2022 MICRA Initiative

What’s Happening Now? 


A ballot measure being pushed by a wealthy out-of-state trial attorney is heading to the November 8, 2022, ballot that would substantially raise health care costs for all Californians, reduce access and exploit patients for profit. 


The so-called “Fairness for Injured Patients Act” is the latest trial lawyer-funded statewide ballot measure scheme to end California’s long-standing liability reform law — the Medical Injury Compensation Reform Act (MICRA). 

The Impact 


This measure will limit patient access to care, vastly increase the number of lawsuits filed in California and further divert resources for patient care to the legal system. It would effectively eliminate the cap on non-economic damages for medical malpractice awards and hold physicians and others personally liable to pay medical malpractice awards. 


If it passes, the measure will have a chilling effect on the health care profession and have a trickle-down effect that would be born primarily by low-income patients, who will face higher costs and restricted access to care. 


In 2014, our coalition worked with CMA to fight and handily defeat Proposition 46, clearly saying NO to changes in MICRA that would have quadrupled the cap on non-economic damages. (See below for more information about defeating a previous anti-MICRA initiative in 2014). This measure goes far beyond what Proposition 46 would have done and the cost to taxpayers would be substantially greater. As recently noted by the independent Legislative Analyst Office, the "Fairness for Injured Patients Act" will cost California taxpayers tens of millions "to high hundreds of millions of dollars annually" in health care costs. 

Current Ask of Physicians

We are currently focused on asking physicians to get ACCMA or CMA ten minutes at their next MEC meeting to address the threat to MICRA. Once that door is open and we can get things scheduled, we can then settle on the presenter and make the financial ask.  


If you know anyone on the MEC and can get us 10 minutes at their next meeting, please contact Mr. David Lopez, ACCMA Associate Director of Advocacy and Strategic Initiatives, at dlopez@accma.org.

If you have any questions about MICRA or would like to find out more about how you can get involved, contact the ACCMA by calling 510-654-5383 or emailing accma@accma.org.

Get Involved to Protect MICRA

Join the Campaign – Join today to get involved in the campaign to oppose this deceptive ballot measure. To join, please click here.  


Donate to the Campaign – To donate to the Californians to Protect Patients and Contain Health Care Costs, please click here.  


Questions? – If you have any questions regarding the campaign, or any suggestions on how we can protect MICRA, please submit your responses by clicking here.

Defeating an Anti-MICRA Initiative in 2014

In 2014, trial lawyers sponsored an anti-MICRA initiative that appeared on the November 2014 ballot called Proposition 46.  Prop. 46 is a deceptive initiative that contains a number of unrelated provisions designed to mislead and deceive voters. Prop. 46 would weaken the Medical Injury Compensation Reform Act (MICRA), California's model medical malpractice reform law that keeps malpractice rates in California stable by limiting noneconomic damages in malpractice awards while providing unlimited economic and punitive damages. 

On November 4, 2014, the voters of California spoke loudly and definitively to defeat Prop. 46.  According to the Secretary of State’s current results, 67% of California voters said no to the trial lawyers’ deceitful proposition, and only 33% said yes.  Locally, 63% of Alameda County voters said no and only 36% said yes, and 65% of Contra Costa County voters said no and only 35% said yes.

This victory is a testament to the effectiveness of professional medical associations, which have steadfastly defended this assault on California’s tort reform – Medical Injury Compensation Reform Act (MICRA) – to preserve access to care and the ability of physicians to serve their patients.

The California Medical Association (CMA) was masterful in its response to trial lawyer vitriol, ensuring that our State Legislators and the public understood the ruse the trial lawyers were running and the consequences that their self-serving proposal would have for Californians.  CMA also effectively brought together one of the largest and most diverse coalitions ever amassed against a statewide proposition, from organized labor to the Chamber of Commerce, the ACLU, California NAACP, Planned Parenthood, local governments, taxpayer organizations, and on and on. CMA engaged editorial boards and political parties on both s ides of the aisle to understand the terrible consequences of Proposition 46 and oppose it.

Locally, the ACCMA engaged physicians, who were instrumental in conducting an effective grassroots effort to inform patients and the general public of why to vote no on Prop. 46, and ACCMA representatives engaged in numerous public forums to convey that message.  And the doctor-owned professional liability carriers in California, borne out of the ashes of a malpractice crisis in 1975 that sent malpractice awards skyrocketing to the point of forcing physicians to stop practicing medicine, provided instrumental support for the campaign along with numerous health care organizations throughout the state.

The medical profession should pat itself on the back for its role in the success of this campaign to defeat Prop. 46, and for investing in the medical associations so that they could do what they exist to do: promote health care access, quality of care, and be the voice of the medical profession on behalf of the patients they serve.

Why has MICRA Succeeded?

Prior to the MICRA reforms the cost of malpractice insurance in California was exceeded only by the cost for physicians practicing in New York City. Since MICRA’s passage the average national cost of malpractice coverage has increased by 854%, while California’s costs have risen only 287%. Current California malpractice insurance costs are in the lower half of rates among all states, and rates in Northern California are in the lower third among all states. In comparison to the states with the highest malpractice insurance premiums, none of which have MICRA reforms, rates in Southern California are about 40% of those rates, and rates for Northern California are almost half again lower than rates in Southern California.

Physicians Owned Insurers Malpractice Premium Comparison Chart, 2012

Important MICRA Links

CMA Resources

The MICRA Manual

MICRA Toolkit Talking Points - free for ACCMA/CMA members (login to access)

MICRA Toolkit Fact Sheet - free for ACCMA/CMA members (login to access)