February 1998 Bulletin

Washington Report

Managed care

Access, patient protection at top of Congress agenda

House and Senate, President’s advisory commission, even some HMOs promote "bill of rights" for public

Momentum is building for federal regulation of managed care organizations in the new session of Congress. More than 70 "quality issue" bills were introduced in the last session of Congress and more are promised this year.

Leading House and Senate Democrats, meeting in mid-December on their 1998 legislative agenda, made it clear that they will seek legislation to guarantee that Americans enrolled in managed care are receiving access to high-quality health care. It also will ensure that access to doctors, treatments and medical care is not arbitrarily blocked. The Republican leadership, which is not enthusiastic about curbing managed care, is faced with pressure within its ranks for legislative changes this year.

The Patient Access to Responsible Care Act (PARCA) introduced by Rep. Charles Norwood (R-Ga.) seems to be the device that can tie together the divergent views of Republicans and Democrats. PARCA has 212 members of the House as co-sponsors. About 90 of the co-sponsors are Republicans. Sen. Alfonse D’Amato (R-N.Y.) is chief sponsor of a Senate companion bill.

PARCA would allow patients to go outside a network by requiring plans that only offer a closed service plan to also include a point-of-service plan. Patients would be able to go to any provider, but would have to pay a higher price to have broader choices. PARCA also would eliminate the federal preemption of medical malpractice law for multistate health plans under ERISA. Another provision of Rep. Norwood’s bill would eliminate bonus payments from insurance companies to claims adjusters, doctors or hospitals to deny health care.

Sen. Edward Kennedy (D-Mass.) plans to introduce a bill early this year that would require employer contributions for insurance for workers and their families. The bill, co-sponsored by Rep. John Dingell (D-Mich.), would include a health care "bill of rights" for patients and physicians.

Sen. Phil Gramm (R-Texas) (Photo: AP/Wide World Photos) has announced his Health Care Bill of Rights and Freedoms. The bill focuses on the right of individuals to control the cost of health care insurance through the use of medical savings accounts, rate negotiation and benefits negotiation.

One provision would make health care insurance fully tax deductible for individual workers who are without employer-provided health insurance coverage and for self-employed people. The bill also calls for routine and full disclosure of health care information including the professional qualifications and performance records of health care providers.

In addition, the consumer "bill of rights" adopted by the President Clinton’s Advisory Commission on Consumer Protection and Quality in Health Care Industry calls for a series of consumer protections including access to needed health care providers, access to emergency services, participation in treatment decisions, assurance that patients are not discriminated against, confidentiality of personal medical information and a grievance and appeals procedures. A final report is due in March.

Meanwhile, managed care organizations, already battered by consumer complaints from denial of medical treatment to restricted access to specialists; rising health care costs that have forced many to scale back earnings projections last year; and the need to raise premiums and/or eliminate benefits this year, are faced with yet another problem. Kaiser Permanente, HIP Health Insurance Plans and Group Health Cooperative of Puget Sound have called for "legally enforceable national standards" for patient protection.

Patient protection proposals

Choice of plan Appeal to outside panel Disclosure of Information
Norwood-D’Amato Yes* Yes Yes
Kennedy Dingell No No Yes
President’s commission No Yes Yes
Kaiser-HIP Group HealthYes Yes Yes

*Requires plans that only offer a closed service plan to also include point-of-service plan

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