Governance of the system
1. How would the health care system be governed?
SB
840 provides for a Universal Healthcare Commissioner, who is appointed
by the governor and approved by the senate. The commissioner establishes
the California Universal Healthcare System and the California Universal
Healthcare Agency that is designated as the single state agency with
full power to administer every phase of the health care system.
The
commissioner has broad powers that include but are not limited to,
establishing the system’s budget, goals, standards and priorities;
hiring, firing and fixing compensation of agency personnel; determining
the scope of provided services and setting their rates of reimbursement;
making allocations and reallocations to health planning regions and
any and all matters related to the implementation of the health care
system.
The
commissioner establishes and oversees the Universal Healthcare Policy
Board comprised of the deputy commissioner, chief medical officer
and other agency health officers and directors who oversee the agency
boards and offices. These include the Universal Healthcare Fund, Office
of Patient Advocacy, Office of Health Planning, Office of Quality
Health Care, Partnerships for Health, Payments Board, Public Advisory
Committee and State Office of Public Health. The policy board works
with the commissioner to establish system goals and priorities that
include research and capitol investment priorities.
The
commissioner establishes an Inspector General’s office within the
Attorney General’s office. The inspector general has broad powers
to investigate and audit financial and business records of those providing
services and products and receiving reimbursement from the Universal
Healthcare Fund.
The
commissioner establishes an accessible process to receive resident’s
concerns, opinions, ideas and recommendations regarding all aspects
of the system.
The
commissioner appoints a transition advisory group that will make recommendations
to the commissioner, governor and legislature on how to integrate
health care delivery services and responsibilities into applicable
state departments and agencies. The advisory group will make recommendations
to the commissioner relative to how the system should be regionalized
to provide local and community-based planning for delivery of high
quality cost-effective care and efficient service delivery.
The
commissioner appoints regional directors for up to 10 Health Care
Regions that are comprised of contiguous counties. Regional directors
will administer the regions with respect to differences in cost-of-living,
population and facilities and provider needs. The regional directors
will appoint regional medical officers and planning boards. Regional
health boards will allow for residents to participate in health planning.
How would the system be funded?
SB
840 provides that the California Universal Healthcare System replace
private and employer-based insurance with new revenues and transfer
government funding for Medicare, Medi-Cal, Healthy Families, and other
government programs into the Universal Healthcare Fund. The new state
revenues will replace what businesses and individuals now pay to HMOs,
insurance companies and other providers. These revenues will provide
for comprehensive health coverage based on a single standard of care
for all residents. This is greater coverage than most private insurance
and government programs now provide.
SB
840 provides for a California Universal Healthcare Premium Commission
to develop an equitable and affordable premium structure for all income
earners and employers within specified guidelines. The commission
must satisfy criteria that maintain the current system’s ratio for
aggregate health care contributions from employers, individuals, state
and local governments and other sources.
The
premium commission will be comprised of health economists, legislators,
stakeholder representatives, relevant state department officers, legislative
analyst, controller, treasurer, and lieutenant governor. The commission
is required to present a premium structure to the legislature and
governor within two years after the enactment of SB 840.
2. Would the new system be accountable and transparent?
SB
840 establishes conflict-of-interest rules for the commissioner and
system officers, who also are subject to impeachment for malfeasance
in office.
SB
840 provides that the commissioner establish an accessible process
to receive concerns, opinions, ideas, and recommendations regarding
all aspects of the health care system from all residents. State and
regional health planning board meetings are open to the public, and
the public has access to all but privacy-protected documents.
The
Office of Patient Advocacy protects the interests of patients. The
patient advocate establishes and maintains the grievance process,
helps residents secure the health care services and benefits to which
they are entitled, represents the interests of consumers in governing
entities of the health care system and establishes a toll-free telephone
number to receive complaints regarding the agency and its services.
SB
840 also provides for an Internet web site to furnish information
about public meetings, information that supports choice of provider
and facilities, and activities for Partnerships in Health.
3. Could the commissioner close a hospital over the
objections of the community?
A
hospital could be closed if providers and patients choose not to use
it or if the hospital fails accreditation under California law. The
commissioner could hold back funds if a hospital fails to meet care
quality standards.
4. Who determines what medical benefits would be provided
under the new system?
SB
840 provides for affordable and comprehensive benefits with a single
standard of care for every resident. The Chief Medical Officer identifies
safe and effective treatments, evaluates existing benefit packages,
seeks feedback from health care providers about needed benefits, receives
feedback from patients or through the Office of Patient Advocacy,
and identifies complementary and alternative modalities that have
been shown to be safe and effective. After evaluation, the Chief Medical
Officer recommends a benefits package based on clinical efficacy to
the commissioner. The commissioner has the final approval of the benefits
package.
5. Who determines compensation for physicians and other
providers?
The
Payments Board determines compensation through negotiations with representatives
of physicians and other providers. The board is composed of designated
representatives of the commissioner, the Universal Healthcare Fund
and regional planning directors as well as experts in health care
finance and insurance systems.
SB
840 provides for actuarially sound payments that include just and
fair compensation for physicians and other providers in the fee-for-service
sector and for providers working in health systems where comprehensive
and coordinated services are provided to residents.
Payment
schedules remain in effect for three years, but adjustments can be
made at the discretion of the Payments Board. Bonus payments are made
for meeting performance standards and outcome goals.
