MEDICARE HMOs: Protections Are Constitutional Right
Several recent editorials weigh in on the 9th U.S. Circuit Court of Appeals' recent ruling that guarantees certain rights for Medicare HMO members (see AHL 8/13):
- Miami Herald: "This is the first ruling to tie beneficiaries' rights to the Constitution rather than to statutes, which Congress can change at whim. The ruling also requires HMOs to tell members how to appeal and support their claims. It gives HMOs five days -- rather than 14 now -- to decide whether to cover the care sought. Most important, it directs Health and Human Services Secretary Donna Shalala to monitor compliance and to terminate Medicare contracts with HMOs that don't follow the directives. All in all, Judge Wiggins [of the 9th Circuit] delivered a slam-dunk for consumers. When the grandstand cheering is audible across the country in Florida, then surely it can be heard in Washington and inspire a dilatory Congress to act as well" (8/24).
- New York Times: "The appeals court essentially found that Medicare benefit decisions made by HMOs, which are paid by the government to provide the coverage, amount to government action. In the field of health care, at least, the courts are finding that managed care organizations through which public benefits are distributed must now meet constitutional requirements that few considered before" (8/22).
- Seattle Times: The editorial notes one "down side" to the ruling: "HMOs have one more reason to dread Medicare patients -- or not serve them at all. Inadequate reimbursement rates are transforming Medicare patients from cash cows into albatrosses. Medicare reimbursements have dropped, and annual increases to reimbursements now lag far behind inflation. Blizzards of paperwork and inflexible regulations make Medicare patients even more unappealing to efficiency-seeking HMOs" (8/23).