Patients’
Bill of Rights legislation easily passes in Senate
Brushing aside objections by NCCBI and others that it would lead to
sharply higher premiums, the state Senate voted unanimously
Wednesday to approve a cornerstone of Gov. Mike Easley’s
health care reform package by approving a bill that allows
people to sue their HMOs in disputes over medical care. The measure,
S.
199 Managed Care Patients' Bill Of Rights, sponsored by
Insurance Committee Chairman Allan Wellons (D-Johnston) and 30
others, now goes to the House, where a companion bill, H.
194, is sitting in the Rules Committee. The House version
is sponsored by Majority Leader Phil Baddour (D-Wayne) and 56
others.
The legislation allows a patient to
sue their HMO in state court for denying coverage but only
after the case had been reviewed by the health plan and by an
independent review panel. The requirements in the legislation
would not apply to most large companies, which self-insure
their employee health benefits and thus come under federal
regulations.
In addition to subjecting HMOs to lawsuits, the measure also
would:
Require HMOs to
cover drugs prescribed by a doctor even if the drug isn’t on
the HMO’s formulary as long as the patient’s doctor
warrants that the drug is necessary.
Allow patients with serious chronic diseases to choose a
specialist in that field as their primary care doctor;
Allow patients under 18 to choose a pediatrician as their primary
care provider;
Require HMOs to
provide coverage for legitimate clinical trials evaluating new
drugs and therapies; and
Create a Managed Care Patients’ Assistance Program, with a
director appointed by the governor, to help educate the public
about their rights and to serve as an advocate for the public
in resolving appeals, grievances and complaints.
Wellons (left), a Smithfield attorney whose law firm is
a member of NCCBI, said during floor debate that a patient’s right to
sue their HMO was very limited in the bill. But unless there
was some possibility of litigation, the mandatory internal
review process wouldn’t have any teeth, he said.
Easley praised the Senate's action.
"The people of North Carolina are one step closer to
getting the basic patients' rights protection they deserve,
thanks to the North Carolina Senate," the governor said
in a statement. "This bill makes it clear that North
Carolina will protect the health care rights of working
families."
Blue Cross and Blue Shield of North Carolina said it supports
the bill. But during debate on the measure earlier Wednesday
by the Senate Insurance Committee, Paul Mahoney, executive
director of the N.C. Association of Health Plans, presented
findings from a study showing that the legislation could lead
to sharply higher premiums. Mahoney said the study by a Duke
University doctor estimated that the HMO liability portion of
the legislation alone would raise total premiums paid by North
Carolina companies by between $19.4
million and $459.4 million a year. Mahoney also said that as
premiums rose, a number of smaller companies inevitably would
be forced to drop health insurance for their employees. He
said the study concluded that between 4,400 and 44,900 people
would lose coverage because of the legislation.
”We think there is a very significant danger that this
legislation will lead to sharply higher cost for employee
benefits,” Mahoney said. “It’s just not realistic to say
they we will place these extra burdens on insurance companies
and subject them to these lawsuits and believe that they
won’t have to raise their rates.”
NCCBI President Phil Kirk also said it was "incredulous
and unbelievable" to think that increasing an insurance
company’s liability won't result in higher insurance costs.
That increase, he said, would result in some employers
dropping health insurance for their workers. Kirk urged the
committee to give external review, which the state has never
passed before, an opportunity to work before clogging up the
court system with lawsuits.
”Most people don’t want to further clog the courts in an
untimely procedure. They want action and external review is
the fair way to do this,” Kirk told the committee. “They
want action and external review is the fair way to do this. I
don’t think we should be doing anything to cause health
insurance costs to go up any more than they are.”
Kirk also challenged the assertion by some members of the
committee that health insurance costs have not gone up in
Georgia and Texas, two states that have passed laws allowing
people to sue their HMOs. Kirk pointed out that the systems
adopted by those states are very different than the one being
proposed in North Carolina.
Mahoney added that the mandatory internal review of complaints
will resolve many issues and prevent many lawsuits, but he
pointed out that the review process doesn’t cover class
action lawsuits.
Observers said the 47-0 vote on the floor belied some sharp
disagreements on the bill when it was debated by the Insurance
Committee. There were split votes on at least two major
amendments offered by Sen. David Hoyle (D-Gaston) – removing
the liability portion of the legislation and delaying its
effective date by a year -- that Wellons ruled had failed but
refused to allow a recorded vote.
”It was obvious to us in the audience that Sen. Hoyle’s
motion to remove the liability provisions passed on a voice
vote but the chairman ruled otherwise,” Kirk said. “At the
very least Sen. Wellons should have allowed a show of hands
and then there would have been no doubt.”
Sen. Hoyle’s second motion – to delay the effective date
of the expanded right to sue an HMO until 2003 – also
appeared to have majority support during a voice vote.
“Again, the vote was close but supporters felt it passed,”
Kirk said, “but again the chairman did not allow a show of
hands.”
Although the bill seemed to suddenly burst on the legislative
stage, a series of meetings had been held quietly over the
past few weeks among insurance companies, patients' rights
advocates, hospitals and legislators to try to reach
consensus. The meetings were led by the
governor’s policy director, Alan
Hirsch.
Return to Page One
|
