MANAGED CARE: FAMILIES USA REPORTS ON STATE LEGISLATION
The health care consumer advocacy group Families USAThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
released a new report today that documents the "avalanche" of
state legislation that has been crafted over the last 18 months
in response to consumer and provider concerns about managed care.
The report, "HMO Consumers at Risk: States to the Rescue," found
that in the first six months of 1996, 33 states enacted managed
care consumer protection laws and more than 1,000 managed care
regulatory bills were introduced nationwide. "This avalanche of
state legislation speaks volumes about the perceived need for
managed care consumer protections. State governments -- in all
regions of the country, often with bi-partisan cooperation -- are
responding to growing HMO-related complaints by consumers about
the care they are, or are not, receiving," said Families USA
Executive Director Ron Pollack.
BROAD FOCUS: The report focused on laws in 14 key areas of
consumer protection including: access to specialists, coverage of
emergency services, maternity stays, "gag" clauses, availability
of information about HMOs and others. Over the course of the
survey, 18 states joined New York and California in mandating
that HMOs provide direct access to OB/GYNs and 25 states set
maternity length-of-stay standards. Additionally, 15 states
passed laws prohibiting "gag" clauses in HMO provider contracts.
Overall, 18 states were cited by the group as "best" in at least
one category of consumer protection and five others received
"honorable mention" in at least one category. Proposed
legislation in New Jersey and recently passed legislation in New
York were identified by Families USA as "some of the strongest
managed care consumer protections in the nation."
NATIONAL NEED: Concluding that states have been "innovative
and successful laboratories" of managed care legislation,
Families USA called for "federal action ... to protect all
consumers." The group said that federal standards would help
because "most of the managed care legislation was passed in
response to singular concerns" like gag clauses, specialty
access, emergency services and data reporting. Pollack said,
"HMO consumer protection legislation is uneven from state to
state. Some states have passed comprehensive bills, others have
focused on only one or two areas of consumer concern -- and the
result is a crazy-quilt pattern that will ultimately need more
HOT OFF THE PRESSES: Families USA is holding a press
conference today in Washington, DC, to formally release the
report, which is available for $15.00 by calling (202) 628-3030
(Families USA release, 7/23).