Today, the SFMS and CMA joined the AMA and dozens of other health care organizations in filing an amicus brief with the US Supreme Court challenging California’s Proposition 8, which denies state recognition of same-sex marriages. Tomorrow, a similar brief will be submitted challenging the Defense of Marriage Act, which denies benefits to same-sex partners of federal employees.

“CMA strongly supports efforts to reduce health care disparities among members of same sex households, including measures to afford such households equal rights and privileges to health care, health insurance and survivor benefits,” said CMA President Paul Phinney, MD. “We also recognize that denying civil marriage contributes to worse health outcomes for gay and lesbian individuals, couples and their families.”

The brief states that the listed Amici—which includes leading associations of psychological, psychiatric, medical and social work professionals— have sought to present an accurate and responsible summary of the current scientific and professional knowledge concerning sexual orientation and families relevant to this case.

These briefs were filed based on policy passed at last year’s House of Delegates:

Date Adopted: 10/15/2012
Status: Adopted

• Resolved #1 - That CMA support efforts to reduce health care disparities among members of same-sex households including minor children

• Resolved #2 - That CMA support measures providing same-sex households with the same rights and privileges to health care, health insurance, and survivor benefits afforded to opposite-sex households

• Resolved #3 - That CMA recognize that denying civil marriage contributes to poorer health outcomes for gay and lesbian individuals, couples and their families.

For a full copy of the Perry brief, please click here. 

This week, the court ruled that California Department of Health Care Services violated disclosure law in 2011 by refusing to provide background information on proposed Medi-Cal payment cuts with the California Medical Association (CMA).

The official signed judgment states that “documents exchanged between DHCS and the federal Centers for Medicare & Medicaid Services… are not subject to the deliberative process privilege claimed by DHCS.” The court also ruled that “the relationship between DHCS and CMS is fundamentally different from that involved in cases which have recognized a deliberative process privilege and any benefit derived from keeping discussions confidential is substantially diminished in this context.” The court ordered DHCS to release the documents that it gave to federal officials. The state has 20 days to appeal the decision or ask for additional time to explain why the documents should not be disclosed.

Background

In October 2011, CMS approved the state's plan to reduce certain Medi-Cal payments by 10%. State officials said that the cuts would save $623 million. In February, U.S. District Court Judge Christina Snyder granted a preliminary injunction to block the rate cuts on the basis that they could cause irreparable harm. Last year, CMA, California Hospital Association, and California Pharmacists Association filed a Public Records Act request to gain access to the state's supporting evidence that the Medi-Cal cuts would not harm beneficiaries' access to care. DHCS denied the request, saying that such documentation needed to remain private so the agency could "engage in candid policy discussions" with federal officials.

The Centers for Medicare and Medicaid Services (CMS) revised downward a looming cut to physicians, but for the medical community, it will be cold comfort. On January 1, 2012, physicians face a 27.4% Medicare Sustainable Growth Rate (SGR) payment cut. The Deficit Committee may be our last chance to eliminate the SGR once and for all. SFMS/CMA believe that stable reimbursement in this program not only protects access to care but also makes economic sense as physicians are important employers in their communities. Repealing the SGR this year will saves hundreds of billions of dollars and put an end to these last minute legislative fixes that inevitably delay and increase the problem. SFMS/CMA has strongly opposed the proposed draconian cuts to Medicare physician payment and will continue to advocate for a repeal of the flawed payment formula and stable and adequate reimbursement for physicians. Please join us in this fight by contacting Congress and let them know the effect this cut will have on your patients and your practice! 

Talking Points

Please include a full repeal of the Medicare SGR in the Deficit Committee legislation.

• Failure to stop the SGR cuts will cause physicians to stop taking Medicare patients or close their doors altogether.
• With the baby boom generation fast approaching retiring age, we’re talking about decreased access to care for more than 5 million Californians.
• It will cause drastic access problems for seniors and military families who need a doctor.
• Repealing the SGR reduces taxpayer costs and the deficit—it is good economics.
• Five years ago the cost to repeal was $48 billion, now it is $300 billion; soon it will be $600 billion. These last minute stop gaps are increasing Medicare costs to the federal government. We must repeal the SGR once and for all.
• Physicians employ more than 500,000 people in California and are substantial contributors to the local, state and federal tax base. Maintaining appropriate, stable Medicare rates keeps physicians in practice and prevents further unemployment and economic erosion.
• Physicians are important businesses and employers crucial to the California economy.

How to Contact Members of Congress

USE THE AMA GRASSROOTS HOTLINE at (800) 833-6354 to call your Representative and Senators Boxer and Feinstein. You will be asked to enter your zip code and select your Representative. Please select your Representative first, then call back to connect with Senator Boxer and Senator Feinstein. EMAIL Senators Boxer and Feinstein through http://writerep.house.gov; www.boxer.senate.gov and www.feinstein.senate.gov. Also contact Congressman Becerra (D-LA), a member of the Deficit Committee at www.becerra.house.gov. Messages can also be sent to California Representatives who are in leadership positions: House Whip-Congressman Kevin McCarthy www.kevinmccarthy.house.gov; and House Minority Leader-Congresswoman Nancy Pelosi www.pelosi.house.gov.

More Information

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The U.S. House of Representatives today passed a bill (HR 674) that would eliminate a 3 percent tax withholding on Medicare payments that was created under the Tax Increase Prevention and Reconciliation Act of 2005. The provision, scheduled to take effect in January 2012, requires a mandatory 3 percent withholding from payments made by government agencies in an attempt to address tax noncompliance. Although programs with eligibility based on recipient income (e.g., Medicaid) would be exempt, programs with eligibility based on age (e.g., Medicare) would not be. The bill now heads to the U.S. Senate. The Senate must also pass this bill for it to become law. If this provision is allowed to take effect, the Internal Revenue Service would require Medicare contractors to withhold 3 percent of Medicare payments to physicians and other health care providers. The 3 percent payment cut would be in addition to any cuts brought on by the Medicare physician payment formula. The withholdings would then be applied to physicians’ tax obligations for the year. Any withholdings in excess of actual taxes due would be refunded after physicians file their tax returns the following spring. SFMS, CMA, and others in organized medicine have told Congress that this flawed provision is untenable in the current Medicare payment system. Not only is there a 20 percent gap between what Medicare pays physicians and the actual cost of providing care to physicians, but physicians are also facing a 30 percent cut on January 1 due to the broken sustainable growth rate (SGR) formula. See additional information in the Wall Street Journal article.

Congress has appointed a Joint Select Committee on Deficit Reduction to develop $1.5 trillion in spending cuts/revenue increases by Thanksgiving. On January 1, 2012, physicians face a 30 percent Medicare sustainable growth rate (SGR) payment cut. The San Francisco Medical Society and California Medical Association (CMA) are joining the American Medical Association, state medical associations, and national medical specialty societies in a united campaign to get a permanent repeal of the flawed Medicare SGR formula included in the deficit reduction package that is currently being developed by Congress’ Joint Select Committee on Deficit Reduction. The deficit reduction committee is also considering proposals that would reduce federal matching funds for California’s Medi-Cal and Healthy Families programs. Decreases in federal expenditures would force California to further reduce physician payment rates and increase patient co-payments. SFMS, CMA, and the physicians of California are extremely concerned that additional cuts to already low payment rates will exacerbate the current access to care problems and cause irreparable harm to patients. There is unanimous agreement that cuts of this magnitude would result in serious disruptions in care for the nation’s elderly and disabled populations, and cannot be allowed to occur. We are asking Congress to repeal the SGR and work with us over the next few years to test and develop alternative payment models and health care delivery systems that ensure access to efficient, appropriate, high-quality, coordinated care. We believe that stable reimbursement in these programs not only protects access to care but also makes economic sense as physicians are important employers in their communities and repealing the SGR saves hundreds of billions of dollars. Physicians have been running a Medicare SGR marathon with Congress for the last decade. We are close to the finish line and need to make one last sprint! It’s NOW OR NEVER!

CONTACT CONGRESS TODAY!

EMAIL Senators Boxer and Feinstein through http://writerep.house.gov; www.boxer.senate.gov and www.feinstein.senate.gov. Also contact Congressman Becerra (D-LA), a member of the Deficit Committee at www.becerra.house.gov. Messages can also be sent to California Representatives who are in leadership positions: House Whip-Congressman Kevin McCarthy www.kevinmccarthy.house.gov; and House Minority Leader-Congresswoman Nancy Pelosi www.pelosi.house.gov. USE THE AMA GRASSROOTS HOTLINE at (800) 833-6354 to call your Representative and Senators Boxer and Feinstein. Key in your zip code and you will be connected to your Senator/Representative. Please state your name, specialty and city/county in which you practice, and urge them to:

• Repeal the Medicare SGR in the deficit committee legislation
• Stop further Medi-Cal physician payment cuts
• Protect access to care for California’s most vulnerable patients: Seniors, military families, the disabled, pregnant women and children

Click here for background information about this issue.

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