REAL PROTECTIONS, NOT PHONY SUBSTITUTES
S. 1344, the bill that passed the Senate on July 15, 1999, fails to
provide the patient protections that America's families need and deserve.
S. 1344 covers only a fraction of the people in this country with
employment-based coverage and excludes more than 100 million Americans.
Because most of its provisions apply only to the 48 million people in
self-insured plans, this bill fails to provide basic protections to
millions of Americans and exacerbates the ineffective patchwork system of
protections already in place.
In addition to failing to protect millions of Americans, S. 1344 is
deficient in other ways. For example, S. 1344:
- Does not ensure that treatment decisions such as how long a patient
stays in the hospital are made by the patient's doctor (except for
certain breast cancer patients);
- Does not hold managed care plans accountable when their decisions to
withhold or limit care injure patients;
- Does not provide for a genuinely independent appeals process -- the
plan selects the reviewing entity and can rig the outcome by defining
the term "medically necessary" any way it chooses, no matter how
inconsistent with best medical practice the definition may be;
- Does not ensure that patients undergoing a course of treatment (such
as women undergoing chemotherapy for breast cancer) can continue to see
the same health care professional when their provider leaves the plan or
their employer switches plans;
- Does not ensure that women can obtain
ob-gyn services from the participating health care professional of their
- Does not require plans to allow parents to select health care
professionals specializing in pediatrics as their child's primary care
- Does not require plans to have an adequate network of providers;
- Does not go far enough to ensure access to specialists (inside or
outside the network);
- Does not prohibit plans from denying access to clinical trials
(except for some cancer trials);
- Does not adequaltely protect people from having to pay out of pocket
for emergency room care;
- Does not ensure that doctors and nurses can report quality problems
without retaliation by HMOs, insurance companies, and hospitals; and
- Does not give consumers access to an independent consumer assistance
program to help them choose plans and get the services they need.
National Partnership for Women & Families.