HMO REFORM: State Legislatures Enacted Fewer ’98 Bills
State legislatures passed fewer managed care reform bills last year than in 1997, but right-to-sue legislation may be on the verge in many states, according to an annual survey by the Blue Cross Blue Shield Association. CongressDaily/A.M. reports that despite 1998's overall dip in managed care legislation at the state level, "states appear to be gearing up to debate the question of whether patients should be allowed to sue health plans over damages resulting from denied benefits," with 30 states considering the issue last year -- albeit without a measure passing anywhere -- and 28 legislatures with bills pending in 1999 (Rovner, 2/10). Susan Laudicina, BCBSA's director of state services research, said the failure to pass right-to-sue measures reflects the fact that "[p]roponents were unable to convince a majority of legislatures that suing health plans is a good way to improve quality." The survey also pointed to bills regulating HMO formularies as likely topics for consideration this year (AP/Baltimore Sun, 2/10).
Reforms ... Bad
The BCBSA argues that many of the reforms passed already -- eight mandates for external reviews of denied care, 11 quality standards laws and nine access to specialist measures -- could have "unintended negative consequences." The BCBSA's Laudicina said that in practice, "such requirements destroy a key element of managed care, which is primary care physicians are in the best position to determine and coordinate care." She added that PPOs could lose much of their lauded freedom from HMO-style restrictions under the quality standards bills, as "PPOs may be forced to limit patients' access to physicians, institute tighter physicians practice guidelines, and reduce the number of physicians in their networks" (Rovner, 2/10). Some consumer advocates point out that whether or not more state managed care reforms are enacted, the mandates will never reach the estimated 50 million Americans enrolled in employer-sponsored plans due to the Employment Retirement Income Security Act. Families USA's Ron Pollack said, "You just can't get the job done purely at the state level" (AP/Sun, 2/10).