April 1997 Bulletin

Congress gets bills to control managed care

Congressional efforts to regulate managed care organizations gained momentum in March with the introduction of two bills that would make certain health care practices illegal. One bill, sponsored by Sen. Edward M. Kennedy (D-Mass.) and Rep. John D. Dingell (D-Mich.), would bar insurers from denying certain kinds of care, including that from specialists, to people with life-threatening or other serious conditions. It would also require health plans to pay some of the patient costs of research conducted in formal settings, and bar "gag rules" that prevent doctors from fully revealing information to patients about their health status and treatment options. The bill would also curb so-called "drive-by" mastectomies and require that patients be given a wide range of information about their rights and medical options.

The second bill, sponsored by Sen. Barbara A. Mikulski (D-Md.), Sen. Tim Hutchinson (R-Ark.) and Rep. Benjamin L. Cardin (D-Md.), focuses only on emergency care. Some health plans refuse to pay the medical bill when patients go to an emergency room but their condition is determined not to be an "emergency." Similar provisions are in the Kennedy-Dingell bill.

In January, Rep. Tom Coburn (R-Okla.) and Rep. Sherrod Brown (D-Ohio) introduced the Medicare Patient Choice and Access Act of 1997 - H.R. 66 - which assures timely and appropriate in-network access to specialists and other patient protection features.

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