Two California unions say they are prepared to file separate state ballot initiatives this week that are considered among the most sweeping attempts to curb alleged HMO abuses.
Sponsors of both initiatives say they have collected the necessary 700,000 signatures needed to place the measures on the November ballot. If state officials certify that enough signatures have been collected, the measures will be put before voters in the general election.
The two unions-the California Nurses Association and the Service Employees International Union-could not agree on the more aggressive provisions in the CNA's measure and are going ahead with separate initiatives.
Both initiatives would prohibit so-called "gag rules" on doctors that prevent them from communicating openly with patients about their healthcare. They also would ban HMOs from paying incentives and bonuses to limit or deny care and would require a physical examination by a second physician before a plan can deny a particular service.
But the CNA's initiative-which it calls the "Patient Protection Act"-goes further and would establish a Health Care Consumer Association to be an advocate for patients. It also would establish a fund to finance the act and assist in maintaining the healthcare safety net.
The fund would be financed by a variety of fees or taxes. These would be levied on hospitals whenever they eliminated beds, on healthcare facilities that convert to for-profit status, on mergers and acquisitions, and on "excessive" stock holdings by industry executives.
Premium increases would be prohibited unless plans certify need and disclose financial results of the increase.
The CNA initiative was prepared under the guidance of consumer advocate Ralph Nader and is sponsored by the CNA and Foundation For Taxpayers and Consumer Rights, an organization headed by consumer activist Harvey Rosenfield.
Rosenfield is the author of Proposition 103, a 1988 initiative that forced insurers to rebate almost $900 million in auto premiums to consumers.
In a written statement, Nader called the CNA initiative "an example for the rest of the nation...the denial of care, gag rules for doctors and nurses...bonuses to reduce care, administrative waste, fraud, abuse and grotesque executive salaries and other riches are all a national scandal."
The SEIU initiative is backed by a coalition of consumer groups. Observers have said the two initiatives signify a rift between the two labor unions, with the CNA taking a harder line than the SEIU. But a spokesman for the CNA said, "We don't view this as being in conflict. We clearly have our eyes focused on the crisis in patient care. That's what's driving" both initiatives, he said.
He said the CNA will mount "a major campaign" both at the grassroots level and in the media in support of the initiative. He could not give an estimate of the campaign's cost.
The initiatives are opposed by Taxpayers Against the Government Takeover, a coalition of hospitals, business, industry, nursing homes, HMOs, insurance companies and other state organizations.
The California Healthcare Association "supports meaningful healthcare reform, but that's not what this is," said C. Duane Dauner, the president of the state's hospital association. "These are anti-provider, anti-managed-care initiatives that would dramatically raise costs without improving care."
Opponents have retained Goddard Claussen/First Tuesday, the Sacramento public relations firm that also is leading the American Association of Health Plans' strategy to redefine managed care's public image.