RIGHT-TO-SUE: TX Battle Portends Tough Road in Congress
The Texas Medical Association, who, along with other consumer groups, in 1997 successfully managed to push right-to-sue legislation through that state's Legislature, is heading to Washington this week to lend support to Senate Democrats pushing Congress to adopt the Texas model, the Los Angeles Times reports. Lobbyists for the Texas Medical Association are eager to point out that the dire predictions of the insurance industry have not played out, at least in Texas. For one, premiums were flat in 1999 and are expected to hold steady next year, according to data from the state Department of Insurance. And while opponents of the legislation predicted a "torrent of patient challenges to health plans' decisions," only 567 of the 10 million Texans enrolled in managed care plans have appealed decisions. Of those, 47% of HMOs' decisions stuck, 47% were overturned and 6% were partially overturned. Fewer than six lawsuits have been filed. "For the first two years there were very few lawsuits filed," said Texas Association of Health Plans Executive Director Jerry Patterson, noting that attorneys have been hesitant to file any "weak cases that would lose and set a bad precedent." Rose Ann Reeser, a senior associate Texas insurance commissioner, said there have been far fewer appeals than she had expected. She suggests that HMOs are "making decisions more carefully" as patients have more leverage to overturn them. Regardless of Texas' success, "its experience suggests that the proponents of a national measure have a rough road ahead." The debate pitted the state's insurers and the medical community against each other in a bitter lobbying campaign that stretched into two legislative sessions. "The insurers waged a very intense, heavily funded campaign -- direct mail, phone banks, and they hired every lobbyist in town with a pulse," said Kim Ross, the vice president for public policy at the Texas Medical Association. Texas doctors, in turn, invited enrollees to call a toll-free number -- straight to their legislator's office -- if they had any complaints about their managed care plans (Rubin, 7/10).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.