STATE LEGISLATURES: Face Raft of Health Care Reform Bills
As state Legislatures gear up and governors are sworn in, lawmakers across the country are again debating a variety of managed and health care reform laws. Maryland Gov. Parris Glendening (D) announced last Thursday during his State of the State address that he will push for five new patients' rights this year. Some were disappointed that he did not include the right for patients denied care to sue their HMOs, but Glendening said he will support such a law if it is submitted by other lawmakers. Under Glendening's bill, health plans would have to cover prescription drugs deemed necessary by physicians. For patients with chronic illnesses, specialists could serve as primary care doctors and these patients could receive "standing referrals" for specialist care, rather than having to obtain a new referral for each visit. Health plans would also be required to cover visits to out-of-network doctors if none of the doctors in a health plan's network have the necessary expertise. A final provision would mandate minimum 48-hour hospital stays after mastectomies, testicular cancer surgery, and 24-hour stays after lymph node dissection and lumpectomies. Or, if patients and doctors agree, patients could return home and receive home visits for the remainder of the time. Glendening would also like to make the insurance commissioner's office a "central clearinghouse" for information about health plans, a proposal that insurance commissioner Steven Larsen said would require more staff, which he suggested be paid for by health plans (Wheeler, Baltimore Sun, 1/23).
The Denver Post reports that 10% of the more than 350 bills submitted to the state Legislature this session concern health care.
- House Bill 1197, sponsored by state Rep. Dan Grossman (R) and co-sponsored in the state Senate by Sen. Mary Ellen Epps (R), would allow patients to sue their health plans for malpractice for up to $250,000 in noneconomic damages.
- Senate Bill 124, sponsored by state Sen. David Owen (R), would roll back the state's "community rating" system, which groups all small business employees in one risk pool to purchase health insurance, and allow insurers to let rates fluctuate up to 25% on some products "depending on the relative health of a company's employees." Owen hopes the bill will lower premiums for younger employees and entice them to buy insurance. But the Post notes the full community rating system may be "small businesses' best protection against sharp premium increases."
- Senate Bill 31, sponsored by state Sen. Norma Anderson (R), would allow companies that lease personnel from small businesses to qualify as large employers for the purchase of health insurance.
- House Bill 1052, sponsored by state Rep. Ann Ragsdale (D), would require health plans to cover breast pumps.
- House Bill 1088, sponsored by state Rep. Marcy Morrison (R), chair of the House Committee on Health, Environment, Welfare and Institutions, would require health plans to cover 60 therapy sessions annually for children with birth defects. Morrison has also submitted a "bill that would mandate external reviews for HMO patients dissatisfied with the result of their internal reviews."
- House Bill 1019, also sponsored by Morrison, would create the Colorado Health Care Task Force, a group of nine lawmakers to advise the General Assembly on health issues for five years (Hubler, 1/25).
Gov. Roy Barnes (D) has included in his budget a proposal that would allow patients denied care to sue their health plans. He has also included a measure that would allow patients to see out- of-network doctors if the doctor accepts the health plan's standard reimbursement fee. The Augusta Chronicle reports there "hasn't been a cease-fire in managed care hostilities for years," and notes that the Legislature's decisions will affect the more than 20% of Georgians enrolled in managed care plans (Salzer, 1/25).