the tax on tobacco products by $2 per pack and stipulated that the new tobacco tax funds should increase access by improving provider payments. Despite being outspent, CMA and its partners in support of the measure got Prop. 56 passed overwhelmingly, providing an influx of new revenue to increase payments to Medi-Cal providers. Governor Brown, however, seeking to secure his legacy of fiscal prudence, sought to re-interpret the provisions of Prop. 56 to redirect the tobacco tax proceeds from Medi-Cal providers to the State General Fund. In his January budget proposal, Governor Brown didn’t include a rate increase for Medi-Cal providers. While there was an initial thought that the Governor was utilizing this proposal as a negotiation tactic to help shape the overarching discussion of the architecture for the state budget, it quickly became apparent that the Governor did not intend to ever support a rate increase for Medi-Cal providers. Thus, the battle began! The Governor’s intentions became more evident with the release of the Department of Finance’s May Revision. Just weeks before the constitutional deadline for the Legislature to pass the budget, the Governor doubled down on this earlier proposal and once again proposed no funding to support a Medi-Cal rate increase for providers. Restoring Prop. 56 funds was CMA’s top budget priority, and we engaged the Legislature through earned media, digital advertising, grassroots outreach and direct advocacy. CMA and its coalition partners, specifically the California Dental Association and Planned Parenthood, devoted the necessary resources to make sure that the Legislature followed the will of the voters and used the tobacco tax money to improve access to care in our state. CMA’s county
medical societies and individual physician members made calls, wrote letters and conducted in-person legislative lobbying visits. Our legislative champions, led by Senator Richard Pan, M.D., and Assembly members Joaquin Arambula, M.D., and Jim Wood, D.D.S., pushed both the State Senate and Assembly to reject the Governor’s budget. The final budget, which Governor Brown signed, provides over $1 billion ($546 million in state funds, with a federal match) to improve provider payments, and nearly $750 million ($375 million in state funds, with a federal match) will be available to physicians. This victory was a collective effort of the entire CMA. A budget team was assembled, comprised of members of the Centers for Government Relations, Health Policy, Strategic Communications and Political Operations. Working in concert, this team successfully pushed the budget as CMA’s top legislative priority. Media coverage of the budget is always competitive, but the issue of Prop. 56 funding garnered a significant amount of attention, even among the sea of other budget fights, thanks to the persistence of the CMA Communications team. CMA’s Political Operations staff organized physicians and county medical society executives to engage in the fight, bringing the issue to the attention of their legislators at in-district meetings and to the Capitol on our Legislative Advocacy Day in April. The CMA Government Relations team, the face of the fight, came armed to each hearing and meeting with the expertise of the CMA Health Policy team. Although this fight will no doubt play out again in some future years and we will need to be vigilant to ensure continued funding, this year’s budget success seals the intent of the voters and will provide relief for California’s shamefully low Medi-Cal reimbursement rates.
AN AGGRESSIVE LEGISLATIVE AGENDA
prescriptions. Our bill would improve privacy protections in the mandated use of CURES. To deal with how opioids are prescribed, Assembly member Joaquin Arambula, M.D., introduced AB 1048, which allowed for partial fill of Schedule II prescriptions and removed the requirement for evaluating pain as the fifth vital sign. These changes will alleviate some of the pressure on physicians to prescribe and reduce the number of opioids given to patients. CMA also successfully pushed a clean-up bill for last year’s AB 2883 (authored by the Committee on Insurance), a workers’ compensation bill that inadvertently created hundreds of thousands of dollars new, burdensome costs to physician practices. CMA’s
Amid the budget battle, the quotidian legislative work continued – as always. However, the routine was not without intensity. CMA this year pushed an aggressive legislative agenda through our package of sponsored bills, seeking to address a wide variety of our members’ issues. Two of our sponsored bills this year pertained to different aspects of the opioid crisis. SB 641 (Lara), which was put on hold for further discussion in the 2018 legislative session, is a supplement to Senator Lara’s SB 482 from last session, requiring use of the Controlled Substance Utilization Review and Evaluation System (CURES) for Schedule II-IV controlled substance
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