MANAGED CARE REFORM: HMOs Release Own Set Of Measures
"The managed care industry, faced with more than 100 bills in the state Legislature, went proactive last week with its own legislative platform," the Sacramento Business Journal reports. The California Association of Health Plans issued a set of 13 bills that are similar to the "recommendations issued in January" by Gov. Pete Wilson's managed care task force. The bills would "impose new restrictions on how coverage decisions are made and explained to health plan members"; "improve access to specialists and emergency care"; "require disclosure of benefits and physician incentives"; "strengthen rules on medical records confidentiality"; "offer health insurance tax deductions for self-employed individuals"; "heighten oversight of drug formularies"; and "remove oversight of health plans from the Department of Corporations to a new agency." The association "hopes to land five reform bills on Gov. Wilson's desk within a week and push for his signature by April 1."
Henry Loubet, a board member at the California Association of Health Plans, said, "There's an incredible amount of skepticism about HMOs and health plans today -- some justified, some not. Historically, we've been reactive. We are now looking for reasonable and responsible reform." However, David Grant, patient action director for Health Access, said, "My guess is they are running in the most unbelievable panic they've been in in years." He added, "A survey by the HMO task force ... estimated that more than 200,000 people contacted elected officials last year regarding problems with their health plans. The level of public discontent is enormous." Some see the move by the industry "as a thinly disguised attempt to set a 'feel good' legislative agenda that precludes tough reform." One measure missing from the industry's package is a bill that would make health plans liable for decisions to deny coverage for treatment. "We are not supporting health plan liability," said Myra Snyder, executive director of the HMO group. "The general reason is that health plans ... do not make medical decisions. Consequently, to be held accountable for an independent medical decision made by a physician is inappropriate." Critics say that the only way to make health plans "truly accountable is through legal action." Jamie Court, executive director of Consumers for Quality Care, said, "Oprah was sued by cowboys for criticizing livestock, but HMOs are not open to liability. There's something wrong here." Court also noted that the federal Employee Retirement Income Security Act preempts many state consumer protection laws for patients covered by employer-based health plans (Robertson, 3/9 issue).