Consumer Protection in Managed Care

July 16, 1998

ISSUE:

Congress is expected to vote on some form of consumer protection for patients in managed care by the end of July, before leaving for the August recess. With the 105th Congress nearly over and few concrete accomplishments this year, House Republican leaders announced on July 14 an ambitious plan to pass bills in the remaining days of the session. House Speaker Gingrich (R-Ga.) predicted that in addition to passing the 13 annual appropriations bills, Republicans would provide leadership to approve legislation to protect patients.

The Republican plan comes as the issue of consumer protection in health care is heating up on Capitol Hill and on the campaign trail. The Republican proposal follows the introduction of a Patients' Bill of Rights Act by two Democrats, Sen. Kennedy (Mass.) and Rep. Dingell (Mich.). That legislation, which has the backing of the Democratic leadership, is supported by consumer groups, the American Medical Association, nurses associations, disability advocacy groups, organized labor and women's groups. It is described by supporters as the most comprehensive and pro-consumer legislation introduced so far.

Meanwhile, Senators Chafee (R-R.I.) and Graham (D-Fla.) are developing legislation intended as a compromise between the Democratic leadership proposal, which includes the right to sue, and the proposal of the Republican leadership, who propose to protect patients without entrusting new power to the federal government. The late-breaking disclosure of the Senate Republican leadership's legislative version on July 15 underscores the timeliness of urging this Congress to deal with consumer protections.

ACTION:

1) Write, phone, fax or visit your Representative and your two Senators. Urge them to support a strong bill of rights for patients, and state the issues you believe such legislation should address. If you prefer a particular bill, explain why.

You need to act promptly! Congress is in session until Aug. 10, then will return Sept. 8 for a final month of work before the scheduled Oct. 9 adjournment.

Honorable ________
U.S. Senate
Washington, DC 20510

Honorable ________
U.S. House of Representatives
Washington, DC 20515

Capitol switchboard: (202) 224-3121. You can obtain your Senator's or House member's Washington fax number by calling the state or district office.

2) Obtain a copy of the Patients' Bill of Rights Act (S. 1890 and H.R. 3605). You may be able to request a copy from your Representative's district office. If you support the bill, ask the district staff to urge your Representative to support it. If you are unfamiliar with the bill, study it, and if you support it, then contact your House member's district or Washington office immediately to urge them to support it as well.

3) Write a letter to the editor of your local newspaper calling attention to the issue of consumer protection in managed care. If possible, refer to an article that has appeared in that paper. In letters to the editor and communications with members of Congress, identify yourself as clergy or a member of the Presbyterian Church (U.S.A.). While you cannot speak for the church, you can go on record as being concerned because you are a member of the church. Encourage people from your congregation or community to speak out on the issue as well.

BACKGROUND:

With the November elections fast approaching, members of Congress are attempting to show that they are responsive to the public concern about consumer protection in managed care plans. However, with much of their legislative agenda on the budget, taxes and welfare reform accomplished last year, the Republican leadership may not feel pressed to move additional major legislation in the time remaining.

Since details of the House Republican bill are vague, there is a very real danger that Congress may pass only a few token patient protectionsþsuch as those allowing medical savings accounts, multiple employer welfare arrangements, and "health marts." Consumer advocates fear these programs, if passed, could override state insurance laws so that enrollees in these plans could lose consumer protections and benefit requirements that states have enacted.

There are several differences between the Republican leadership bills in the House and Senate. For instance, the Senate bill includes language that would prohibit insurance companies from using a family history of disease or the results of genetic tests in deciding how much to charge a patient for coverage. The House bill does not include such language.

Many provisions in the more moderate Chafee-Graham bill are taken word for word from legislation introduced by the Democratic leadership. The Chafee-Graham bill is supported by a coalition of 25 health maintenance organizations (HMOs), which are mostly nonprofit groups.

An umbrella group that lobbies for managed-care companies, the American Association of Health Plans, is running television advertisements that oppose legislation to regulate the industry. The commercial says, "When politicians play doctor, real people can get hurt." The association has spent $2 million on advertising and public relations this year and says it plans to spend more.

GENERAL ASSEMBLY GUIDANCE:

These actions are consistent with the 1988 General Assembly policy on "Life Abundant: Values, Choices and Health Care," and the 1991 resolution on "Christian Responsibility and a National Medical Plan," which states that "Assessment and assurance of quality refers to the standards that are established for the safety, efficacy and outcomes of medical service use, and the methods employed to assure the quality of the services provided."