Dems Push Health Bill Of Rights

Emergency room care and access to specialists would be guaranteed under managed care legislation Democrats introduced Tuesday. The proposed legislation falls in line with President Clinton's call to Congress to develop a consumer 'Bill of Rights.'

The bill, one of several introduced to overhaul managed care, is aimed at providing consumer protections for people using health maintenance organizations, or HMOs.

The legislation also would prevent "inappropriate interferences by insurance companies in the doctor-patient relationship," said House Democratic leader Dick Gephardt of Missouri.

"I'm co-sponsoring this legislation because, right now, we have a system where HMOs make more money when they deliver less care," Representative Sam Gejdenson, D-Conn., said.

"To stop the abuses that HMOs inflict on their patients and to make health care affordable, we have to ensure that patients and their doctors, not accountants, have control of the health care system," he added.

President Clinton endorsed the bill in a letter to Gephardt and Senate Democratic leader Tom Daschle of South Dakota.

"The bill you are introducing today provides a critical step towards developing bipartisan legislation that will pass the Congress," Clinton said. "I look forward to working with the Congress to enact a 'Patients' Bill of Rights' act that I can sign into law this year."

A trade group representing managed care plans objected to the legislation, calling it "a bill that moves in the wrong direction," said Susan Pisano, spokeswoman for the American Association of Health Plans.

It would subject health plans to too much government regulation, she said.

"We think that it will increase costs, particularly through a high level of government micromanagement, but will not increase the quality of care," Pisano said. "It's a hidden tax that masquerades as consumer protection."

The bill includes provisions that would:

  • Require plans to cover the cost of emergency medical care, even if performed without prior authorization, in any situation that a "prudent lay person" would regard as an emergency.

  • Allow patients to go out of the plan's network for specialty care at no extra cost if there is no appropriate provider in network.

  • Require timely appeals and independent external appeals when plans deny a course of treatment.

  • Provide enrollees understandable information about their health plan.

  • Hold plans legally accountable for decisions that lead to serious injury or death.

By Cassandra Burrell.
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