Whether it marked decisive support for managed care or a simple reluctance to authorize abrupt change, voters in California and Oregon turned down several ballot initiatives Nov. 5 that would have placed crippling restrictions on managed care plans. California residents resoundingly rejected two highly publicized initiatives that called for the imposition of extensive regulations and additional costs on HMOs and other managed care plans. Both California initiatives would have limited physician compensation arrangements, set minimum staffing levels at hospitals and other health facilities, restricted circumstances under which providers could be removed from a plan's network and required disclosure of certain health plan operational data.
"The side of reason has prevailed," declares Alan Hillman, M.D., director of the Center for Health Policy at the University of Pennsylvania's Leonard Davis Institute of Health Economics, encouraged by the recent vote. In making this "wise choice," he says, the voters "decided to let managed care evolve a bit more and to protect it from the kind of incrementalist potshots that would undermine certain aspects of it."
When the votes were counted, 58 percent of California voters rejected Proposition 214, sponsored by the Service Employees International Union. Proposition 216, offered by the California Nurses Association and the Foundation for Taxpayer and Consumer Rights, also was solidly defeated, with 62 percent of the state's residents voting No. The more onerous of the two, Proposition 216 also called for several billion dollars in new fees and taxes on health care businesses.
The California Association of HMOs (CAHMO) was especially pleased with the vote, which it contends sends a signal that voters are generally satisfied with their health coverage and health care service. "For the past three consecutive general elections, California voters have rejected bogus, special-interest health care 'reform' proposals," says Myra Snyder, CAHMO's president and CEO.
In 1992, residents in the state rejected a "play or pay" employer mandate initiative. Two years later, they voted down a single-payer ballot measure.
"Clearly, the message from California voters," says Snyder, "is that they do not want health care reform proposals that do little to improve access to health care, or that increase costs resulting in more government burdens on taxpayers."
Nevertheless, the issues behind the two California initiatives are not expected to fade away. Supporters will likely push for a bill covering some of the same points in the next legislative session. A spokesman for the National Conference of State Legislatures notes that the backers of the two measures have "raised the visibility" of the concerns consumers have about managed care .
Also aware of these concerns, managed care plans will continue to undertake quality studies and to educate consumers concerning "what man- aged care is all about," says CAHMO's Alan Tomiyama.
In Oregon, voters also rejected a highly publicized anti-managed care initiative spearheaded by Gordon Miller, a Salem ophthalmologist (see Managed Care's cover article, November). The measure would have allowed just five forms of reimbursement, effectively banning capitation as a method of provider payment.
On another ballot initiative, Oregon voters approved a measure giving the state government authority to raise Oregon's tobacco taxes to fund its health plan and tobacco-use reduction programs.
In Arizona, voters gave the state's Medicaid managed care system a boost by approving Proposition 203. It will add from 150,000 to 180,000 new enrollees to the system, and set aside $17 million a year from lottery proceeds for health programs. Joan Szabo