Printer Friendly

Senate Republicans propose reform package. (Short Takes: News at Deadline).

In a move designed to counter the Presidents health care reform efforts, Senate Republicans have unveiled their Patients Bill of Rights proposal. Assistant Majority Leader Don Nickles announced the plan, which was produced after seven months of closed door hearings. The measure focuses on workers covered under ERISA plans that cannot be regulated by states. Many state lawmakers and regulators have been frustrated by the limitations on their ability to place requirements upon self-funded ERISA plans. Their inability to control the activities of these plans has inhibited their ability to do health care reform at the state level.

Employers who utilized such plans, however, have long claimed that the freedom to innovate and being able to avoid costly state mandates has enabled them to control costs much better than would have otherwise been possible. There are approximately 48 million Americans covered under self-insured plans in which the employer assumes the risk for the coverage. The Republican Senators said that they did not want to usurp the regulatory powers that rightfully belong to the states by regulating non-ERISA plans, especially since many states had already addressed the patient protection issue.

Democrats slammed the proposal for limiting the patient protections to these workers and their families. They declared that all patients were worthy of protection and that a distinction should not be made because of the type of health coverage a person has. A White House aide commented, "We thought there was consensus that all protections apply uniformly to all Americans. But this bill does not do that."

Big business was not excited about the bill either. Chip Kahn, President-designate of the Health Insurance Association of America, said, "This whole process has become too politicized, and regardless of the merits of any individual proposal, we don't think this is the time for legislating anything." The Coalition for Patient Choice, a conservative consumer advocate group. however, praised the proposal for provisions that are responsive to the needs of the self-employed.

The patient protections included in the GOP Bill of Rights include the right to choose one's own doctor. The Republican plan has point-of-service and continuity of care requirements designed to give patients more control over their choice of a physician, Women would have the right to see an obstetrician/gynecologist without a referral from a gatekeeper."

In addition, "gag" clauses in HMO contracts would be prohibited and a "prudent layperson" standard would be used for ER claims. Health plans would be held accountable for their decisions. Health plans would be required to disclose a range of information to consumers, including, but not limited to, what's covered and what is not, how much they will have to pay in deductibles and coinsurance, and how to appeal adverse coverage decisions. Patients would be guaranteed access to their medical records. It would also require organizations handling medical information to establish safeguards to protect the confidentiality, security, accuracy, and integrity of protected information and let consumers know of these safeguards.

A couple of separate provisions would apply to virtually all Americans. Discrimination by insurers on the basis of genetic information would be banned. In addition, patients would be given the right to external appeals of decisions to deny care f the cost of the treatment was at least $1,000.

The proposal promotes quality improvement by backing research aimed at giving patients and physicians better information regarding quality. It would create the Agency for Healthcare Quality Research in an effort to bridge the gap between what is known and what is done today. In an effort to make health coverage more affordable, the proposal would allow self-insured individuals to deduct the full amount of their health care premiums. It would also make Medical Savings Accounts available to everyone and reform the way cafeteria plans operate in order to let consumers save for future health care costs.

James A. Hawkins is Publisher of Healthcare Briefings, a newsletter available in print, on cassette, via fax, and on computer disk. He can be reached at 800/338-5486.
COPYRIGHT 1998 American College of Physician Executives
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1998, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
Printer friendly Cite/link Email Feedback
Author:Hawkins, James A.
Publication:Physician Executive
Geographic Code:1USA
Date:Sep 1, 1998
Words:667
Previous Article:Reader feedback.
Next Article:AFL-CIO joins reform debate. (Short Takes: News at Deadline).
Topics:


Related Articles
The Republican task force health reform proposal: loyal opposition or bipartisan collaboration?
House kicks tax increase toward floor.
DEMOCRATS SEEK BALLOT SPOT FOR EASIER BOND APPROVAL.
ASSEMBLY DICKERING OVER BONDS; IMPASSE COULD AFFECT EDUCATION PROGRAMS.
CLINTON LASHES OUT AT GOP OVER SCHOOL SPENDING.
Top issues in Campaign 2002.
Poor tax revenues may force another state budget cut.
OVERSTATING THE 'SAVINGS'? ALARCON SAYS INSURANCE COMPANIES GOUGED EMPLOYERS BY BILLIONS.
EDITORIAL REFORM WINS WORKERS' COMP PACKAGE A TESTAMENT TO NEW LEADERSHIP IN SACRAMENTO.

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters