The Legislative Agenda

Article excerpt

Lawmakers in Washington are not the only ones debating health care reforms. Among the hundreds of bills facing Oklahoma legislators when they return to the State Capitol Feb. 2 are several proposing expanded health insurance coverage.

Under House Bill 2808, by Rep. Scott Adkins, R-Broken Arrow, health insurance and health benefit plans could not prohibit a physician from waiving all or part of a co-payment for charitable purposes or if the physician reasonably believes the patient could not afford the services otherwise.

Dick Howard, Blue Cross/Blue Shield vice president of public affairs, said this bill could defeat the very purpose of co-payment requirements -- to discourage unnecessary utilization of health care coverage. Factors such as deductibles and co-payments help keep health coverage costs in check, he noted. Simply put, if a health insurance plan has to pay more in benefits due to a lower deductible or waiver of a co-payment, Howard said rates are necessarily impacted. Rep. Wallace Collins, D-Norman, has filed House Bill 2947, which would require group health insurance and health benefit plans to offer coverage for severe mental illness equal to benefits for other physical diseases and disorders. The bill defines severe mental illness as schizophrenia, bipolar disorder, major depression, panic disorder, obsessive-compulsive disorder and schizoaffective disorder. It allows limitations for pre-existing conditions and exempts specified-disease policies. The bill is similar to a measure approved by the Legislature last year but vetoed by the governor, who said it could increase employers' health insurance costs substantially. Howard said the costs associated with the Collins bill would depend upon whether it covers managed care or traditional group insurance plans, among other issues. Backers of last year's measure said it might add about 1 percent to health care costs. A study by the National Center for Policy Analysis estimated annual additional costs at between 5 percent and 10 percent. A measure Howard said, at first glance, that has the potential of adding more to health coverage costs than any other filed so far this year is House Bill 2981, the Health Care Liability Act by Rep. Richard Phillips, R-Warr Acres. A "shell" version of this measure also has been introduced by Rep. Sean Voskuhl, D-Marshall, in House Bill 3185. The bill provides that health care entities have a duty to exercise ordinary care when making treatment decisions, making them liable for damages and harm to an insured proximately caused by a provider's failure to exercise such care. The bill would extend liability to treatment decisions made by a health care entity's employees and representatives which result in the failure to exercise ordinary care. It also would prohibit removal of a physician or health care provider from a plan for advocating, on behalf of an enrollee, appropriate and medically necessary health care. Howard said a similar measure passed the Texas Legislature last year. In addition to the substantial cost of defending lawsuits, Howard said such a law could have a far-reaching impact on the health care utilization review process, if plan reviewers know they could be sued over the decisions they make. Another NCPA study estimated legislation holding health plans liable for the actions of their providers could increase health plan costs by 4 to 5 percent, while citing Congressional Budget Office data placing the figure as high as 12 percent. This study attributed additional increased costs chiefly to the increased practice of what is termed "defensive medicine" -- that is, health care providers ordering more tests and procedures than they normally would as a protective mechanism -- additional liability insurance costs and increased administrative costs due to the mandate. Rep. Frank Davis, R-Guthrie, has filed House Bill 2803, which would require health plans providing pregnancy-related benefits to extend coverage to diagnosis and treatment of infertility. …