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Congressman
Elijah E. Cummings |
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Congressman
Elijah E. Cummings |
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(7/1/00 Baltimore AFRO-American Newspaper)
by Congressman Elijah E. Cummings
On June 26, the American Medical Association reported the results of two Kaiser Family Foundation surveys with clear implications for the ongoing national debate about a Patients' Bill of Rights. "People happy with HMOs -- until they're sick," the headline in AMNews read, echoing the complaints about managed care that I receive on a regular basis.
Problems with their health maintenance organizations are seriously endangering the health of too many Americans, and too few of those harmed are able to effectively challenge their HMO's decisions by a fair and independent process of appeal.
Of those surveyed, one-half said they had experienced a problem with their plans during the prior year. One-third had difficulty obtaining necessary health care - 21% reported that plan actions resulted in a decline in their health ranging from somewhat to very serious, and 6% said it resulted in a permanent disability.
Insurance should assure quality medical care, but that often is not the case. As Kaiser President Drew Altman, PhD, noted, the survey results confirm that the Washington debate about patients' rights legislation is "grounded in real patient experience."
Americans are being harmed by the Senate's failure to support the reasonable protections contained in the bipartisan Norwood-Dingell Patients' Bill of Rights we passed in the House last year. After months of wrangling, the key differences between the House and Senate approaches remain the same.
Who will be protected by a nationwide Patients' Bill of Rights? How will that be accomplished?
The Senate Republicans would protect only those people who are insured by federally-regulated plans currently beyond the reach of state law. Those of us in the bipartisan coalition who passed the House bill, however, are convinced that quality medical care requires the same national standard of protection for everyone.
As Rep. Charles Whitlow Norwood Jr. (R-Ga.), who co-sponsored the House bill with Rep. John D. Dingell (D-MI), has observed, "We can pass the greatest bill in the world, but if we leave off more than 100 million people, we've really not done very well."
Meanwhile, the Republican conservatives who dominate the Senate leadership speak of states' rights. Senate Assistant Majority Leader Don Nickles (R-OK) has declared that "every state has regulations governing managed-care plans that are not covered by federal law, and they are working."
I am more concerned about our people's right to high-quality medical care than with abstractions like states' rights, but the Kaiser Family Foundation surveys raise an even more fundamental question.
If state regulation is working, as Senator Nickles asserts, why are so many people being harmed?
One of the reasons, I believe, is that the states have not uniformly mandated the systems of independent review (including access to the courts) that would hold HMO bureaucrats and their companies fully accountable for the harm they are causing.
Varying remedies for resolving conflicts between patients and their health plans are now available in 33 states (as well as for Medicare beneficiaries). Yet, as the Kaiser surveys point out, few patients (only 6%) take advantage of those rights to appeal. Many are unaware they exist.
Americans deserve a straightforward, nation-wide system of independent review that can hold powerful HMOs accountable. The House and Senate proposals differ, however, as to how protective that accountability would be.
While the Senate bill would provide a right of independent, external review only for disputes over "medical necessity" and experimental treatment, the more-protective measure we passed in the House would apply to any coverage question involving medical judgment. We would also expand the right of patients to sue their health plans for coverage decisions that result in injury or death.
Last October, I predicted Republican attempts to weaken or eliminate key patient protections during the process of reconciling the House and Senate measures. Sadly, the Republicans have confirmed the accuracy of my prediction.
Americans deserve and are demanding a Patients' Bill of Rights that will assure everyone the same, high-quality medical care. If Republican leaders continue to reject these demands, the American people are likely to correct that failure during our congressional elections next November.
-The Honorable Elijah E. Cummings represents the 7th Congressional District of Maryland in the United States House of Representatives.
