Bills Enhancing HMO Coverage of Women Gain

SACRAMENTO — The Assembly passed bills Monday aimed at forcing HMOs and insurance companies to liberalize policies for women’s health care, including covering costs of contraceptives and allowing for two-day hospital stays after breast cancer surgery.

A third measure was approved requiring managed care providers to allow patients to obtain a second opinion after an initial diagnosis.

It was the second set of bills approved this year by the Assembly that apply similar pressure on the industry, and drew opposition from some Republicans charging that the Legislature was trying to micro-manage the medical profession.

But not all Republicans agreed with opponents. The legislation that passed Monday attracted bipartisan support.

A bill (AB 7) by Assemblywoman Valerie Brown (D-Kenwood) requiring insurers and health maintenance organizations to pay hospital costs up to 48 hours after a woman undergoes a mastectomy was approved easily, 50 to 15.

The bill would allow a shorter stay if the patient and the doctor agree, and also would require a minimum 24-hour stay for women who go in for a lymph node dissection, a type of cancer test.

The money-saving economics of managed care, Brown said, have “resulted in incentives to dramatically shorten hospital stays”--a trend on a collision course with spiraling incidents of breast cancer in recent years, placing an ever-growing number of women in danger of inadequate care, she said.

In recent weeks, several measures have passed the Assembly similarly requiring that hospital stays be taken out of the hands of HMOs and insurers, including two bills by Assemblywoman Liz Figueroa (D-Fremont).

One bill (AB 38) calls for a 48-hour stay for mothers and newborns, if prescribed by a doctor. The other (AB 12) would apply to postoperative mastectomy treatment, as does the Brown bill, but the duration would be left entirely to the patient and doctor. No set number of hours or days is specified.

On Monday, the bill allowing patients to be covered for a second medical opinion, (AB 341) by Assemblyman Michael Sweeney (D-Hayward), passed 48 to 15.

The contraceptive measure, (AB 160) by Assemblyman Bob Hertzberg (D-Sherman Oaks), passed on a closer Assembly vote, 43 to 25, but it also had GOP backers. Six Republicans joined majority Democrats in voting for approval.

Hertzberg’s measure, drafted mainly for the benefit of women but not specifically excluding men, would allow claims for contraceptives that meet Federal Drug Administration approval.

It was unclear whether any of the bills approved by the Assembly would become law. They were expected to receive a friendly hearing in the Senate Health and Human Services Committee chaired by Sen. Herschel Rosenthal (D-Los Angeles).

But Gov. Pete Wilson vetoed a measure similar to Hertzberg’s contraceptive bill in 1995. Another version was killed in a Republican-majority Assembly committee last year. A spokesman for Wilson said it would be premature for the governor to comment on this year’s package of bills.

On Monday, Republican opponents charged that new costs imposed on managed care providers would only drive up the cost of health care for employers, jeopardizing coverage for employees.

Assemblyman Bruce Thompson (R-Fallbrook) called the contraceptive bill an outrageous intrusion by government and scorned the debate as reducing human reproduction issues into dollars and cents.

“Where does [Hertzberg] get the right to to tell people how to live their lives,” said Thompson, a devout Mormon who is against birth control.