HMO Bill a Needed Prescription

The people who created health maintenance organizations did so as a mechanism to provide greater preventive health care. Instead, HMOs have gained a reputation as organizations that prevent health care.

When I agreed to become an original co-sponsor of the Patient Protection Act in 1998, I did so out of a firm belief that Congress has a duty to rein in abuses by HMOs. Americans deserve affordable and accessible health care from providers who are held accountable. Unfortunately, after passing the House, the Patient Protection Act stalled in the Senate.

Last month the House again passed comprehensive health care reform through the Bipartisan Consensus Managed Care Improvement Act, also known as the Norwood / Dingell bill.

Norwood / Dingell is comprehensive legislation that offers families, singles and seniors health care that is affordable, accessible and accountable--three equal parts of a health care tripod that would collapse if any of the legs were weakened.

Accessibility means allowing women direct access to their gynecologists. Norwood / Dingell would enable a family with children to designate a pediatrician as a primary care physician. It would require health insurers to provide a referral to specialists for patients with conditions that require ongoing treatment.

Accessibility also would be provided by letting patients make fully informed decisions. The bill would prohibit “gag rules” that restrict physicians in giving advice.

In cases of emergencies, Norwood / Dingell says health plans must pay for emergency room care if a “prudent layperson” would agree the trip was necessary. People with chest pains shouldn’t have to determine if they are having a heart attack before seeking treatment. Finally, the bill would allow patients with ongoing conditions to have access to their specialist for up to 90 days if that specialist left the health plan or if the health plan were terminated.

Affordability would be provided in part through a companion health care bill, the Quality Care for the Uninsured Act, approved by the House the day before. Among other provisions, the Quality Care for the Uninsured Act would give small businesses the same health insurance tax breaks large businesses enjoy. It would allow all taxpayers to establish medical savings accounts and allow the self-employed and others who buy their own health insurance to deduct 100% of the premiums from their income taxes.

Initially, I was concerned that Norwood / Dingell might invite excessive litigation. However, my research convinced me that argument has been overplayed. Norwood / Dingell would provide solid alternatives for resolving disputes before they escalate into court fights and limit damages for companies that follow the rules in good faith. In addition, having the hammer of litigation might actually discourage excessive litigation by forcing health care providers to base their decisions on sound medical practices instead of the bottom line. And, while I have fought and will continue to fight against regulations that invite frivolous lawsuits, people with legitimate claims have the right to seek redress.

I voted for Norwood / Dingell because it would create a health care tripod strong enough to allow Americans to enjoy accessible and affordable health care from accountable providers. I urge my colleagues in the Senate and the president to join the House in providing the means for quality health care.