November 21, 1997 in Nation/World

‘Bill Of Rights’ Aims To Ease Concerns About Health Care But Critics Contend Measure Really Just Government Intrusion

R.A. Zaldivar Knight-Ridder
 
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President Clinton endorsed on Thursday a health care “bill of rights” which prescribes patient protections supported by many states, employers and some Republicans.

“It is a mild piece of consumer protection law that corresponds to a lot of other protections in areas such as air safety and banking,” said Robert Blendon, a health policy professor at Harvard University. “It is in the mainstream.”

But critics have called the proposal excessive government intrusion.

And a fight is looming in Congress about whether the “rights” should be embodied in federal law, as Clinton is proposing, and what that would cost.

The provisions were drafted by a 34-member presidential commission of doctors, consumer advocates, business people and policy experts.

Recommendations include allowing patients to go to the nearest hospital in an emergency, guaranteeing access to specialists, providing detailed information about quality of care and creating a system for appealing denials of care to a neutral party.

The proposals are meant to address anxiety about managed-care plans, the newly dominant form of health insurance in the United States. Managed care aims to cut medical costs by reducing unneeded treatments and stressing prevention, but critics say it can stand in the way of the sick getting the care they need.

A major telecommunications company - GTE - voluntarily adopted the “bill of rights” Thursday. GTE will require the health plans that provide coverage for 400,000 employees and their dependents to abide by the standards.

Supporters of federal legislation, including Clinton, many lawmakers of both political parties, consumer groups, doctors and some employers and managed-care plans, say a single national standard for ensuring quality care is needed.

They say that 40 percent of privately insured workers are in federally regulated plans that are exempt from any protections passed by the states. Many states have adopted stricter rules than the federal government.

Thursday, Clinton ordered federal agencies to apply the consumer protections to taxpayer-supported programs such as Medicare and Medicaid and to the federal employee health plan. Many of the standards already were in effect for Medicare and Medicaid, which cover the elderly, disabled and poor.

“Today, Americans receive consumer protections when they purchase cars, use credit cards, buy toys for their children,” Clinton said to commission members. “All this commission is recommending is that we extend that protection when a person visits a doctor, checks into a hospital or buys into a health plan.”

Some lawmakers are several steps ahead of Clinton. Separate managedcare consumer bills introduced by Reps. Charlie Norwood, R-Ga., and Greg Ganske, R-Iowa, have garnered strong support and are expected to come up in Congress next year.

But opponents of federal rules - including business groups, Republican congressional leaders and insurance industry groups - say regulations get in the way of employers and insurers solving problems themselves. They also worry the protections will drive up insurance costs.

“We support the focus on health care quality that the president has initiated,” said Gail McDonald, a top health policy specialist for the Business Roundtable, which consists of 200 chief executives of major companies. “But we are very concerned about mandates that restrict the ability of the marketplace to adapt.”

McDonald said the group does not rule out a compromise, but organizations that represent small businesses are adamant in their opposition.

One such group, the National Federation of Independent Business, complains that the patient protections are part of a stealthy strategy by Clinton to enact his failed 1993 health reform plan one piece at a time. They say the consumer protections will drive up costs and force employers to drop coverage.

House Majority Leader Dick Armey, R-Texas, who is working closely with opponents, has called the “bill of rights” a “bill of goods.”

There’s no question among experts that more rules will increase costs. But there is wide dispute as to how much.

An independent economic analysis for the president’s commission concluded that the recommendations would raise costs by about $1 a month for every insured person. In comparison, annual health benefit costs now average about $3,900 per employee.

Experts also say regulation could produce benefits: Some lives might be saved or improved by requiring health plans to provide more treatment options.

MEMO: These 2 sidebars appeared with the story:

1. FOR MORE INFORMATION

For a copy of the “bill of rights,” call 1-800-732-8200 or write “Consumer Bill of Rights and Responsibilities,” P.O. Box 2429, Columbia, Md. 21045-1429. The Internet addresses are: www.whitehouse.gov and www.hcqualitycommission.gov.

2. HIGHLIGHTS OF ‘BILL OF RIGHTS’

WASHINGTON - Here are some of the consumer protections proposed in President Clinton’s health care “bill of rights,” which aims to address patients’ concerns about managed-care insurance:

Complaints and appeals. Health plans would be required to provide timely written notice of decisions to deny service or treatment. Outside review would be available if appeals within the plan fail to resolve the issue.

Quality ratings. Health plans would develop a system allowing patients to obtain information about the quality of care provided by health maintenance organizations, hospitals and individual doctors.

Choice. Health plans would have to guarantee a choice of doctors. Women would have direct access to gynecologists and obstetricians for routine women’s health care.

Specialists. Chronically ill people would have direct access to a specialist without having to get prior approval. If a health plan lacks a specialist qualified to provide a particular treatment, the patient could see an outside specialist at no extra cost.

Communication. Insurance plans could not interfere with full and open communication between doctors and patients, including discussions of whether costly treatments are available.

Emergencies. Patients could go to any emergency room, not just those dictated by their plans, if they fear that a lack of medical attention would put their health at serious risk.

Confidentiality. Consumers would have the right to review their medical records and correct errors. Doctors, hospitals and insurers would face stricter rules about disclosing information.

These 2 sidebars appeared with the story:

1. FOR MORE INFORMATION For a copy of the “bill of rights,” call 1-800-732-8200 or write “Consumer Bill of Rights and Responsibilities,” P.O. Box 2429, Columbia, Md. 21045-1429. The Internet addresses are: www.whitehouse.gov and www.hcqualitycommission.gov.

2. HIGHLIGHTS OF ‘BILL OF RIGHTS’ WASHINGTON - Here are some of the consumer protections proposed in President Clinton’s health care “bill of rights,” which aims to address patients’ concerns about managed-care insurance: Complaints and appeals. Health plans would be required to provide timely written notice of decisions to deny service or treatment. Outside review would be available if appeals within the plan fail to resolve the issue. Quality ratings. Health plans would develop a system allowing patients to obtain information about the quality of care provided by health maintenance organizations, hospitals and individual doctors. Choice. Health plans would have to guarantee a choice of doctors. Women would have direct access to gynecologists and obstetricians for routine women’s health care. Specialists. Chronically ill people would have direct access to a specialist without having to get prior approval. If a health plan lacks a specialist qualified to provide a particular treatment, the patient could see an outside specialist at no extra cost. Communication. Insurance plans could not interfere with full and open communication between doctors and patients, including discussions of whether costly treatments are available. Emergencies. Patients could go to any emergency room, not just those dictated by their plans, if they fear that a lack of medical attention would put their health at serious risk. Confidentiality. Consumers would have the right to review their medical records and correct errors. Doctors, hospitals and insurers would face stricter rules about disclosing information.

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