Clinton to Sign ‘Patients’ Rights’ Order

President Clinton plans to sign a sweeping executive order today to largely bring all federally administered health programs, which serve 85 million Americans, into compliance with a set of minimum standards for patient care by next year, according to administration officials.

The order would guarantee certain “patients’ rights” to the roughly 1 in 3 Americans covered by those programs.

The standards include guaranteed access to specialists and emergency care, as well as patients’ rights to participate in decisions about their medical treatment and appeal a health plan’s decision to an independent agency. Patients in the covered plans would have the right to be informed about all medical options open to them, and their doctors would have to tell them about any cost considerations that might be influencing their treatment recommendations.

Covered by the executive order are all federal employees; soldiers and other military personnel and veterans; native Americans, who receive their health care through the Indian Health Service; the elderly, who are insured through the Medicare program; and the poor and disabled, who receive their health care through the Medicaid program.

The order will have the least effect on the private sector, where congressional legislation is needed to give workers similar consumer protections. However, the order requires all health plans to respond to patient appeals for urgent care within 72 hours. Other appeals would have be resolved within 15 days.

Clinton also plans to call on Congress to enact legislation to ensure that individuals in private-employer health insurance plans will be guaranteed the same minimum standards of care. Congressional action also will be needed to enforce some of the changes in the federal programs.

Clinton’s announcement comes just one week after congressional Democrats named a patients’ bill of rights as a priority for the party this year. Democrats are attempting to lay claim to the issue, which wins high approval ratings in polls. Many people are satisfied with their own managed-care plans but fear that, if they become ill, treatment will be delayed or denied.

Some rank-and-file Republicans also are working on health care legislation, but so far the GOP leadership has opposed increasing federal regulation of managed care because of strong opposition from business groups and health plans which argue that it will be costly and burdensome.

Indeed, the cost implications are unclear for both the increased regulations in Clinton’s order and the legislation that lawmakers are planning to introduce in the next month.

As many as 75% of Americans are enrolled in managed care plans, such as health maintenance organizations, which control costs by limiting access to specialists, certain treatments and expensive tests.

The rights covered by Clinton’s order track closely with the recommendations of his Advisory Commission on Consumer Protection and Quality in the Health Care Industry, which were released in November.

“The president wants to move to ensure that the health plans administered by the federal government are in compliance with the patient bill of rights,” said an administration official.

“Our hope is that this will raise the standard of care that will influence public and private plans since many plans serve both populations. However, it is clear that we will need legislation to be sure that all private plans come into compliance,” said the official.

Managed care plans serve millions of patients in federally administered health programs--more than 13 million in the Medicaid program and more than 6 million in Medicare--and the numbers are rising monthly, according to statistics assembled by the American Assn. of Health Plans, which represents more than 1,000 managed care plans nationwide.

While plan executives say that they are already complying with many of these standards voluntarily, they do not want the federal government to force more regulations and requirements.

“This is very broad,” Karen Ignagni, president of the American Assn. of Health Plans, said. “We don’t know what the implementation is and what the timetable is, and that’s key to determining the cost impact.”

Clinton is slated to announce the order this morning at a senior center in suburban Maryland. Vice President Al Gore, Secretary of Health and Human Services Donna Shalala and other Cabinet officials are expected to attend.