COMMENT: Sure, just read the "but" in the third paragraph;
              rejection or no, you bet your boots that your
              government is still bound and determined to make sure
              that all you idiot citizens who can't care for your
              own health are going going to have corrupt 'National
              Healthcare' NONcoverage whether you like it or not.
              Just think of Health Insurance and quadruple the
              pure hell of that.

     July 14, 1998
      
     H.M.O. Group Backs Controls G.O.P. Rejects

     By ROBERT PEAR
      
     WASHINGTON -- A coalition of 25 health maintenance organizations
     said on Monday that it was willing to accept substantial federal
     regulation -- much more than the Republican leaders of Congress
     want.
     
     In a move that they said should restore public confidence in their
     industry as it is buffeted by sharp partisan attacks, the HMOs
     endorsed a series of guarantees, including coverage of emergency
     room care, grievance and appeal procedures for patients and assured
     access to medical specialists.
     
     But the group said it was opposed to one major provision demanded
     by Democratic congressional leaders: a wide expansion of patients'
     ability to sue HMOs and insurance companies when medical benefits
     are improperly denied.
     
     The coalition, known as the HMO Group, said that patients could
     resolve such disputes by appealing to an independent panel of
     medical experts, and that lawsuits would unnecessarily increase
     costs and reward lawyers.
     
     The HMOs, which are mostly nonprofit organizations, supported
     legislation being developed by Sens. John Chafee, R-R.I., and Bob
     Graham, D-Fla.
     
     The Chafee-Graham plan is intended as a compromise between a
     Democratic leadership proposal, which includes the right to sue,
     and legislation being drafted by Republican leaders of the Senate
     and the House, who promise to protect patients without entrusting
     vast new power to the federal government.
     
     George Strumpf, senior vice president of HMO Group, which
     represents 25 HMOs with more than six million members in 26 states,
     praised the Chafee-Graham legislation.
     
     "It's a moderate proposal," Strumpf said. "It represents the best
     interests of consumers, providers and health plans. It strikes a
     balance. That's what's lacking in the bills introduced by other
     people."
     
     The HMO Group includes some of the nation's oldest and largest
     HMOs: Kaiser Permanente, based in Oakland, Calif.; Group Health
     Cooperative of Puget Sound, in Seattle; HIP Health Plans, in New
     York City; Harvard Pilgrim Health Care, based in Brookline, Mass.;
     Health Partners, of Minneapolis, and the Fallon Community Health
     Plan, in Worcester, Mass. The HMO Group has offices in New
     Brunswick, N.J., and Washington.
     
     Bruce Lesley, a lobbyist at the National Association of Children's
     Hospitals, said on Monday night: "The Chafee-Graham legislation
     could be the basis for a bipartisan agreement. It includes the most
     important protections for patients, including children, while
     leaving out the most controversial proposals found in other bills."
     
     The umbrella group that lobbies for managed-care companies, the
     American Association of Health Plans, is running television
     advertisements that oppose legislation to regulate the industry.
     "When politicians play doctor, real people can get hurt," the
     commercials say.
     
     Mark Merritt, a vice president of the association, said it had
     spent $2 million on advertising and public relations this year, and
     would spend much more. "The budget keeps growing every day," he
     said.
     
     For-profit companies like the Cigna Corp., which have branched out
     from traditional health insurance into managed care, are also
     resisting federal legislation. The Health Benefits Coalition, which
     includes employers and insurance companies opposed to "patient
     protection" bills, said it had spent $1.5 million on radio and
     print advertising, direct mail and public relations since January.
     
     But the HMO Group has adopted a detailed statement of principles
     that is generally consistent with the Chafee-Graham bill.
     
     "We are bewildered to see what the public thinks about our
     organizations and the industry now," said Daniel Wolfson, president
     of the HMO Group. "Patients feel they are not in control of their
     health care. They feel powerless. Legislation could defuse that
     distrust."
     
     Ronald Pollack, executive director of Families USA, a consumer
     group, said he could not endorse the Chafee-Graham bill because it
     did not authorize lawsuits against HMOs. But he said, "It does
     contain many features that are important in a patients' bill of
     rights."
     
     Many provisions of the Chafee-Graham bill are taken word for word
     from legislation introduced by the Senate Democratic leader, Tom
     Daschle of South Dakota, and Rep. John Dingell, D-Mich., with
     support from House Democratic leaders.
     
     The HMO Group has endorsed these proposals, all of which are in the
     Democratic leadership bills and in the Chafee-Graham bill:
     
     -- HMOs would have to disclose large amounts of information on
     costs, benefits and the quality of care, so consumers could
     intelligently compare health plans.
     
     -- HMOs would have to pay for emergency care in any situation that
     "a prudent lay person" would regard as an emergency.
     
     -- HMOs would have to allow access to appropriate specialists
     whenever a patient required specialty care. Women would have direct
     access to routine obstetrical and gynecological services, without
     having to get approval in advance from their health plan.
     
     -- People denied care or coverage could demand a review first
     within their HMO and then before an independent panel of medical
     experts outside the health plan.
     
     -- HMOs could not use financial incentives as an inducement for
     doctors to reduce or limit medically necessary services.
     
     -- HMOs must insure "continuity of care" for patients receiving a
     course of treatment from a particular doctor. Such patients could
     continue using that doctor for several months even if the doctor's
     contract with the HMO had expired or been terminated.
     
     -- HMOs covering a limited number of prescription drugs would have
     to make exceptions for patients who could show that they needed
     other medications not on the list of approved drugs.
     
     In addition, the HMO Group has endorsed a provision of Daschle's
     bill that would prohibit health plans from retaliating against
     "whistle-blowers" who advise federal or state authorities of
     substandard care endangering patients.
     
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     Copyright 1998 The New York Times Company