Lawmakers to Introduce Managed-Care Bills

By Paul Heldman Bloomberg Business News | THE JOURNAL RECORD, January 14, 1997 | Go to article overview

Lawmakers to Introduce Managed-Care Bills


Paul Heldman Bloomberg Business News, THE JOURNAL RECORD


WASHINGTON -- Republican and Democratic lawmakers in nine states will introduce legislation regulating some of the cost-control practices of managed-care health insurers.

The state legislation would make it harder for insurers to deny coverage for emergency room visits and would eliminate clauses in doctor contracts that prevent them from recommending treatments not covered by a health plan. The legislation, unveiled at a Washington press conference, was developed by Women in Government, an association for women in state government, and will be introduced in New Jersey, Texas, Oregon, Colorado, Delaware, Georgia, Kansas, Ohio and Tennessee. Other states may follow.

"`We're hoping this bill will give other state legislatures a template for drafting their own consumer protection legislation," said Tennessee State Representative Kathryn Bowers, a Democrat. The legislation suggests that the nation's statehouses will again be deluged with bills to regulate the business of managed-care insurers. "It's going to be a fairly active year," said Chris Petersen, vice president of state affairs at the Health Insurance Association of America. About 800 bills regulating the health insurance industry were filed in the nation's statehouses last year, and more than 80 passed, according to Petersen. While some legislation that passed was considered favorable to the industry, health insurers and the businesses that pay much of the nation's health bill consider most of the new laws a threat to their efforts to control rising health-care costs. Managed-care insurers, including health maintenance organizations, hold down costs by limiting patients to a roster of affiliated doctors and by controlling access to expensive services. HMOs, the strictest form of managed care, now cover 60 million Americans, while another 80 million Americans are covered through other forms of managed care. Consumer activists and doctor groups say government regulations are needed to prevent managed-care health insurers from skimping on necessary care to save money. The legislation unveiled today would give states oversight of several areas of managed care. It would, for example, ban insurers from making doctors agree to so-called "gag" clauses that physicians say prevent them from recommending care not covered by a patient's health policy. …

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Lawmakers to Introduce Managed-Care Bills
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