Panel to Propose ‘Bill of Rights’ for Health Care

A presidential commission today will propose a far-reaching health care “bill of rights” that could begin to swing the balance of power away from managed care companies and back toward patients.

President Clinton is expected to embrace the recommendations and announce on Thursday how he proposes to make the rights a reality.

“The public is . . . interested in consumer protections that ensure that when they are at their most vulnerable, that they have an avenue to appeal and seek assistance,” said Chris Jennings, deputy assistant to the president for health policy. “These are not radical things; these have been passed by many states with Republican and Democratic governors alike.”

The rights would:

* Require all health plans to pay for emergency room visits if a prudent layperson thinks that without immediate care, the patient is at risk of permanent injury.

* Require plans to give patients the opportunity to have any denials of coverage, treatment or payment reviewed by plan doctors and an external board.

* Require plans to disclose information about their physicians--including how many times they have performed certain procedures, whether they have been sued for malpractice and how they are paid. Plans would also have to disclose information about their accreditation and financial solvency.

* Require plans to give patients direct access to specialists as well as primary care doctors.

Additional rights include equal treatment of patients regardless of their race or ethnicity, patient participation in treatment decisions and the confidentiality of patients’ medical records. The commission is expected to announce today how strongly it will recommend that health plan members have access to a consumer advocate.

“This commission is really the proving ground for the real fight, which will be in Congress in the next year,” said Nan Hunter, a member of the panel and a law professor at Brooklyn Law School. “This is a step toward giving consumers more power in a health care system that has changed so fast that many of them are at a loss for how to protect themselves,” she said.

About 150 million people are enrolled in managed care plans, which insure consumers, provide health care and use primary care physicians to limit patient access to specialists and sophisticated medical tests.

Nowhere will the outcome of the debate be felt more strongly than in California and Minnesota, which led the nation in the move toward managed care. More than 90% of Californians receive their care through a health maintenance organization or other managed plan.

The battle over managed care already has been joined in Congress, where it is creating strange alliances. Democrats and many rank-and-file Republicans have sided with doctors and consumers to advocate new restrictions on big health plans. GOP leaders have allied themselves with managed care companies and employers to oppose such changes, which they fear will cause health costs to rise and set a precedent for government intervention.

At a mid-October meeting, GOP leaders instructed business groups and managed care companies to sharply increase their lobbying efforts and produce a white paper that would trash the consumer rights legislation.

House Majority Leader Dick Armey (R-Texas), writing in Monday’s Wall Street Journal, criticized the commission’s recommendations as a thinly disguised effort to “nationalize health care” more gradually than Clinton’s 1994 proposal for a massive overhaul of the system.

Speaking for employers, Neil Trautwein, manager of health policy for the U.S. Chamber of Commerce, said: “It’s all too easy and dangerous for members of Congress and the administration to propose new bureaucracies, new programs, but the net effect is to price employers and employees out of coverage.”

Managed care executives express similar concerns. “Consumers aren’t protected if we price health care beyond their reach,” said Susan Pisano, a spokeswoman for the American Assn. of Health Plans. If the bill of rights or legislation in Congress became law, she said, it could “take us back to the failed fee-for-service health care system.”

However, recent polls show that patients are anxious about whether they will get the care they need in a managed plan--especially when they are ill. They also blame managed care for the diminishing amount of time that doctors spend with patients.

The rights endorsed by the 34-member commission are only those that the group agreed to unanimously. The commission sidestepped for the moment the politically charged question of how the rights should be enforced, leaving that for a second report due in March.

The commission includes consumer representatives, managed care executives, a state insurance commissioner, employers, ethicists and doctors. It is co-chaired by Health and Human Services Secretary Donna Shalala and Labor Secretary Alexis M. Herman.