SFMS/CMA Defeats AB 533 September 21, 2015 Advocacy, CMA AB 533, legislative advocacy 0 SFMS and the California Medical Association have defeated a bill that would have drastically changed the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. AB 533 was an attempt to shield patients from billing disputes between providers and health plans and would have required non-contracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. Although SFMS/CMA is in favor of removing patients from billing disputes between health plans and out-of-network physicians, this specific solution would have transferred far too much power to health plans. If physicians were required to accept Medicare rates, the plans would have no motivation to contract with physicians. This would have eliminated physicians’ abilities to negotiate fair contracts and payment rates, reduced patient access to specialists, and incentivized plans to maintain narrower networks—without any punishment for failing to maintain adequate networks. AB 533 would have done more harm than good by giving massive market power and profits to health plans and insurers, while placing unfair burdens on the state’s physicians and patients. The measure would also have implemented a three-day delay for patients accessing out-of-network physicians under a PPO plan and created complications for physicians with an undefined dispute resolution process. SFMS/CMA fought the measure to the end, rallying physicians and lobbying against it until a final vote was taken at midnight on the last day of the legislative session. Ultimately, the bill did not receive enough votes to advance. Comments are closed.
