PATIENTS’ RIGHTS: Senate GOP Eyes Scaled-Back Bill
Managed care reform legislation being drafted by Senate Republicans "would mandate fewer patient-rights protections than rival plans proposed by both the House GOP leadership and congressional Democrats," the Washington Times reports. The Senate GOP plan "would not require health plans to pay for emergency room visits that a prudent layperson would consider necessary or allow families to choose OB-GYN specialists or pediatricians as primary care doctors." Nor would the plan allow patients "to sue employer-run health plans." However, Senate Republicans are backing a number of mandates included in other proposals, including giving HMO enrollees the right "to appeal denials of care to independent review boards and require a point-of-service option." A new proposal in the Senate GOP plan would "allow people to use their Roth IRAs to buy health insurance as a supplement to coverage by employers." The Senate GOP plan was drafted by a task force chaired by Majority Whip Don Nickles (R-OK).
Sharon Cohen, a lobbyist with the Health Insurance Association of America, said the PPO and external review mandates in the Senate GOP proposal "could cause substantial premium increases and force employers to stop offering health insurance coverage." She said, "I think that politics is driving this whole debate rather than sound policy" (Goldreich, 7/9).
Under the headline, "Managed Care Battle Heats Up," Investor's Business Daily looks at the politics of HMO reform. GOP pollster Bill McInturff is quoted as saying "[w]hat will drive" congressional Republicans' actions on the issue "is political need." He said Republicans need "to blunt" Democrats' efforts to use the patients' rights issue as a wedge in the coming elections. "If we pass GOP legislation, and I think that is likely, then it is going to allow the Republicans to say, 'Well, we did it,' and the Democrats will be left trying to explain why it wasn't enough," McInturff said.
So far, Democrats "are the only ones using the managed care issue in campaign ads," according to American Health Line Founding Publisher Doug Bailey. After surveying "150 TV ads aired during primaries in 40 Senate, House and gubernatorial races," Bailey found that only 15 ads focused on patients' rights and "they were all on the Democratic side" (Litvan, 7/9). See today's Raleigh News & Observer for news on how HMO reform is shaping the North Carolina Senate race (7/9).
An editorial in Investor's Business Daily argues against government health care mandates, saying they "distort consumers' and providers' decisions and drive up the cost of health care." The editorial also goes so far as to recommend that the government "either phase out its health care programs or set them up so they are real insurance." "In other words," the editorial continues, "cover catastrophic costs, but make consumers responsible for routine costs. Auto insurance doesn't pay for windshield wipers. Why should health insurance pay for a checkup?" The editorial concludes: "If patients want to ensure their health care rights, they should look to themselves and the power of the marketplace, not government" (7/9).
Yesterday, the Health Benefits Coalition sent a letter to White House health policy adviser Chris Jennings, decrying Jennings' statement that President Clinton will insist that health plan liability be a part of managed care reform. In the letter, HBC Chair Dan Danner writes: "[T]he prospect of years, if not decades, of expensive litigation and appeals offers little comfort to anyone denied coverage. It would be far better to ensure fast and fair resolution of claims and appeals, thus ensuring not a costly and interminable lawsuit, but the coverage that the plan in fact provides. Diverting scarce health care dollars from patients to the plaintiffs' bar is not the way to improve health care quality" (7/8).
In a letter to the Washington Post, American Psychological Association Executive Director Russ Newman takes issue with a Post editorial that voiced support for external appeals in place of health plan liability. Newman points out that a Texas law allowing patients to sue HMOs "apparently has produced only one lawsuit." "In the end, consumers of health care will not accept only partial protection from managed care's efforts to save money by sacrificing necessary care and jeopardizing patient health. It will hardly help restore badly needed trust in this country's health care system to continue allowing managed care companies to get away with providing inadequate health care" (7/9).