Ballot Measure Would Rework HMO, Health Plan Oversight
The Foundation for Taxpayer and Consumer Rights is drafting a ballot initiative for 2010 that would restructure the way HMOs are regulated and cap out-of-pocket maximums and prescription drug costs for patients, among other reforms, Capitol Weekly reports.
The initiative includes provisions to:
- Transfer oversights of HMOs from the Department of Managed Health Care to the Department of Insurance;
- Require HMOs and other insurers to seek state approval for rate increases;
- Bar insurers from canceling coverage after an illness has set in;
- Cap out-of-pocket maximums and prescription drug costs;
- Require HMOs to submit detailed financial information to state regulators;
- Allow state regulators to penalize companies for violations and to seize and operate companies with suspect financial situations; and
- Make it easier for consumers to sue HMOs and other health plans.
Health insurers have not seen the language of the ballot initiative but have voiced skepticism, Capitol Weekly reports.
In addition, a study by Clark Kelso, former head of the Department of Insurance and current federal receiver for the state prison health care system, highlighted challenges that could arise in combining DMHC and the Insurance Department (Howard, Capitol Weekly, 3/13).