MANAGED CARE August 1998. ©1998 Stezzi Communications
After more than four months of wrangling with the issue in a working group, the House GOP leadership released an outline of its package of insurance reforms and consumer protections. And it wasn't long before the proposal, developed under the guidance of Illinois Rep. Dennis Hastert, was attacked from many sides. Democrats and consumer groups said it doesn't go far enough because there are no health plan liability provisions, while businesses and insurers said it's overly laden with "government mandates." Here's what's in it:
- Health marts, or voluntary purchasing arrangements;
- Direct access to pediatricians and obstetrician/gynecologists as primary care doctors;
- A ban on gag clauses in managed care contracts;
- Coverage of emergency services if a "prudent layperson" would have considered the condition an emergency;
- Broad disclosure requirements for health plans;
- A $250,000 cap on malpractice punitive damages;
- A strengthened appeals process for patients, including the right to submit denials of coverage to an independent review panel once such recourse through health plans has been exhausted.
Sample reaction: Families USA damned the outline, labeling it the "Gingrich proposal" and saying it was chock full of "recycled ideological proposals" designed to make sure no managed care legislation passes this year.
House Minority Leader Richard Gephardt of Missouri referred to the GOP outline as a "fig leaf" and predicted that it would receive a presidential veto if passed. Bill Gradison, president of the Health Insurance Association of America, argued that no congressional action would be a better alternative. The American Association of Health Plans is running television commercials aimed at discrediting this and any legislative attempt to manage managed care with the message, "When politicians play doctor, real people get hurt."
Look for the debate to continue right up to Election Day, with both sides blaming each other if no bill is enacted.