Ashby Wolfe, MD, MPP, MPH
political pulse
CAFP Fights Health Care Cuts Through November Ballot Proposition Positions Next month, citizens will be asked to vote on more than 10 propositions, numerous candidates for state and federal offices and the President of the United States. This past July, the CAFP Legislative Affairs Committee and Board of Directors reviewed the propositions and narrowed their focus to those that would most affect the practice of family medicine. The Committee recommended, and the Board approved, two positions: Yes on Proposition 30 and No on Proposition 31. Yes on Proposition 30 The economic recession has led to a precipitous decline in California state revenue. Despite tens of billions of dollars in state funding cuts and program eliminations, California has been unable to reduce its debt burden. Proposition 30 is an attempt to change the state’s economic course by balancing cuts with an increase in state revenue. Family physicians have seen firsthand the effect cuts to health and human services have had on their practices and their patients. Medi-Cal payment reductions have driven physicians out of the program and forced nearly half of those remaining to close their practices to new Medi-Cal patients. Family physicians have also seen an increase in patients seeking oral care in their offices because Medi-Cal dental coverage has been eliminated. The state has made cuts to child care assistance, In-Home Supportive Services, developmental services, hospitals and nursing home services, and Adult Day Health Care. The number of visits a patient could have with his or her physician has been capped. This attrition and elimi-
...the CAFP Legislative Affairs Committee and Board of Directors reviewed the propositions and narrowed their focus to those that would most affect the practice of family medicine. The Committee recommended, and the Board approved, two positions: Yes on Proposition 30 and No on Proposition 31. 14 California Family Physician Fall 2012
nation of coverage and services have hit the most vulnerable patients the hardest and must be addressed. A “Yes” vote on Proposition 30 would increase the personal income taxes on high-income taxpayers (individuals making $250,000 or more; couples making more than $500,000) for seven years and sales taxes by 0.25 cent for four years. It is estimated that approximately $6 billion would be generated through 2019. The new tax revenues would fund current state programs that have been hit hard by cuts over the past four years. The proposition would also guarantee funding for public safety services realigned from state to local governments and prevent implementation of “trigger” cuts to education. Organizations such as the California Medical Association, California Budget Project, California State Association of Counties, League of Women Voters, California Primary Care Association and others support this measure as a way to avoid further strain on the state’s General Fund and thereby prevent further cuts to health care programs. CAFP agrees and urges your support of Proposition 30. No on Proposition 31 The CAFP Board faced a difficult decision on Proposition 31. It is a government reform proposition with the goal of streamlining and improving budgetary processes. Certain aspects of the measure could yield positive results, such as establishing a two-year state budget cycle, requiring performance reviews of all state programs and requiring the Legislature to show how bills that increase state spending would be paid for with spending reductions, revenue increases or a combination of both. Other provisions, however, could affect programs important to family physicians and their patients in a severely negative way, including the provision that would allow the Governor to cut health and human service programs unilaterally. Programs such as Medi-Cal, the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program, the Family Planning, Access, Care and Treatment Program (FPACT) and others could be decimated in favor of other state programs, such as prisons and education, without a vote of the Legislature. Because this measure would give the Governor significant new powers to unilaterally cut spending, including for health programs, a future Governor hostile to health care programs or primary care could exercise this power to the detriment of family physicians and their patients. Given these concerns, CAFP is opposed and urges a “No” vote on Proposition 31. Dr. Wolfe is Chair, CAFP Legislative Affairs Committee