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Late Breaking News |
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| Date: July 16, 1998 4:53 pm Contact: Families USA Lorie Slass 202-628-3030 |
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Latest News Releases
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Despite State Managed Care Laws, Most People Still Go Unprotected;Families USA Releases Comprehensive Review of State Managed Care Laws | ||
| WASHINGTON - July 16 - An examination of state legislation in 13 areas
of basic managed care consumer protections finds that no state has all 13 on the books
according to a new report released today by the national consumer group Families USA. Hit & Miss: State Managed Care Laws examines state laws for a number of patient protections including the right to independent external appeals when health care services are denied, access to emergency room coverage, the right to sue health plans for wrongful denials of care, and the establishment of state funded consumer assistance programs. The study reveals that only one state, Vermont, had passed 10 or more of the protections, 16 states enacted 5 to 9 of the basic protections, 33 states had passed only 1 to 4 of the protections and South Dakota had passed none. The report also reveals that, despite state legislation on managed care, many consumers are not protected by those laws. According to the report, one in three people with employer-based coverage are in self-insured health plans and are not covered by state consumer protection laws. The federal Employee Retirement Income Security Act (ERISA) exempts self-insured employer plans from state health insurance laws. Approximately 51 million Americans are not covered by any of the managed care consumer protection laws in their state because of ERISA. "Not only do managed care consumer protections vary greatly from state to state," said Ron Pollack, executive director of Families USA, "but even with laws on the books, many consumers who get their coverage from their employer are not protected because of ERISA. Only a federal patients’ Bill of Rights would ensure consumer protections for all Americans who receive employer provided coverage." Other key findings of the report include: The requirement of disclosure of treatment options and protection advocacy (that is, a ban on "gag rules") has been passed by the most states -- 45 states and the District of Columbia. Thirty-one states and the District of Columbia have passed laws requiring health plans to pay for emergency room care when a person believes he or she is experiencing a medical emergency. Only 15 states have passed laws establishing an independent external appeals process for consumers who believe they have been wrongfully denied care. Eight states have passed laws requiring plans to have a procedure to allow individuals to obtain prescription drugs that are not on the managed care plan’s list or "formulary." Of the 13 key protections studied, the establishment of independent consumer assistance programs and changes in liability laws had been passed by the fewest states. Vermont is the first and only state to pass a law that provides funding for an independent statewide consumer assistance program. Two states, Texas and Missouri, passed laws that open the door so that consumers can hold their health plans accountable through litigation. This issue is still being debated in the courts. While the ERISA statute preempts state insurance laws for people in self-insured plans, the statute goes even further in preventing Americans from suing their health plans for damages in the event of wrongful denials of care. The study found that 83 percent of Americans who get their health care from their employer, 124 million people, cannot hold their health plans liable for their denials of care because of ERISA preemption of state laws relating to grievance resolution. Public employees (state and federal workers) are not preempted. "ERISA – which was intended to protect employees in pensions and health plans – has become a protective shield for managed care plans even when they wrongfully deny care, either through negligence or malicious indifference," added Judy Waxman, director of government affairs at Families USA. "Health plans have no accountability for their decisions to deny needed care and treatment. This lack of meaningful remedies invites abuse." Current proposals in Congress address many of the protections studies in the new Families USA report. The Patients’ Bill of Rights introduced by Senators Daschle and Kennedy and Representatives Dingell and Gephardt would establish all 13 of the protections studied. The House Republican proposal, which is not yet in legislative form, would address from two to four of the issues. "The American public has said very clearly that they want managed care protections, but because of ERISA they are denied the protections passed by their state," added Pollack. "Because of the federal ERISA law, this issue can not be left up to the states. Federal protections are needed to ensure all Americans get fair treatment from their managed care plans." ### |
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