AAP-CA Update - December 1, 2003

From the Desk of Kris Calvin, MA AAP-CA Executive Director
District Update, December 1, 2003

1. Budget, budget, budget...

Governor Schwarzenegger has wasted no time in letting the California Legislature know where he stands relative to improving the state's dire financial picture. Paired with a proposed $15 billion dollar bond initiative to bring in revenue, a major component of his budget proposal is a slate of significant (some would say disastrous) cuts to health services. The proposed cuts include a 10% Medi-Cal physician reimbursement reduction, which on top of last year's 5% cut would put us last in the nation in Medi-Cal payments to physicians. The Governor has also proposed freezing Healthy Families (HF) enrollment, as well as some portion of CCS enrollment. (The details are not clear yet as to what level enrollment would be frozen at in CCS or HF and whether only subpopulations of CCS would be affected.) The Lanterman Act, which creates an entitlement for specific special needs populations for certain services, is also on the table for "suspension".

AAP-CA is taking a multi-pronged approach to fighting all budget actions that would potentially weaken the already under funded system of care for California's children. These include:

*Lawsuit
The AAP-CA has joined as a plaintiff in a multi-specialty lawsuit against the state.
CMA has provided the leadership, staffing and the bulk of the funding for this effort to block the 5% cuts (with implications for the 10% cuts, as well). The first hearing on the case will be December 17th in Sacramento. Both Robert Black, MD of Chapter 1 and I provided declarations for the suit. Unlike lawsuits based solely on the equal access provisions of federal law (which can take years to play out in the courts), this suit asserts that the action through which California enacted the budget cuts was not appropriate and that an immediate injunction to stop the cuts is therefore warranted.

District Chair Burt Willis, MD appointed Robert Adler, MD, of Chapter 2 to chair a District Access/Reimbursement Task Force, which is taking the lead on the lawsuit and related issues. You may have already received and completed the District survey from that Task Force asking for input from you on your reimbursement and access concerns. If not, please look for it in your e-mail, or you may request a copy from the District office at AAPCALIFORNIA@aol.com

* Direct advocacy
Under the leadership of the AAP-CA SGA Committee, Chaired by Robert Black, MD of Chapter 1 and Vice-Chair Quynh Kieu, MD of Chapter 4, AAP-CA will provide testimony at critical hearings throughout the budget process. (Jackie Miller, our dedicated lobbyist, will guide us through this maze!) Lucy Crain, MD of Chapter 1 will testify on our behalf at the Senate Budget hearing Wednesday, December 10th. Dr. Crain also recently testified in opposition to a move to make "emergency" restrictions on CCS eligibility permanent. She was assisted in preparation for that testimony by Marc Lerner, MD of Chapter 4. Dr. Lerner also submitted written testimony on AAP-CA's behalf in opposition to the implementation of co-pays for some CCS services.

* Coalition building and activities
We will continue to work actively with our child advocacy coalition partners in Sacramento, who also strongly oppose cuts to children's services. To that end, Richard Pan, MD of Chapter 1 and I will represent the AAP-CA at the upcoming December 11th meeting of the Children's Roundtable, where budget strategies will be discussed. We also work closely with CMA on state government affairs, facilitated in part by our active AAP-CA Delegates to the CMA House Stuart Cohen, MD of Chapter 3, Paul Qaqundah, MD of Chapter 4 and Alan Burckin, MD of Chapter 1. Robert Black, MD and Quynh Kieu, MD also play an important role in representing us on the CMA Council on Legislation (COL). Recently Richard Pan, MD of Chapter 1 was nominated to be the Vice-Chair of the COL, a critically important position that will provide visibility and access for pediatrics in CMA legislative activities.

* PR
The AAP-CA is working directly with our press contacts to ensure that the public is made aware of the disastrous effects for children that the health cuts will have, if enacted. (We are also working to that end with our medi-savvy partners, including Children Now.) At a recent Chapter 2 Board meeting enthusiasm was expressed by many Chapter 2 Board members for leveraging the contacts they have through their patients and families in the entertainment community to get our budget message out. Effective use of this valuable network of contacts will be discussed by the SGA Committee and District Board.

2. Legislation

The current special legislative session is focused solely on the budget, so not much is happening with respect to legislation at this time. However, we were advised by Assemblymember Yee that he intends to introduce legislation to prohibit the sale of ultraviolent (rated "M" for mature) video games to children. John Bolton, MD and Tonya Chaffee, MD, both of Chapter 1, recently joined Yee at a press conference in San Francisco to educate the public about the link between violent media, including games, and youth violence.

Senator Jack Scott recently successfully carried legislation that now requires guns to have a visible chamber load indicator showing whether the gun is loaded. Joan Hodgman, MD of Chapter 2 spoke at a press conference with Senator Scott on youth violence and gun safety efforts.

3. Immunization Activities

AAP-CA is in the ninth year of a CDC-funded partnership with the state immunization branch and the California Academy of Family Physicians to improve immunization rates in private physician offices. As part of that effort we will be conducting 4 focus groups with physicians across the state to determine attitudes and knowledge about specific state immunization initiatives and activities. Some of the issues we will be looking at include ways pediatricians might help parents to prevent pertussis transmission to newborns and very young infants; bioterrorism readiness and vaccine issues; and consideration of involving OBs in vaccine efforts, including expected new STD vaccines. If you are interested in participating in an immunization focus group in your area, please contact us at AAPCALIFORNIA@AOL.COM.

The AAP-CA is also a founding and active member of the California Coalition for Childhood Immunization (C3I). We are working with C3I to educate legislators about the need for funding a fully-functioning immunization registry "hub" at the state level to link regional registries. C3I is also in the process of establishing a Natalie Joy Smith, MD Immunization Champion award, to honor Dr. Smith, a true immunization advocate and leader. Dr. Smith recently passed away at the age of 41. If you are aware of pediatricians or others whose activities have exemplified dedication to improving the immunization of California's children, such that you might want to see them nominated for the award, please let us know at AAPCALIFORNIA@aol.com.

4. What You Can Do

All four California Chapters have contributed greatly to the joint AAP-CA legislative effort. If you have ideas, concerns, or ways to make our advocacy stronger on your behalf, please contact your Chapter's SGA representative (see list below). We are making a difference. With your input and participation we can do even more.

Until next month...

Regards,

Kris E. Calvin, MA
AAP-CA Executive Director

Chapter SGA Representatives:
Chapter 1 (N Cal)	Michael Harris, MD	drmikeh49@comcast.net
Chapter 2 (LA)	Steven Feig, MD	pedsdoc2@aol.com
Chapter 3 (San Diego)	Stuart Cohen, MD	scohen98@ipninet.com
Chapter 4 (Orange County)	Quynh Kieu, MD	qkieu@projectvietnam.net