HMO REFORM: From Hollywood to D.C., Movement Gains Momentum
When moviegoers nationwide loudly clapped and whistled at Helen Hunt's rant against HMOs in "As Good As It Gets," legislators at both the state and national level could see they had a campaign issue on their hands. Two years later at the U.S. Capitol, bipartisan support is growing for a House bill that would allow patients to sue their HMOs in cases where care is denied or delayed. On Monday, the American Medical Association announced its approval of a bill, authored by Reps. Charlie Norwood (R-GA) and John Dingell (D-MI), and cosponsored by twenty Republican House members. Alarmed by the "mutiny," the Republican leadership -- which until recently had vigorously opposed any reform that could drive up premiums -- has announced its tentative support for a rival plan, authored by Reps. Tom Coburn (R-OK) and John Shadegg (R-AZ), which also contains a liability provision, albeit a more narrow one.
Texas was the first state to permit private citizens to sue HMOs directly for denial of or delays in medical care, and California could soon follow in its footsteps. Among the California General Assembly's array of HMO reform bills coming up for consideration is one that explicitly contains such a provision. Current law allows only state employees to file suit against commercial HMOs; everyone else can file medical malpractice suits only against individual doctors, and awards are capped at $250,000. State Senator Liz Figueroa's (D-Fremont) bill would permit all California residents to sue their HMO for both compensatory and punitive damages. The threat of litigation would spur HMOs into providing timely care, says Figueroa's chief of staff, Liz Fenton. "We are trying to change [HMOs'] behavior, not have a million more lawsuits," says Fenton. Figueroa's bill still must clear the Assembly Appropriations Committee before going to the Assembly floor for a full vote. A second measure, sponsored by Assembly Speaker Antonio Villaraigosa (D-Los Angeles) would raise the current $250,000 cap to include annual cost of living increases. That bill, its scope having already been substantially trimmed, is currently being considered by the Senate Judiciary Committee.
Such proposals, both at the federal level and in California, are vigorously opposed by HMOs, many of which argue that the threat of litigation would force the industry to hike premiums even further. Donald White, spokesperson for the American Association of Health Plans, says, "We believe that any proposal should increase access to high quality health care. And we believe suing HMOs will do exactly the opposite. There is no question that there will be employers who no longer provide health care" should consumers be allowed to sue. Cory Black, of the California Association of Health Plans, said, "We are strongly opposed to expanding health care liability. We think it's the wrong solution to a real problem." Black adds that the industry supports an external review process for patients who feel they were denied needed treatment, which the industry believes would be more efficient than timely and costly litigation.
A Mother's Fight
Legislators and lobbyists on both sides of the issue have never heard of her. This California mother hasn't appeared at any hearings or signed any petitions. But Dorothy Cancilla fervently supports passage of both Figueroa and Villaraigosa's bills. In tomorrow's California Healthline, the story of a mother's fight to make HMOs more accountable (Caroline Noel, California Healthline).