members of Congress are promoting legislation to mandate a one-size
fits-all health care system that dictates the type of health care
coverage Americans receive from their employers, health plans, and
The stated intention of these mandate bills is commendable:
improving the quality of health care for all. The health care
system has changed dramatically in the past decade. That
change hasn't been even. The unevenness of some aspects of health
care delivery has caused discomfort, and those problems have been
very real for some. But government mandates aren't the
solution. One bill laden with mandates – the so-called
"Patients' Bill of Rights" – would have the following impact:
- Health insurance premiums will increase by as much as 39
percent and caue 4.5 to 7.8 million Americans to lose their health
insurance. (Milliman and
Every time a mandate
raises the cost of insurance by one percent, some 200,000 to
400,000 Americans lose their coverage (Congressional
Budget Office and Lewin Group Study)
Nearly half of small
employers would likely drop health insurance coverage if this
legislation drives their premiums up 20 percent or more.
Additionally, 57 percent of small employers would likely drop
insurance coverage for their employees if medical liability is
Opinion strategies study by Bill McInturff)
To implement and enforce
these mandates, a minimum of 3,828 new full time federal employees
would be needed and a minimum increase of $155,294,304 in annual
appropriations to the Departments of Labor and Health and Human
Services would be needed. (Multinational
Business Services, Inc.)
Health care mandate
legislation drives up the cost of health insurance for families and
employers, causes employers to reduce benefits, increase the number
of Americans without health insurance, and leads to the type of
government-run health care system rejected in 1994.
Patients' Bill of Rights Act and some other health care mandate
legislation would require health plans to pay for any service
ordered by treating physicians that they believe is "medically
necessary," as long as it is consistent with "generally accepted
principles of professional medical practice."
The "medical necessity" provision will:
Harm patients –
Studies show that American health care quality has historically been
dictated more by where you live than by scientific evidence or what
is best practice medicine. For instance:
- A patient is 33 times more likely to have breast-conserving
cancer surgery in parts of Ohio than parts of South
- Only 20 percent of all physicians practice evidence-based,
best practice care.
- Forty percent of medical procedures have no scientific,
Stop the quality revolution – Today, with information technology
and research on treatment outcomes, health plans help encourage
best-practice medicine. Reviewing and monitoring doctor
practices has brought about dramatic improvements in the quality of
- HMO members are 2.5 times (80 percent) more likely to receive
life-saving Beta blockers after a heart attack than those in
- HMO members are 2.5 times more likely to receive ACE
inhibitors for congestive heart failure than a person in
traditional fee-for-service medicine.
Cause costs to skyrocket and loss of coverage – This provision
could cause employers to pay as much as $929 more in health
insurance per worker, workers to lose $1,124 in wages, and 1.4
million people to become uninsured. (Barents Group, 1998)
Let the quality process continue to develop and move forward
within the delivery system. Medical innovation cannot be
legislated. Innovation in health care, like in all endeavors,
comes from competition. When government attempts to define
quality with regulation, it freezes in place today's best
of the Patients Bill of Rights assert that the 1974 ERISA law
protects health plans from being sued for malpractice. That
assertion is false.
Fifteen times since 1995, federal courts have ruled that
HMOs may be held liable for medical malpractice.
The Supreme Court's landmark Travelers decision in 1995
significantly narrowed ERISA's preemption of state law.
Federal district and appellate courts since have ruled no less
than 15 times that ERISA doesn't shield HMOs from medical
malpractice liability under state law.
The opinion in the Pacificare case is typical: "Just as ERISA
does not preempt the malpractice claims against the doctor, it
should not preempt the vicarious liability claim against the HMO .
. . ."
The Clinton administration has contradicted itself on the
President Clinton implies in his statements that HMOs can't be
sued because of ERISA. For example, he said July 16, "Some
people will say to us . . . we'll be for all the substantive
positions in [the Patients' Bill of Rights] . . . as long as you
don't give patients a right to sue. . . . "
Meanwhile, his own Secretary of Labor has filed amicus briefs
in eight court cases arguing that ERISA does not preempt medical
malpractice claims against HMOs
– The Department of Labor's
solicitor's office states unequivocally in a memo, "Medical
malpractice claims against HMOs are not preempted by ERISA."
The assertion that HMOs are immune from being sued is
false. In at least 15 Federal court decisions over the past
three years, the courts have ruled that the federal ERISA law does
not block patients from suing HMOs for medical malpractice.
The Patients' Bill of Rights would expand liability to coverage
decisions made by health plans, and to employers
themselves. Every medical dollar should go toward
medical services, not to lawyers and bureaucrats.
ANY WILLING PROVIDER
provision in the Patients Bill of Rights would require health plans
to accept the services of any willing provider, whether or not that
provider belonged to a given network. The criterion for
receiving payment for services would be that the provider had been
licensed in that state.
"Any willing provider" mandates would raise health care
costs, leading to more uninsured Americans.
Consumers and employers would pay as much as 8.6 percent more
for health coverage because of this mandate.
"Any willing provider" provisions would make it difficult, if not
impossible to operate an HMO, PPO, or any kind of integrated
delivery network because they would not be able to ensure high
quality providers. "Any willing provider" would return us to
the costly fee-for-service world where every provider gets paid,
without regard to quality of care practiced.
Congress may consider as part of potential "patient protection"
legislation is to require that employers provide a point-of-service
option. Mandatory POS would be government requiring a
particular form of coverage under employers' voluntary action –
offering employees health benefits.
Mandatory POS will raise health costs by an estimated
three to 11 percent, according to a Coopers & Lybrand
Every one percent increase in health coverage costs cause up to
400,000 Americans to lose their health benefits.
If employers are required to offer a health plan with an open
panel, some employers – especially small businesses, which are the
least likely to offer health insurance benefits – might decide not
to offer health coverage at all.
Of the eight percent of workers who are offered only HMO
coverage, more than half work in companies with fewer than 200
Employers provide employee health benefits voluntarily.
Congress shouldn't treat a voluntary fringe benefit as though
mandatory coverage would have no effect on the employer-based