Letter on Scope and Liability to House and Senate Managed Care Conferees
April 5, 2000
The National Partnership for Women & Families chairs a diverse coalition of patient and provider groups that support strong, enforceable patient protections. We write to you in your capacity as chair of the patients’ rights conference committee. While we are pleased that some of the differences between the House and Senate bills have been resolved, we are concerned about the slow pace of the conference and about what the conferees are not discussing -- who will get the benefit of any agreed-upon patient protections and how patients will be able to hold their health plan accountable.
Most of the provisions in the Senate bill, by design, cover only people in self-insured ERISA plans, a fraction of the people in ERISA plans and an even smaller fraction of those with employment based insurance. By contrast, the House bill would provide common-sense patient protections to all people with employment based insurance, including state and local government workers and people in Achurch plans@ -- plans that are not covered by ERISA at all. (Church plans cover people who are employed by churches or organizations run by churches). The House bill also provides these protections for people in the individual market, people who get insurance on their own for themselves and their families because they do not have access to group plans sponsored by employers.
If the Senate’s version were to prevail, millions of people would be left out. Those without federally-guaranteed protections would include fire fighters, police officers, school teachers, family farmers, ministers, health department nurses, and workers in church-run day care centers. It would be a tragic mistake for Congress to enact a patient protection that fails to protect these hard working Americans. Every day we count on them to provide an array of essential services, and we must not turn our backs on them.
True accountability is also an essential component of meaningful managed care reform. Opponents of real accountability argue that patients who have been unfairly denied health care should be limited to external appeals. But external review is simply not enough to protect patients against the worst managed care abuses. A solid external appeals system must go hand in hand with accountability. Accountability is the ultimate deterrent and an essential last resort when all else fails. Only legal accountability gives injured patients what they need to ensure that managed care does the right thing before it is too late.
Such accountability exists for all other actors in our health care system -- from the doctors, nurses, psychologists, and other health care professionals to the hospitals, clinics, and nursing homes in which they provide care. Such accountability also exists in all other sectors of our society, yet we continue to exempt health plans. Courts across the country have recognized the injustice of leaving patients with no remedy.
We hope you will keep these concerns in mind as you complete the work of the conference, and we urge you to complete this work expeditiously. America is watching and time is running out.
Judith L. Lichtman
National Partnership for Women & Families.