Maelstrom over patients rights - Patient Access to Responsible Care Act

Business & Health, Dec, 1997 by Janet Gemignani

As Congress breaks for the holidays, insurance and business lobbyists have mobilized to combat a host of managed care bills seeking consumer protections and a patient "bill of rights" that President Clinton has vowed to pass. "What most people don't realize," the National Federation of Independent Business (NFIB) contends, "is that they are encouraging politicians to slap more mandates onto plans, costs that force affordable health insurance out of the reach of the nation's smallest employers."

At the urging of House Republican leaders, the NFIB has joined with The Business Roundtable, the national Blue Cross and Blue Shield Association, the American Association of Health Plans, CIGNA and Prudential to form a coalition to fight the proposed mandates, which it views as a costly and unnecessary intrusion. Tony Burns, CEO of Ryder Systems, Miami, and a member of The Business Roundtable, says: "We urge the president and Congress to reject reforms that would lead us down the path of government-run health care at a time when the private health care market is providing innovative improvements for our employees."

Meanwhile, consumer groups applauded the draft patients' bill of rights released shortly before Thanksgiving by the president's advisory commission on health care quality. The commission's recommendations would entitle patients to, among others things, unfettered access to emergency care, confidentiality of medical records and a fair appeals process (See Washington Memo on page 16). While urging providers to adopt the proposals voluntarily, President Clinton has instructed federal agencies overseeing health insurance to study which of the safeguards can be enforced under existing law.

Interestingly, the 34-member panel did not reach consensus on all the issues. S. Diane Graham, owner of a small business in Kansas, was the lone dissenter, arguing that the recommendations would drive up health care costs for small employers. Agreeing to implement the proposals at GTE, executive vice president Randall MacDonald, another panelist, estimates that his firm's costs will rise by 1 to 3 percent as a result. The commission's final report, due March 30, is expected to propose the creation of an infrastructure to promulgate industry standards and provide comparative data and consumer information.

Ironically, the managed care bill receiving the most heat, the Patient Access to Responsible Care Act (PARCA), was introduced earlier this year by two Republicans - Rep. Charlie Norwood (GA) and Sen. Alfonse D'Amato (NY). Having mustered over 200 co-sponsors in both houses, the proposed measure could drive up premiums by anywhere from 7 to 39 percent, according to estimates by the actuarial firm Milliman & Robertson. Among PARCA's mandates: coverage of emergency care without prior authorization, an efficient appeals process and PPO network coverage of services by non-participating providers.

The bill, which has strong support by physician groups, would also amend ERISA. Because of employer concern over firms' possible liability in malpractice suits should PARCA be enacted, Norwood introduced a narrower bill in early November that would exempt employers from liability.