(11/29/97 Baltimore AFRO-American Newspaper)
by Congressman Elijah E. Cummings
Last Thursday, President Clinton announced his support for a broad new set of government standards that will guarantee Americans better care and more clout in the nation’s health care system. I welcome the President’s action and I think this "Bill of Rights" will help assure insured patients easier access to treatment, more information to help them select health plans and doctors, and new ways to appeal if they are dissatisfied with their care.
The President’s action was a result of the findings of an advisory commission, which was made up of representatives of insurance companies, consumers, health care providers and employers. The President appointed this commission because it is clear that the American public is growing very dissatisfied with the health care they receive. The Commission’s efforts were very timely and important in light of the rapid expansion of health maintenance organizations and other kinds of "managed care" which seek to curb medical costs by limiting how much and what kind of care patients may receive.
That is why I am a sponsor of H.R. 586, the Patient Right to Know Act. The purpose of this legislation is to return to patients their basic right to receive all relevant information from their doctor, or provider, about costs, benefits, risks, and appropriate treatment options that are important to their health. This bill would allow doctors and other providers to comply with their ethical and legal responsibility to fully inform patients of all their reasonable and legal options, regardless of cost or coverage limitations of their plans.
Some managed care plans forbid doctors and other providers from even mentioning reasonable treatment options to patients, either because the managed care plan's benefits will not
pay for a particular treatment, or because of the relative cost of different treatments for the same
condition offered by the plan.
In recent years, there have been media accounts of a few of the countless individuals who have
been denied care by physicians and plans in an effort to control costs. In April 1994, ABC's
`20-20' reported on the case of a woman who was denied information about a bone-marrow
transplant to treat her breast cancer. In October 1995, CBS presented a story about a woman
who was denied information about, and access to specialists. She was later diagnosed with
cancer.
Americans have clearly noticed the deficiencies in some managed care plans. In a 1996 poll conducted by the Patient Access to Specialty Care Coalition, 92.7 percent responded that it was very important that they be told of all treatment options, and 53 percent believe that they do not now receive enough information about how HMO's or managed care plans make treatment decisions.
Limited antigag regulations have been promulgated by the Health Care Financing Administration
that apply to Medicare and Medicaid managed care insurance contracts. However, this still leaves us without a systematic approach to the problem. I believe we need a single, clear Federal standard, enforced by the States, that provides consistent protection of medical communications for all health plan beneficiaries, no matter which State they live in, or which health plan they buy. This is the only certain way to stop individuals or entities whose goal is to reduce costs--at the expense of health care quality--by restricting medical communications between providers and patients.
Another bill that I support is H.R. 1415, the Patient Access to Responsible Care Act. This Act, like the President’s plan, seeks to establish basic protections for patients and health care providers in order to ensure the best medical care for patients. These basic provisions give Americans a set of health rights, in the form of a Patients' Bill of Rights, when dealing with HMOs and other health insurance plans. These rights include:
The Right to Choose Your Own Doctor. This bill will allow patients to select their own doctors within their plan and change their selection of doctor as the patient feels necessary. It also gives patients, who are in managed care-only health plans, the option to see doctors outside their HMOs for an additional fee.
The Right to Quality Health Care. This legislation will ensure that doctors are not prohibited or limited in any way from discussing a patient's health status, treatment options or any other medical communications. It also stops HMOs from using financial incentives for doctors to deny or limit care to patients. We must make sure that health care decisions are based on sound medical criteria and not the financial bottom line.
The Right to Justice. This Act closes loopholes in current law that allow the vast majority of health insurance plans to escape legal responsibility for decisions causing needless injury or death to a patient. Currently, self-insured managed care plans cannot be held liable for a patient's wrongful death or personal injuries resulting from plan policies even when those policies directly contribute to the patient's death or injury. This is wrong and this bill would guarantee that if HMO policies hurt patients, the HMO will be held accountable for their actions.
The Right to Full Disclosure. This bill also provides that health insurance plans make available to each patient a list of what health care is covered, what are the plan’s costs and profits, and how much is the plan spending on marketing and other non-medical costs.
I am confident that with the President’s guidance and with the enactment of these bills, patients in Baltimore and around the country will have access to the appropriate care that they need and deserve.
-The Honorable Elijah E. Cummings represents the 7th Congressional District of Maryland in the United States House of Representatives.