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Posted on 05-05-2016

AB 2407 Results in Special Hearing

Last week’s Corner featured the circuitous and tortured road our AB 1992 endured.  This week’s Corner features another convoluted example of the legislative process.  Another process that doesn’t exist in the text book I use for my community college course on American Government.  Never the less, it is part of the system.  If you want the six-minute Reader’s Digest version of the events, check out the video explanation:

                             

Let me begin with the obvious: AB 2407, authored by Assembly Member Rocky Chavez, was not heard in Assembly Insurance Committee this past Wednesday morning as scheduled.

Let me also reiterate the obvious again: everything we did to lobby AB 1992, enumerated in last week’s Corner, we also did on behalf of AB 2407.  If you missed last week’s Corner, click here to view our strong and comprehensive lobbying activities.

So let’s walk the wild and wacky path of AB 2407.

The genesis of our bill began in Oregon in 2014.  Oregon’s health plan realized they had a huge use of opioids and back surgeries for residents with back injuries and the outcomes were poor.  They formed a task force comprised of neuro and back surgeons, pain specialists, mental health experts, acupuncturists and chiropractors.  Their charge was to assess all evidence-based peer reviewed studies on care for back pain and submit recommendations.

No surprise to any of us, the recommendation was to ensure immediate access to conservative care and back surgery should only be a last or emergency resort.

Enter AB 2407.  Early opposition to the introduced version of the bill accused us of circumventing the Medical Treatment Utilization Schedule (MTUS) recommended guidelines.  In conversation with our CCA Workers’ Compensation Committee members it was revealed that if Primary Treating Providers (PTP) actually followed the recommended guidelines, injured workers would be much better off, since the guidelines called for conservative care first in the case of back injuries.

To address the opposition’s concerns, the week before the hearing, we amended AB 2407 so that it would require all PTPs in workers’ compensation to follow the MTUS guidelines for workers with back injuries.  There is no requirement in law these guidelines be followed.

The MTUS recommended guidelines require conservative care for back injuries prior to other care, but are routinely ignored by PTPs.  Simply requiring PTPs to do what they are already supposed to be doing, made the bill much stronger and harder to oppose.  Unfortunately, opponents of the bill, California Chamber of Commerce, Insurers, and California Medical Association didn’t want PTPs to be forced to do what they were already supposed to be doing.  They claimed AB 2407 was redundant of existing law.  We proved there is NO statute requiring the guidelines be followed.  They claimed it would result in new litigation.  We proved there has been zero litigation with respect to MTUS, so it’s inconceivable requiring these guidelines be used would suddenly spur litigation.  Opposition also claimed it would cost the state more money.  We proved conservative care cost less, so adhering to MTUS would actually save the state money. 

In spite of our decimating rebuttals, the committee consultant writing the analysis parroted the opposition arguments in a one-sided analysis.  Most staff and members base their votes on the information in the staff analysis to a great extent.  Consequently, our retail lobbying (Monica Miller and me) was cranked up yet another notch to try and counter the biased analysis.  See the analysis here.

In one conversation with one Assembly Member, an attorney, the response was “You’ve made a compelling argument, Why don’t you have a Democratic author?”  My response was “It wasn’t for lack of effort; we asked every Democrat in the Legislature.”  The Assembly Member asked, “Even my office?”  I looked at the Chief of Staff, a very old and dear friend, and responded, “Of course.”  Hey, sometimes the truth hurts, and maybe next time we pitch our bills my friend won’t be so quick to say his boss’ legislative package is full.  The point of this story is, our arguments were strong, Democrats think a Democratic author would improve our chances, and we’re building rapport with Democrats that should help us get them as author or co-authors on our bills in the future. We are grateful our Republican authors have been willing to take on powerful interests on our behalf.

Our retail lobbying effort was ongoing and relentless, which takes us to the night before the hearing.  This is where the process digresses from the pages of American Government text books.

While one of our star witnesses was literally on an airplane to Sacramento, a domino fell that set in motion an entire row to fall.

It had become clear our arguments would not overcome the biased analysis and specious arguments of the opposition. At the end of the day it always comes down to the math in politics: do you have the number of votes necessary?  But, the Republican committee consultant was attempting to find a way to help us get the bill out of committee and came up with an amendment he hoped would remove opposition and get us the seven votes we needed. 

The amendment he offered would delete the current version of the bill and replace it with requiring the Division of Workers' Compensation to have a study done on utilization of MTUS for back injuries.  We believed this wasn’t necessary since we wouldn’t have an opioid epidemic if PTPs followed MTUS guidelines, but this could be better than a loss in committee. 

Republican committee members were loath to vote for the bill if the Chamber continued to oppose, and this would likely remove the Chamber’s opposition. 

So while the author's office worked on finding out if it would remove opposition, we worked with Drs. Moses Jacob, Chair of our Workers' Compensation Committee and Dr. Wayne Whalen, also a member of the committee and a key witness, to figure out if a study would be helpful to our cause, if the data is out there to be found, and what such a study might cost.  Yes, it would be useful, the data exists and there would be little or no state cost.

The Republican consultant took his idea to the Democratic consultant.

The Democratic consultant took it to the Chair of the committee.

The Chair of the committee took it to the Vice Chair.

The two Chairs discussed the bill and came up with an entirely different idea.  They decided this issue definitely needed scrutiny by the legislature and that an informational hearing by the committee on this issue, during the interim this Fall, would provide the opportunity for that scrutiny.   

Since it was clear we didn't have the votes, but our author, Assemblyman Chavez, was willing to hear the bill regardless, so we could make our case, he saw this option as an improvement. 

We too saw this as an improvement.   Instead of getting 15 minutes or so to make our case and lose the bill, we’ll get 90 minutes or so to educate in detail and come up with a course of action we can get passed next year.

Our author is committed to our cause on this and will continue to carry this torch for us.

The hearing will provide CCA and other conservative care providers an advantageous opportunity to provide testimony and data unrestricted by the constraints of time and political pressures associated with hearings on legislation.  CCA expects the hearing to produce consensus on next steps to address under use of MTUS by PTPs.

The committee voted unanimously in support of the committee Chair’s motion to hold the hearing in the Fall.

Palmer West Student Tracy Lam Honored

Tracy Lam, Dr. Benevento & Dr. Bill Meeker

In other news, I’d like to thank our esteemed colleague Dr. David Benevento for pinch hitting for our President, Dr. Brian Stenzler. 

Dr. Benevento and Dr. Bill Meeker, Palmer West President had the honor of presenting the President’s Endowment for Student Excellence award to a deserving Palmer West College student.  

Tracy Lam was the surprised and ecstatic recipient. Congratulations, Tracy!

Election 2016

On the political front I’d like to thank Drs. Dennis Buckley, Ronald Benson, William Updyke, Philip Dieter, and Kathleen Doyle for cranking up the early endorsement process in key legislative districts.  These early endorsements are critical for these candidates and those I’ve spoken with personally have expressed their appreciation.  Keep in mind, one of CCA’s biggest goals is to not only help pro-chiropractic legislators get elected, but help elect legislators that will stand up for us when others wish to do us harm.

In addition, I’m in conversation with people to maximize our Independent Expenditure Committee activities in this election cycle.  I’ll keep all apprised on developments, but fear not, I’ll redact any we don’t want viewed by certain players.  We know who they are.

That’s all the news that’s fit to print, and some that probably isn’t…for now.

©2016 California Chiropractic Association. All rights reserved. Please do not disseminate in part or whole without prior permission. Questions or permission to disseminate? Contact Cris Forsyth at cforsyth@calchiro.org.

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