WASHINGTON, D.C. - Congressman John
Boehner (R-OH) today challenged a Washington Post report on Texas'
experiment with HMO liability and argued that the Lone Star State's
experience, if anything, underscores the value of giving patients a
strong, enforceable, binding external review as an alternative to
lawsuits.
"If anything, the Texas experience proves
what we've been saying all along: external review works," Boehner
said.
"Texas' external appeals system has been
tested repeatedly since the Texas law was implemented, while the
liability provision itself - by the trial bar's own admission - hasn't
been tested at all," Boehner said. "If we're going to jump the gun and
conclude that the Texas law hasn't caused higher costs and reduced
access, then let's give credit where credit is due: to external
review."
Instead of expanding lawsuits, Boehner's
CARE Act (H.R. 2926) gives patients the protection of a strong,
enforceable, legally-binding external review by independent doctors and
medical experts. Under the CARE Act, health plans are subject to
prosecution and severe financial penalties of up to $5,000 per day if
they fail to provide patients with the care physicians prescribe. The
Texas law also features a strong external review for patients - a
component that is keeping patients and insurers out of court, Boehner
says, because it's doing what lawmakers have said it would
do.
Boehner also pointed out that Texas
adopted a sweeping tort reform law several years before passing its HMO
liability law - a measure that has helped discourage trial lawyers from
filing frivolous suits. Boehner, who was interviewed by the Washington
Post for this morning's story, expressed concern that this key fact was
omitted. Medical tort reform is a major component of the CARE
Act.
While Texas' external appeals system is
performing admirably, the state's liability law is largely untested - a
fact the Texas trial bar itself acknowledged to the Post.
"Plaintiffs' attorneys in Texas
acknowledge that they are proceeding gingerly for now, choosing their
first cases with special care to try to make the point that some HMOs
stint on care," the Post reports.
Last spring, the House Education and the
Workforce Subcommittee on Employer-Employee Relations heard compelling
testimony from the head of Georgetown University's Institute for Health
Care Research and Policy, Dr. Geraldine Dallek, M.P.H., regarding the
institute's study on the external review experiences of patients in 13
states. In virtually all cases, the Georgetown study found, external
review was "widely regarded [by managed care patients] as a valuable and
fair process" for ensuring that patients get the care they need when
they need it.
Boehner is chairman of the
Employer-Employee Relations Subcommittee.
