MANAGED CARE REFORM: CALIFORNIA SENATOR OFFERS HMO RULES
"Declaring that national legislation is needed to combat HMOThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
abuses," U.S. Sen. Barbara Boxer (D-CA) yesterday "proposed a
'bill of rights' for health care consumers," the San Francisco
Chronicle reports. Speaking at a news conference in San
Francisco, Boxer said, "The only way to make certain that every
insurance plan is held accountable for quality is to pass a
national law." Catherine Dodd, the head of the American Nurses
Association's California affiliate, appeared at the news
conference in support of the proposal. Dodd said that while
"women seem to run into more problems with HMOs than men," they
"are less likely to complain about their care." As a result, she
said, "The public wants the government's help."
THE USUAL SUSPECTS
Boxer's proposal, which contains six health care consumer
protections, was included in a bill she co-introduced in November
with Rep. Charles Schumer (D-NY). The bill would require "health
plans to give enrollees with chronic conditions automatic access
to specialists," and to mandate coverage of emergency room visits
"if 'a prudent layperson' would consider an illness or injury
serious enough to warrant a trip to a hospital emergency room."
The proposal also would forbid so-called "gag rules" in HMO
physician contracts and would "outlaw discrimination because of
race, gender, age, sexual orientation or health status." Boxer's
bill would require health plans to provide enrollees "with a
prospectus summarizing benefits and costs and methods used to
compensate doctors."
CRITICISM
According to Pacificare Health Systems Senior Vice President
Nick Franklin, HMOs are "already voluntarily offering most of the
protections demanded by the legislation." He also asserted that
"[m]any of the problems that supposedly exist, like gag rules, do
not exist." Franklin specifically opposed the provision
requiring third party review of consumer complaints, saying it
could increase health care costs. He said that for every one
percent increase in health care costs, 200,000 Americans lose
their health insurance because they are no longer able to afford
it. The Chronicle notes that Boxer is up for reelection this
fall (Russell, 1/7).