Defending MICRA... Again

An anti-MICRA initiative has been filed for the November 2022 ballot by wealthy out-of-state trial attorneys. This initiative would substantially raise health care costs for all Californians, reduce access to health care, and exploit patients for profit.
While most reporting to date has focused on the proposed changes to California’s existing law—the Medical Injury Compensation Reform Act (MICRA)—this misguided initiative would effectively eliminate California's medical lawsuit limits to create new financial windfalls for California's trial lawyers.
Recent reports show that proponents of this measure had collected enough signatures to qualify for the November 2022 ballot, which is why we need your commitment to oppose this dangerous initiative now more than ever.
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. 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.

Proposition 46 taught us the power of a strong coalition (see below for more information about defeating a previous anti-MICRA initiative in 2014), and this time around it will be even more important. To learn more about the new initiative, and to donate to the "NO" campaign, please visit  

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

Background on MICRA

The Medical Injury Compensation Reform Act of 1975 (MICRA) is California's nationally-acclaimed tort reform law. This section provides information on why MICRA must be protected, recent MICRA news, and access to additional MICRA resources.

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

Scroll below for the latest MICRA news and other MICRA-related information.

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.

Contact the ACCMA at 510-654-5383 or with any questions.