June 16, 1999
WASHINGTON - "The so-called managed care reform bill, H.R 2089 introduced by
Representative John A. Boehner (R-OH) and expected to be marked-up by the House
Committee on Education and the Workforce, Subcommittee on Employee/Employer
Relations does more harm to consumers than no legislation at all," according to
Adrienne Hahn, legislative counsel at the DC office of Consumers Union.
Consumers must have a means for holding managed care plans legally
accountable for medical negligence. The ability of a consumer to hold a managed
care plan fully accountable for sub-standard health care that results in injury
or death is essential. Compensation to injured consumers acts as an important
counter-balance to financial incentives to increase profits through
under-treatment of patients. In fact, the effectiveness of all other patient
protections hinges on whether managed care plans remain immunized from
responsibility for egregious behavior.
Meaningful managed care reform legislation must include a truly independent
external grievance and appeals systems. In a truly independent external
grievance and appeals process, the state selects the review entity. "Today, many
consumers are trapped within their health plan, which is totally in control of
treatment decisions," said Adrienne Hahn. "The result: consumers risk not
getting the medical care they need when bottom-line considerations, not medical
appropriateness, have undue influence on decision-making."
"While an adequate external review is important, full accountability can only
be achieved when consumers have further recourse in the courts. Ultimately, the
purpose of liability is not to encourage lawsuits, but to prevent them, by
providing a meaningful incentive for plans not to deny needed treatment in the
Unfortunately, H.R. 2089 does not provide for either an independent external
appeals process or a means for holding managed care plans legally accountable
when they deliver sub-standard health care. Consequently, Consumers Union urges
members of the House Committee on Education and the Workforce to vote against
H.R. 2089. Instead, Consumers Union looks forward to working with Congress to
pass meaningful and comprehensive patient protection legislation as embodied in
the Patients' Bill of Rights Act, H.R. 358 that does not include anti-consumer
measures such as Association Health Plans which could make health care less
affordable and reduce health benefits consumers receive.
Consumers Union, Publisher of Consumer Reports magazine, is an independent nonprofit testing, educational and information organization serving only the consumers. We are a comprehensive source of unbiased advice about products and services, personal finance, health, nutrition and other consumer concerns. Since 1936, our mission has been to test products, inform the public and protect consumers.