RELEASE: Wednesday, September 1, 1999
EVANS CALLS FOR ACTION ON
MANAGED CARE REFORM
Turn Medical Decisions Back in the Hands of Doctors,
Cong. Lane Evans is calling for action on managed-care reform legislation
that would provide essential protections for patients and return medical
decisions back in the hands of doctors and their patients.
"This legislation would put health care decisions back in the hands of
doctors and their patients and take it back from managed-care companies who are
only looking to the bottom line," Evans said.
He said the House Republican leadership is holding up action on the bill. The
Senate passed its own legislation in July that greatly limits the number of
patients who may take advantage of it and makes it more difficult for consumers
to hold HMOs accountable for their actions.
The legislation Evans is supporting would extend coverage to all 161 million
Americans with private health insurance and makes it easier to hold insurers
Key provisions in the bill include:
- Direct Access to Specialty Care: Patients could choose a specialist
as their primary physician for special needs or ongoing conditions. Women
could choose an obstetrician/gynecologist or families could designate a
pediatrician as the primary doctor for their children.
- Emergency Care: Ensures that health plans cover the costs of
emergency room care, even if the treatment is delivered in a facility that is
not part of HMO coverage. Insurers would also be required to pay in cases
where the patient legitimately believes an emergency exists regardless of the
- Continuity of Care: Patients would be protected against disruptions
in care because of a change in a plan or a change in a provider's network
- Clinical Trials: Access to clinical trials can be crucial for
treatment of an illness, especially if it is the only known treatment
available. Plans would have to create a process for allowing patients to
participate in approved clinical trials, and the plan must pay for the routine
patient costs associated with the trials.
- Appeals Process: Appeals of HMO decisions could be arbitrated by a
panel of medical experts.
- HMO Liability: Makes HMOs accountable by allowing lawsuits when a
refusal to authorize treatment results in death or impairment of the patient.
- No "gag rules" on what a doctor call tell a patient: Consumers
should have a right to know all of their treatment options. The legislation
prohibits plans from gagging doctors and from retaliating against providers
who advocate on behalf of their patients.
"Both consumers and doctors are complaining about the delivery of care
allowed under managed care plans," Evans said.
"This is the most important health issue for the public. I know how important
it is to be able to get the health care one needs. We have to respond to the
needs of individuals for patient protection and access to care."
Manage-care companies now provide health insurance for most Americans. The
proportion of privately insured Americans enrolled in managed care plans has
grown from 13% in 1987 to 75% today, but there is no effective oversight. Over 6
million people in Illinois who belongs to HMOs lack key patient protections.
Evans said managed care is particularly important for women because they make
more than 60 percent of all doctor visits and are not able to receive important
preventive services because of limitations on care.
"Too often health plans are interfering with medical care instead of ensuring
patients can get the care they need," Evans said. "We have to return medical
decision-making back to where it belongs: with patients and health care
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