Preserving MICRA and patient access to surgical care in California

In November, Proposition 46 on the California statewide ballot will seek to weaken the state’s landmark Medical Injury Compensation Reform Act (MICRA) by raising the cap on noneconomic damages four-fold to $1.1 million from $250,000. The leadership of the Northern California, Southern California, and San Diego Chapters of the American College of Surgeons (ACS) have joined in a statewide effort to empower surgeons to advocate with their patients, colleagues, and other health care professionals for the preservation of MICRA to ensure patient access to quality care. A parallel intent is to educate members of the California legislature about the need to maintain this type of meaningful medical liability reform. MICRA has been the gold standard for medical liability reform since its enactment, and surgeons in other states with tort reform laws may use this vote as a barometer of what could happen to their own liability legislation.

Originally signed into law by Gov. Jerry Brown (D) in 1976, MICRA was enacted as a means of preserving patient access to care and deterring frivolous lawsuits against health care professionals and hospitals. The $250,000 cap on noneconomic damages ensures that legitimate claims move forward and discourages trial lawyers from filing non-meritorious lawsuits. MICRA allows patients to receive unlimited compensation for economic damages for past and future medical costs, past and future lost wages, and punitive damages. Over nearly four decades, MICRA has helped to contain health care costs, improve patient access to care, and stabilize medical liability premiums so that rates are much lower than in other populous states without similar reforms, such as New York and Florida.

Potential effects of Proposition 46

The need to preserve MICRA is essential in California, as millions of new patients have health insurance coverage through Covered California, the state’s health insurance exchange. A report from the Legislative Analyst’s Office (the California legislature’s nonpartisan fiscal and policy advisor) states that if Proposition 46 passes, the costs for California taxpayers will increase by hundreds of millions of dollars annually. A full report is available online.

The campaign on behalf of Proposition 46 is misleading, as the initiative appears to focus on patient safety and prescription drug abuse, but hidden within is the quadrupling of the MICRA cap. California surgeons have many opportunities from now until the November 4 election to become educated and engaged in the “No on 46” efforts. Examples include the following:

  • Visit the official “No on 46” Web page for valuable information on the campaign, as well as materials that may be useful for engagement. While there, consider signing up as a supporter of the campaign.
  • Send a letter to the editor of your local newspaper. Editors in small towns and cities are
    always looking for items to publish. Talking points are available at the “No on 46” Web page, or surgeons may contact Justin Rosen, ACS State Affairs Associate, for assistance at
  • Where appropriate, use “No on 46” campaign materials in patient waiting rooms. Be sure to find out beforehand what institutional policies may exist restricting or banning such activity.
  • Social media can be a useful tool. Post or repost related items on your Facebook page or Twitter account.
  • Take action when requests are sent from the California ACS Chapters.
  • Vote “No on 46” on November 4.

The campaign to defeat Proposition 46 is a major undertaking, and tens of millions of dollars will be spent in support of and in opposition to this ballot initiative. The ACS, the California Chapters of the College, and many prominent medical, civic, government, and labor organizations have united to preserve patient access to quality care. California surgeons can play a major role in the campaign by making their voices heard, and their votes counted.

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