of course, then the specialists would be concentrated, so both goals—of 24/7 coverage and reasonable call schedules—could be achieved. It might even be possible to have some limited outreach from these centers, but not to have the 24/7 call coverage everywhere. The planned concentration would also have the benefit of not having ambulances go to uncovered hospitals as might happen with the simple change being proposed, which might lead to a somewhat haphazard schedule of which ERs are covered at a given time. Of course, the public would also need to understand that many “ERs” would only function for “urgent care”, but with a planned system could learn this.
This sort of regional planning has been happening with respect to trauma centers for some time, so certainly is possible. This is yet another way in which a national health plan would benefit the country.
Margaret Wacker, M.D. is a neurosurgeon with Arrowhead Neurosurgical Medical Group which covers Arrowhead (San Bernardino County) Regional Medical Center and Riverside County Regional Medical Center.