PATIENTS’ RIGHTS: Wyden Proposes Compromise Plan
Sen. Ron Wyden (D-OR) yesterday said when the 106th Congress convenes next month he would recommend that the government reimburse Medicare HMOs at higher rates, if the HMOs agree to provide all patients -- including non-Medicare beneficiaries -- with greater protections. Reuters/Los Angeles Times reports that Wyden's proposal is "designed to break a congressional deadlock on patients' rights and address a looming crisis in providing Medicare recipients access to managed care." The senator said he had received "positive feedback" from both Democrats and Republicans, as well as industry and consumer groups. Wyden's plan for patient protections "would include holding health plans more accountable for their decisions" in a variety of ways, but would not necessarily include the right to sue (12/15). However, the Associated Press reports that specific reforms would include "the ability to file lawsuits," as well as assurances that "patients can always see the doctors they need" and "that any financial incentives for plans to deny patients' coverage be eliminated." Additional reforms would include allowing patients to choose their own primary care physicians, eliminating "'gag' clauses," and establishing an ombudsman program (12/15). Wyden said his proposal is in outline form now, but that he would offer it as legislation "as part of next year's budget process" (Reuters, 12/15). Karen Ignagni, president and CEO of the American Association of Health Plans, said Wyden's proposal "shows that a bipartisan consensus is emerging in the Senate that the current payment system for Medicare+Choice plans needs to be adequate." In addition, Ignagni added that "[w]ith Senator Wyden's refusal to embrace trial lawyer protections, he has recognized the need for a different health care discussion in 1999." The AAHP is prepared to work with Wyden "and others to help lead this discussion in the new 106th Congress," said Ignagni (AAHP release, 12/14).
The Bottom Line
The Associated Press reports that Wyden's plan would "cost HMOs about $30 per Medicare patient." The increase in reimbursements for Medicare HMOs is expected to total $1 billion, "which is the additional cost HMOs say they have to bear because Congress limited Medicare payment increases to just 2%." Wyden said that with "close to 100 HMOs plans" having pulled out of Medicare, he hopes his plan will forestall any additional withdrawals (12/15).