PATIENTS’ RIGHTS: Democrats Weigh Tougher Protections
Today's Los Angeles Times reports that the White House "is seriously considering measures that would not only set tough federal standards for every health insurance plan in the country but also establish an independent appeals process to enforce the standards." The proposals are expected to be "included in draft legislation written by House and Senate Democrats," and are modeled on the patients' "bill of rights" package endorsed by President Clinton last fall. One "controversial" provision in the draft bill "would allow consumers to sue for damages under state law if a health plan's improper denial of care resulted in death, injury or economic loss." According to the Los Angeles Times, Clinton has not decided yet whether to endorse this provision, "which is vehemently opposed by the managed care industry." The Democrats' managed care bill is expected to be introduced next week.
"The portion of the Democrats' draft bill that could have the greatest effect on consumers is the guarantee that patients would have recourse to a speedy independent appeals process that would assure consumers that disagreements with their health plan would be reviewed by experts with no connection to the plan," the Los Angeles Times reports. Sen. Joseph Lieberman (D-CT) said, "The one thing you hear from constituents is that they are interested in having the right to appeal their health plan's decisions. They want to know there is somebody up above who, if they are denied care, will hear their argument." David Richardson, president of Health Dispute Resolution, the company that "runs Medicare's appeals program," said, "There are literally millions of decisions that get made about these benefits all the time, so there are going to be mistakes. We're not trying to second-guess anybody, but we try to provide a way to correct what is often a random event."
Not Okey-Dokey In Muskogee
Republicans are arguing that "the Democrats' position is unrealistic" (Rubin, 2/17). Senate Majority Whip Don Nickles (R-OK) said, "Oklahomans angry over the way they are treated by their managed care insurance plans should not look to Congress for relief." "I haven't seen anything to convince me that bigger government, more regulations and expanded bureaucratic control is the means to higher quality," he said recently while announcing a new GOP task force on health care. "Quality health care can't be managed and directed from Washington, D.C.," Nickles said (Myers, Tulsa World, 2/16).
Don't Call Them Harry & Louise
The Health Benefits Coalition, a group of business and health care interests, is running new radio ads around the country to inform the public about the costly consequences of federal health care mandates. The 60-second radio spots will be aired in 16 media markets during the February 16-23 congressional recess. The ads feature a husband and wife "wondering what they will do if government regulations drive up the cost of their health care." At one point in the ad, an announcer says, "Claiming to protect consumers, the White House and some members of Congress want government mandates on health care. But these new requirements will leave millions unprotected. Just one of these bills would force premiums up 23% ... and cause more than 5 million Americans to lose their coverage entirely" (release, 2/13).
Yesterday's New York Times looks at the battle over managed care regulation at the state level. National Conference of State Legislatures analyst Molly Stauffer "said that 17 states enacted comprehensive consumer rights laws last year, and she predicted that at least six more would this year." Center for Studying Health System Change President Paul Ginsburg said "providers, primarily doctors, are winning" the state-level legislative battles. "Elected officials feel their unhappiness. It's the providers who are organizing and saying, 'This is what you want to do.' The quip going around is that this is physician protection, not consumer protection," he said. The New York Times looks at the managed care reform effort in Illinois, where a comprehensive patients' rights bill passed in the state House last year is facing tough business opposition in the state Senate (Kilborn, 2/16).
Kaiser In The Spotlight
On Friday, ABC's "Nightline" looked at a Texas malpractice ruling that went against Kaiser Permanente last year. Click here for the full transcript.