Davis Names AIDS Activist Director of Managed Care

Ending months of speculation, Gov. Gray Davis on Monday appointed Washington, D.C., AIDS activist Daniel Zingale the state’s first director of managed care.

The move puzzled many in the managed-care industry, who had expected that the appointment would come from the ranks of consumer advocates or industry officials already familiar with managed-care issues in California. But health-care activists familiar with Zingale’s work praised the appointment, saying that the 39-year-old’s record as an advocate for those with AIDS and HIV shows that he knows how to fight for the most underserved patients.

“It’s a fantastic appointment for consumers,” said Peter Lee, executive director of the Center for Health Care Rights in Los Angeles. “It’s all that Californians could hope for.”

Zingale, a longtime associate of Davis, forged his relationship with the governor when they both worked in the state controller’s office, Davis as controller and Zingale as his chief deputy.

Davis chose Zingale over the activists, industry leaders and health-care attorneys in the running for the position because he understands both health-care advocacy and, as a result of his stint as deputy controller, the needs of business, said Michael Bustamante, the governor’s spokesman.

“The governor is interested not only in delivering good quality health care, but in doing so in a way that makes good business sense for the HMOs,” Bustamante said. “Mr. Zingale knows how to merge the two together.”

Zingale’s relationship with the governor, said insiders who knew them both, would make it easier for him to navigate the tricky business of advocating for consumers while understanding the governor’s concerns about business.

“You need to have a direct avenue to the governor,” Lee said. “And with this appointment we have someone who has a direct connection to the governor.”

Zingale, who is still in Washington, could not be reached for comment late Monday.

Technically, he was made interim director of the new Department of Managed Care, but the appointment is expected to be made permanent once the department is up and running in the summer. He will earn $112,571 per year.

Much will be riding on Zingale’s appointment. The health-care apparatus is in financial disarray, with many physician groups, hospitals and nursing homes in or near bankruptcy, and the state’s much-vaunted settlement with collapsed managed-care giant MedPartners Inc. still not finalized after six months.

The state’s previous mechanism for overseeing health-maintenance organizations and other managed-care companies, the Department of Corporations, was so widely criticized for lax regulation that Davis himself campaigned on a promise to set up a new department of managed care and appoint a health-care czar to run it.

The new department, however, does not yet exist. The law that created it does not take effect until July. So when Zingale arrives to take the reins in a few weeks, he will have to set up an entire bureaucracy, and find a way to evaluate and oversee not only the care that HMOs provide but their underlying finances. He also will be required to develop a framework for financial regulation of the hundreds of physician groups upon which managed care in the state is based.

Those groups are in dire financial straits, with as many as 90% suffering serious financial strains. When doctor groups go under, as did MedPartners last March and FPA Medical Management about a year before that, patient care is disrupted and doctors and hospitals lose millions of dollars in unpaid claims.

Zingale, little known in the state’s $15-billion HMO business, will likely meet with some skepticism at first, as industry leaders attempt to size him up.

“It sounds like he has credentials that consumers should be comfortable with and that’s important,” said Walter Zelman, president of the California Assn. of Health Plans, a trade group based in Sacramento. “And all we can expect is that he will try to listen to us as well. Regulators should not be advocates.”

Zingale has a long history of advocacy, and is credited by many with building the AIDS Action Council into a formidable organization. Prior to joining the council in 1997, he served as director of public policy for the Human Rights Campaign, a gay rights organization.