Justice For All
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GOP Introduces Managed Care Bill
commentary by Families USA
On June 24th, Republicans in the U.S. House of Representatives
unveiled their long-awaited managed care consumer protection plan. The
plan, which is only an outline and contains no details, addresses
managed care consumer protections as well as several conservative
ideological proposals that have been rejected in the past. Legislative
language will not be ready until the House returns from recess on July
14th, at the soonest.
This Republican action comes after the issue of patient protection has
heated up significantly on Capitol Hill and on the campaign trail at
home. It
follows in the wake of the introduction of the "Patient Bill of Rights
Act of
1998," which is the most pro-consumer and comprehensive legislation
and is supported by consumer groups (including Families USA), the
American Medical Association, organized labor, women's groups, and
many other organizations concerned about patient protections in
managed care.
Consumer advocates have three concerns about the Republican plan:
(1) the lack of details makes it hard to know what's really in the bill;
(2)
some important protections were left out; and (3) there are a number of
"poison pills"-controversial and extraneous proposals-in the package. In
addition, it is unclear whether the 11th hour unveiling represents an
election-year gambit or a serious interest in enacting something this
year.
Our sense is that the GOP leadership is more concerned with "incumbent
protection" than in "patient protection."
LACK OF DETAILS: The Republican press release, which was the only
document distributed, outlined the consumer protections that the bill
will
supposedly address. The outline says the bill will include the prudent
layperson standard for emergency room access, direct access to
ob-gyns and pediatricians, and a point of service option (whereby
consumers buy a more expensive health plan that entitles them to go to
providers outside their plan). The GOP outline says plan accountability
will be enhanced by expediting internal review, providing medical
expertise in external review, safeguarding confidential information,
disclosing plan information, and lifting the gag rule.
As always, the devil is in the details. We hear rumors that internal
bickering has begun over what some of these "protections" actually
mean. For example, is the independent review is done by a doctor who
is outside the plan? Or does the plan pick the reviewer? And will the
decision be binding on the plan?
MISSING PROTECTIONS: A number of very important consumer
protections are not part of the Republican proposal. The Republican
outline will not hold health plans liable for damages to patients when
the
plans' decisions to withhold or limit care injure patients. It will not
ensure
that patients undergoing treatment can continue to see the same health
care provider if their provider leaves the plan or their employer changes
plans. It does not include "whistleblower" protections for health care
workers who report quality problems. It will not prevent health
professionals from receiving financial rewards for limiting a patient's
care. And it will not establish an independent consumer assistance
("ombudsman") program.
POISON PILLS: The proposal also contains a number of items that
consumer groups (and Congress) have rejected in the past. The items
include permitting Multiple Employer Welfare Arrangements, or MEWAs;
so-called Health Marts; and an expansion of Medical Savings Accounts.
Again, the press release on these items included a bulleted sentence for
each item. No details are available. But we know that each of these
proposals segments the health insurance pool, resulting in people with
higher medical costs facing higher premiums. Apparently these programs
would override state insurance laws so that enrollees in these plans
would also lose benefit requirements and the consumer protections that
states have enacted. The plan also includes caps on liability for doctors
in malpractice suits. Even the AMA (which supports the Patients Bill of
Rights Act as well as liability caps) has publicly stated that the
inclusion
of this provision with the consumer protections is a bad idea.
A chart comparing the Patients Bill of Rights Act to the Gingrich
proposal
is on our web site (www.familiesusa.org/managedcare). Feel free to
use this memo and chart in any way you would like.
Jeff Kirsch, Field Director
<jkirsch(AT)familiesusa.org>
Families USA
1334 G St., NW
Washington, DC 20005
ph: 202/628-3030; fx: 202/347-2417
<http://www.familiesusa.org>
-- Fred Fay Chair, Justice For All jfa(AT)mailbot.com HTTP://www.mailbot.com/justice
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Thank you.
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