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Issue
Should Congress focus its efforts toward passing legislation to allow
plan participants to sue their health insurance company and employers
in state and federal courts or should they focus their efforts toward
enacting legislation to curb growing health care costs?
Status
Last year, the House and Senate again passed different versions of Patients'
Bill of Rights (PBOR). The Senate passed a version that was worse than
our previous nightmare, the Dingell/Norwood bill that passed in the House
in 1999. Senator Edward Kennedy (D-MA) and the Bush Administration failed
to reach a compromise and conferees were not appointed before Congress
recessed for the fall elections. No action is expected in the lame duck
Congress. Further, the Senate failed to pass a Medicare prescription drug
bill or any other legislation to deal with rising health care costs.
Concerns
New “designated decision-maker” language emerged in the debate
last year. This provision theoretically allows employers to shift liability
to a third-party administrator. There are several problems with this language,
particularly in the Senate passed bill. “Direct participation”
would require employers to go to court to affirm that a health benefits
decision-maker other than the employer had been designated. Also, the
specific actions that would constitute direct participation were not defined
in the bill. PIA has always opposed increased liability, and both the
House and Senate increased liability, although the Senate’s limits
on damage awards were much higher.
The bottom
line on PBOR is that there has not yet been a bill considered by Congress
on this issue that would not significantly increase costs. Shifting the
decision-making burden costs the employer, the employee, and all consumers
of health care. Those who cannot afford the increased premiums and deductibles
pay the most when they opt out of health benefit programs.
Even in the
current economic environment, Congress continues to consider ill thought
out legislation that would increase costs such as a broad mental health
parity bill, various individual mandate bills such as coverage for colorectal
examinations, a genetic discrimination bill with broad employer liability
provisions, just to name a few.
Position
PIA opposed both versions of managed care reform legislation because they
would hinder the ability of printers to provide affordable health benefits
to employees by significantly increasing costs. Instead, PIA continues
to advocate increased health care access and a prescription drug bill.
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