MEDI-CAL/HEALTHY FAMILIES: Lifting HMO Direct Marketing Ban Will Create More Problems

      The Legislature's proposal that would allow HMOs to market health plans directly to parents of uninsured children might "[s]ound attractive -- but based on experience, it will create more problems than it will solve," a San Jose Mercury News editorial asserts. The editors argue that the last time HMOs were permitted to directly sell their insurance plans to parents, "they engaged in widespread misrepresentation and outright fraud." The editors add, "Poor families were promised services that were never delivered; told they could keep their current doctors when they couldn't and told they must join a health plan or lose their coverage. It was so bad that direct marketing was banned in 1996." Noting that 1.5 million California children currently are eligible for Healthy Families or Medi-Cal coverage but are not enrolled, the editors argue that there are "better ways to sign up more children for health coverage, including simpler rules, simpler applications and more funding for community outreach efforts that have proven worthy." The editors indicate that HMOs also can help the process by ensuring that "clients fill out forms on time and keep their coverage up to date." When Daniel Zingale takes control of the new Department of Managed Care, he "will have his hands full carrying out the existing legislative mandate" of reducing medical errors, establishing an independent review system and overseeing the fiscal solvency of health groups, the editors argue. "He doesn't need the additional burden of preventing insurers from deceiving the low-income, limited English, overworked parents who are least likely to see through slick marketing gimmicks" the editors conclude (6/22).