Health plan coalition may be making a bid to bump patients' rights

Is the managed care industry sincere in its announced change of ways, or is this just another attempt to stall a patients' rights law?

Editorial. Aug. 14, 2000.

Last year, congressional lawmakers were tired of the way their constituents were being treated by the airlines, and both the House and Senate were eyeing air travelers' bill of rights legislation.

Then the airline industry came along with a substantial -- at least at first glance -- list of concessions. The talk about tough legislative approaches stalled, and air travelers were back at the mercy of the airlines.

By the way, have you heard that traveler complaints for the first quarter of this year are up 74% over last?

It is a cautionary tale that should make anyone -- doctor, patient, lawmaker, policy wonk -- deeply skeptical of the managed care industry's recent touting of its Coalition for Affordable Quality Healthcare. Twenty-two big-name insurers, plus their two trade groups, have run a full-page ad loaded with feel-good promises directed at patients, physicians and -- not incidentally -- lawmakers with enough time on the clock to still pass some tough-minded patients' rights legislation. Their announcement also comes at a time when resentment at managed care is rising among patients and physicians, HMO enrollment numbers are showing some first-ever slippage, and plans are trying to get price increases of up to 10%.

But just like the airlines' list of concessions -- some of which turned out to have loopholes big enough to fly a 747 through -- what the health plans are offering should be read very closely. For example, they offer good news on some fundamental patient concerns -- like ob-gyn and emergency department access and external appeals -- but those things are already mandated by at least two-thirds of the states. Other offers closer to the practice management concerns of physicians -- such as simplified credentialing and greater use of the Internet -- still seem to be deep in wish-list mode.

There's often a disconnect between managed care's corporate rhetoric and true progress. The first company in the top row of signers of the CAQH pledge provides a timely example. Aetna U.S. Healthcare undoubtedly holds that position by dint of alphabetical order, but it is also the nation's biggest managed care plan. Arguably, it also may merit such prominent placement because, in the spirit of the ad, it has so much to be contrite about.

Earlier this year Aetna inked a high-profile settlement with the Texas attorney general over Aetna's practices, a deal touted as a blueprint for the rest of the nation. Early reaction tended to give Aetna the benefit of the doubt. But the AMA and Texas Medical Assn. have since closely examined that document and have found it contains troubling ambiguities and provisions that protect Aetna practices that are unfriendly to patients and physicians -- including matters of determining medical necessity. (For its part, Aetna has defended the settlement and denied organized medicine's charges.)

Aetna is also among three CAQH insurer members -- as well as trade groups American Assn. of Health Plans and Health Insurance Assn. of America -- that are members of another group concerned with patients' rights. It's the Health Benefits Coalition, an employer-insurer group with an agenda that is explicitly against patients' rights legislation. Patients and physicians have the right to be suspicious that the CAQH is the good cop to HBC's bad cop on patients' rights.

The Coalition for Affordable Quality Healthcare is absolutely right in assuming that the way its members do business can be greatly improved. But based both on managed care's track record and what's at stake for patients, a strong legislative action is now a must. Lawmakers should not make the same mistake with health care that they made with air travelers' rights: Don't leave patients' rights stuck at the gate.