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Bill to Extend HMOs' Birth Care Is Shelved

Health: Panel votes not to forward measure, which sought minimum 48-hour hospital stays for mothers and newborns, to full Assembly. Backers argued that earlier discharges pose risks; insurers say that contention lacks proof.


After fierce opposition from the health insurance industry, a bill that would have required HMOs and other insurers in California to cover at least 48 hours of hospital maternity care was derailed in a key legislative committee Wednesday.

Backers of the legislation have contended that some HMOs are rushing mothers and their newborn babies home from the hospital too quickly. Similar bills have been enacted by 25 state legislatures.

So-called "drive-through delivery" has become a lightning rod for criticism of the managed care industry. It heated up last year after reports that one California HMO was sending mothers and babies home as soon as eight hours after delivery. Critics charge that in their zeal to slash costs, HMOs are imperiling women and their newborns.

But the California Assn. of HMOs, among others, argued that earlier maternity discharges pose no greater risk to mothers and babies than longer hospital stays. They also say it is inappropriate for government to mandate medical decisions that are better left to doctors.

"Is there data out there that shows California women that have babies are dying in greater numbers or that major problems are occurring that weren't occurring before" because of shorter maternity stays? asked Maureen O'Haren, legislative affairs director for the HMO trade group.

O'Haren said it is the medical groups that contract with HMOs, not the insurers themselves, that are largely determining the proper length of maternity stays.

But the bill's backers dispute that, and called the action a sign of the HMOs' power in the Legislature. While the issue was being shelved Wednesday, the HMOs were holding a health fair outside the Capitol.

"Some of the strongest lobbyists in this state are HMOs," said Assemblywoman Liz Figueroa (D-Fremont), the bill's author. "It's ironic that the HMOs are having a big health fair out there today, and their high-paid lobbyists are inside fighting against mothers and babies."

Figueroa added, "Physician after physician is reporting to us that when they go to see the hospital chart of the newborn, there is a sticker there saying the HMO has called and said, 'This baby needs to get out.' "

The bill, AB 1841, would generally have required HMOs, disability insurers and some nonprofit hospitals to provide minimum inpatient maternity stays of 48 hours after normal deliveries and 96 hours after caesarean-section births.

A legislative analyst's report concluded that the bill could have cost the state Medi-Cal program as much as $50 million in 1997 by increasing the average hospital stays for Medi-Cal recipients from 1.6 days to 2 days.

The bill had already passed the state Senate. But the Assembly Appropriations Committee, in a procedural move Wednesday, voted not to forward it to the full Assembly.

"As far as I'm concerned," Figueroa said, "it's dead." But others expect it to be revived in some form.

The bill had drawn support from the California Medical Assn., the American College of Obstetricians and Gynecologists, and the Traditional Values Coalition, a conservative religious group.

Gov. Pete Wilson's Department of Finance, the California Chamber of Commerce and the California Manufacturers Assn. opposed the bill. The governor "had not had an opportunity to look at the bill," said Jesus Arrendondo, a spokesman for Wilson.

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