Sacramento Business Journal: “Union seeks to block Kaiser from health benefit exchange”

KaiserSeptember 11, 2013

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Kathy Robertson
Senior Staff Writer- Sacramento Business Journal
September 5, 2013

The National Union of Healthcare Workers filed a lawsuit against Covered California in Sacramento County Superior Court on Wednesday, seeking to block Kaiser Permanente from participating in California’s health benefit exchange due to substandard care that violates exchange rules.

The lawsuit points to a $4 million fine levied against Kaiser in June by the California Department of Managed Health Care for serious deficiencies in providing access to mental health services — and alleges state and federal law exchanges can only contract with plans in good standing with regulators.

Filed by NUHW, which is in contentious contract negotiations with Kaiser, and five other plaintiffs — including current Kaiser members and employees and an uninsured resident who plans to seek coverage through Covered California — the lawsuit seeks a ruling that the exchange violated its duty to pick a health plan in good standing, a court order that would require the agency to enforce this duty, fees and court costs.

Kaiser has been selected by Covered California to offer coverage through both its individual and small employer marketplace. Open enrollment starts Oct. 1 for coverage that begins in January.

“Before Kaiser is allowed to enroll thousands more patients through the exchange, it should first demonstrate that it can take care of patients who already rely on Kaiser for their health care,” Dr. Horace Beach, a plaintiff and psychologist who has worked for Kaiser’s medical center in Vallejo, said in a news release.

Covered California spokeswoman Anne Gonzales said the exchange couldn’t comment because it hadn’t been served with the lawsuit.

Kaiser weighed in, though.

“The assertions that NUHW is making are patently untrue,” Kaiser spokesman John Nelson said in statement. “Kaiser Permanente has been approved for, and will enthusiastically participate in, the Covered California health plan exchange. Kaiser Permanente is in good standing and fully licensed by the state to offer health insurance in California. There are no restrictions on our ability to offer health insurance, including in the Covered California exchange.”

The union continues to make unfounded allegations as part of their protracted labor negotiations with Kaiser Permanente, and this behavior does nothing to further the negotiations that should be taking place at the bargaining table, Nelson added.

The Department of Managed Health Care did not identify problems with the quality of the mental health care provided to Kaiser members or with the ability of our members to obtain urgent or emergency mental health care, the statement says. The agency did identify some areas where non-urgent appointment waits times and data tracking needed improvement.

A corrective action plan was developed and wait times for non-urgent appointments have improved, Nelson added.