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The Business of
Health Care Report After endless debate in Congress over a "Patients' Bill of Rights," it has come to this: Where and when can patients sue HMOs? The final outcome has significant implications for the cost and availability of both insurance and health care for all Americans. Both major political parties have made the dubious assumption that the federal government should be the manager of "managed care" and the HMOs deliver it. A bill has been introduced in the House of Representatives that would allow the 161 million Americans enrolled in HMOs to sue in state or federal court if their HMO makes decisions they believe are too restrictive. The Senate version would allow such lawsuits only in federal court, and only after an independent reviewer determines that the HMO improperly denied care. The effects of either version would be costly. A recent Congressional Budget Office study concluded that if the Patients' Bill of Rights were enacted, it would cost $350 more each year to provide health insurance for a family, and 1.8 million more Americans would be without health insurance. The legislation would force the nation's small business owners to comply with numerous mandates and subject small business employers to lawsuits over the health coverage they provide. Three of every five Americans without insurance come from families headed by someone who works in a small business. The threat of lawsuits will lead many small employers that are now providing insurance to drop it. The increased costs that will accompany expanded liability will push health insurance even further out of the reach of small business. That means even more Americans without insurance. While Washington bickers over the litigation question, some states are already moving toward what may be a better solution: independent, external reviews by medical experts who judge whether a health plan's decision is appropriate. If you have questions about health care or suggestions for topics on this program, e-mail me at DougHawthorne@TexasHealth.org. Tune in to News Radio 1080 KRLD and here at TexasHealth.org for more on the Business of Health Care. ©
2001 Texas Health Resources |
