Traditionally allied California health groups split over Proposition 35

Californians have begun voting on Proposition 35, which would establish a permanent tax on managed care organizations (MCO), with all revenues going to Medical, the state's Medicaid program that covers at least 15 million low-income Californians.

Proposition 35 states that funds from the MCO tax are intended largely to reimburse providers who care for medical patients in primary and specialty care, emergency care, family planning, and reproductive care, among other areas.

The proposal is supported by the California Medical Association (CMA) and Planned Parenthood.

Although no counterargument has been officially presented to the voter guide, the League of Women Voters and the California Pan Ethnic Health Network oppose the measure.

“The devil is in the details of Prop 35,” said Ronald Coleman Baeza, executive director of policy at the California Pan Ethnic Health Network, an Oakland-based organization that advocates for health equity for minority communities. “We are very concerned about the approach in Proposition 35 because it directs our state’s resources toward selecting vendors who paid to bring the initiative to the vote.”

Opponents point to the possibility of a loss of funding for community programs currently covered by Medical, such as: B. Day centers for adults and pediatric centers for children with disabilities. While these programs can still apply for funding from the state budget, these organizations may have less funding available because larger portions are earmarked for direct funding to providers.

Three major California newspaper editorial boards, the LA Times, Mercury News and San Francisco Chronicle, have also spoken out against the measure. They cite the confusing nature of the measure as the main reason.

“The average person, no matter how intelligent, cannot become expert enough in a month to cast a carefully considered vote,” says the LA Times editorial board, citing the bill's impact on federal funding and stripping lawmakers of flexibility.

Riti Shimkhada, a physician and senior researcher at UCLA's Center for Health Policy Research, is neutral on the proposal but shares the opinion that the bill is confusing. Some people believe that this proposal would introduce a tax that would burden individuals, which is not true, says Shimkhada.

“It's very complicated. Even many of us in healthcare don’t fully understand it, so I’m not sure what the general public’s expectation is.”

She also points to a body of research showing that higher reimbursement rates for physicians have been shown to lead to better patient access to care and better health outcomes.

Shimkhada, who has worked with organizations on both sides of the issue, says that while both parties want better medical reimbursement, the real debate is how best to get there.

Still, proponents of the measure have raised $38 million for Vote Yes on Prop 35.

“This is a once-in-a-lifetime way that we can make a difference in the way this system works,” says Tanya Spirtos, president of the California Medical Association (CMA).

“What's happened over the last 20 years as funding for Medi-Cal has dwindled is that fewer and fewer doctors are accepting Medi-Cal because you're losing money on every single patient you treat… which is what Prop 35 does, is that it will bring in a larger amount of money that will go specifically to basic health care.”

Advocates say that Proposition 35's promise of Medi-Cal funding to providers will encourage more doctors to treat low-income patients. This could expand the list of providers Medi-Cal beneficiaries can see. In return, the measure could lead to shorter wait times for Medi-Cal patients to receive care from specialists.

Although the proposal does not mandate or eliminate actual reproductive rights in California, Spirtos said it could make these services easier to access.

Jodi Hicks, president and CEO of Planned Parenthood Affiliates of California and former vice president of government relations at the California Medical Association, is co-chair of the YES on 35 campaign.

“Voters can help protect access to family planning and more for 15 million Californians on Medi-Cal, including the more than 85% of Planned Parenthood patients in California who use Medi-Cal,” Hicks wrote in a statement to the Peninsula Press.