CDA opposes bill that would allow state to set health care prices

CDA last week became aware of a bill that seeks to regulate and cap provider rates to a percentage of Medicare. Assembly Bill 3087 (Kalra, D-San Jose) raises significant concerns about fracturing the market and undermining the ability of providers to balance their patient mix.

AB 3087 would create an independent state agency “to control in-state health care costs and set the amounts accepted as payment” by physicians and other health care providers in an effort the bill’s author and supporters say would enable California “to achieve a sustainable health care system.”

The commission’s nine appointed members would meet at least once quarterly and, beginning July 1, 2019, would “annually determine the base amounts that health care entities, as defined, are required to accept as full payment for health care services, and would specify that the base amount for a health care provider shall be a percentage of Medicare rates,” according to the bill’s text.

CDA joins a number of other major provider groups representing a wide range of California health care professionals in voicing deep concerns about AB 3087 and issued the following statement from CDA President Natasha Lee, DDS.

“Maintaining and improving California’s robust health care system continues to be the most thoughtful approach to ensure we expand access to care that millions still lack. AB 3087 appears to be a far-reaching regulatory scheme with a nearly incalculable number of unintended consequences, which includes interfering with health care providers’ ability to care for patients. As a dentist, small-practice owner and professional association president, I strongly support thoughtful cost control measures, however, consolidating price-setting power in a commission as this bill proposes is simplistic and shortsighted. This bill would only speed us toward intensifying consolidation of the health care industry, turning care into a one-size-fits-all assembly-line commodity, and I am deeply concerned about its potential to disrupt care for millions of Californians as well as limit the number of health care providers willing to practice in the state.”

Although the bill requires the commission to create an advisory committee of 15 volunteer members who may include one physician and another licensed health care provider, the nine-member commission that sets provider rates would not include physicians, dentists or any other health care provider, unless the provider does not receive compensation for the care he or she provides. CDA strongly objects to the commission’s structure in light of the extreme regulatory scheme proposed by the bill and its potential to disrupt access to care.

CDA is additionally concerned that the bill, if passed, could undo the gains California has made under the Affordable Care Act. Under the ACA, more than 5 million Californians who were previously without health coverage now have access to care. CDA in January joined the Coalition to Protect Access to Care, composed of more than 100 California dentists, physicians, nurse practitioners, community clinicians and pharmacists, to protect this expanded coverage, and the coalition is working with legislators to expand coverage to the remaining Californians who don’t have coverage and to bring down the cost of care for patients.

Opposing this legislation is a high priority for CDA and the association will continue to update members as information is available.

Updated: 4/18/18

Related Items

If enacted, Assembly Bill 2643, co-sponsored by CDA and the California Society of Pediatric Dentistry, would require medical insurance plans to cover general anesthesia costs in the dental office setting when a patient’s developmental or other physical condition prevents that patient from receiving dental treatment unless deeply sedated but does not necessitate a hospital setting for care.

CDA is sponsoring new legislation that will allow dentists who provide care in the Medi-Cal dental program to be reimbursed when using silver diamine fluoride as a caries arresting agent. With the passage of Senate Bill 1148, SDF will be placed in dentists’ tool belts as an evidence-based option to manage dental caries when used as part of a comprehensive treatment plan, particularly beneficial with patients who present challenges to receiving traditional treatment.

New legislation sponsored by CDA and introduced by Sen. Nancy Skinner (D-Berkeley) is working to increase value and transparency of dental benefit plans. Senate Bill 1008 calls for the establishment of a minimum dental loss ratio for individual, small and large group dental benefit products and requires increased transparency for consumers who purchase dental savings or dental discount products by requiring standardized disclosures of what a dental benefit plan does or does not provide.