HMO REFORM: Clinton Calls Patients’ Rights ‘Urgent’

      At a White House ceremony attended by Vice President Gore, Secretary of Labor Alexis Herman and Secretary of Health and Human Services Donna Shalala, President Clinton yesterday called on Congress to enact managed care reform this year, saying the need for a patient bill of rights is "urgent." The president also released a "report, compiled by the White House Domestic Policy Council and the National Economic Council ... indicating that only federal legislation -- as opposed to measures enacted by the states -- can provide comprehensive managed care reform" (CongressDaily, 5/28). The AP/Philadelphia Inquirer reports that the administration's report noted that although many states have enacted patient protection legislation, such a "patchwork" is inadequate, and many of the laws "are preempted by ERISA, the 1974 Employee Retirement Income Security Act" (Sobieraj, 5/29). According to the report, 44 states have enacted at least one of the provisions recommended by the president's Quality Commission, but under ERISA, states cannot require self-insured plans to provide patient protections (release, 5/28). The president said "122 million of us are enrolled in plans not fully governed by state law. For example ... [i]f California passed the bill now pending in Congress ... there would still be 13 million of the 30 million Californians who'd be totally unaffected by it ... because of the way ERISA works." Thus, he concluded, "This really is a problem that must have a national solution" (release, 5/28).

One Way To Go
      The AP/Inquirer reports that a team of Republican congressional members is expected to finish drafting patient protection legislation "early next month." The bill is expected to include provisions that would allow patients to appeal denials of care to independent boards, mandate access to specialists and provide coverage of emergency care under a reasonable standard. House Ways and Means Committee spokesperson Ari Fleischer said the group is seeking to create a bill that Clinton will sign, but "with a cautious eye to doing no harm (by) driving up health care costs" (5/29). In his remarks, however, Clinton downplayed the significance of increased costs: "[H]ow can you let some person with the mentality of an accountant who will only see ... the bottom line of what the chemotherapy costs, make a decision? We're not that kind of people, we're not that kind of society. And if we have to endure a smidgen more inflation, bring it on."

Clinton Appeals To Women
      President Clinton also stressed that managed care reform is essentially a women's issue, and his remarks were tailored as such. He said, "I think it's important to note that according to all the research that we have, three-quarters of all the health care decisions in this country are made by women" (release, 5/29). In an interview prior to the news conference, HHS Secretary Shalala echoed these same sentiments. She said, "[W]omen use the health care system more than men do. They use it for their families. They often manage their family's health care, making sure their children get to the doctor (CNN's "Early Edition," 5/28). The Washington Post notes that "[i]n targeting women, the White House is hoping to find allies in a group that traditionally has been particularly concerned about health issues" (5/29).

Reaction From The Lobby
      The American Nurses Association applauded the president for his action yesterday, saying nurses "are particularly concerned about the lack of protection for women because it is they -- and not insurance industry executives and lawmakers -- who confront in their daily practice the human consequences of defective and deficient health care" (release, 5/28). Consumers For Quality Care agreed. Director Jamie Court said, "Washington politicians will continue to be confronted daily with the eyes, faces and stories of HMO ... casualties ... until they break the current gridlock, which benefits only the cash-rich managed care industry" (release, 5/28). But business interests were far less complimentary. The Health Benefits Coalition argued against Clinton's assessment that the plan would only raise costs a "smidgen." They claim that a premium increase of one percent would cause 400,000 Americans to lose their insurance (release, 5/28). The National Association of Manufacturers made the argument that the bill would actually hurt women-owned businesses. "Raising the cost of health care for struggling, women-owned small businesses is bad enough," said vice president for human resources policy Pat Cleary (release, 5/28). Secretary Shalala, however, downplayed their alarm: "There is no evidence that it's going to raise costs dramatically. In fact, many businesses believe it will save costs because the more information we have, the more likely we are to use our health care system correctly. And that, in the long run, will save costs" ("Early Edition," 5/28).