(Washington, DC) Piecemeal managed care legislation being considered by the House Committee on Education and the Workforce would establish extremely weak external appeals and would override stronger state external appeals laws according to the national consumer watchdog organization, Families USA. The legislation would also allow Association Health Plans to ignore state minimum benefit requirements.
"We need to pass managed care protection legislation and we need to pass it in this Congress," said Ron Pollack, Executive Director of Families USA. "But the worst thing we could do is pass legislation that puts consumers in a worse situation than they are today. That is exactly what Representative Boehner's legislation would do."
The Boehner legislation is missing key consumer protections including access to specialists, consumer assistance programs and accountability for health plans that wrongfully deny care. Despite claims that this year's external appeals provisions are stronger than those proposed by the Republican leadership last year, according to Families USA, the external appeals provisions in Representative John Boehner's (R-OH) bill are much weaker.
In addition, Boehner includes provisions from last year's House Republican bill that would tie the hands of reviewers by limiting the scope of appeals to whether the managed care plan followed their own rules in denying care and not to what is medically necessary. Under Boehner's legislation the appeals process would be very cumbersome, and would place greater restrictions on what is reviewable.
The Boehner Bill would also override, in some states, requirements to provide well-child care visits, screenings for cervical cancer, prostate cancer, and mammographies for anyone joining Association Health Plans.
"The Boehner legislation gives the insurance industry carte blanche to ignore health care benefits required by state law," added Pollack.
Almost all fifty states and the District of Columbia have established some minimum benefits for those receiving health insurance. Benefits in each state may include coverage for mental health care, hospice care, diabetic supplies, alcohol abuse treatment and home health care. Under the Boehner bill, those consumers who participate in Association Health Plans would not be required to receive those benefits.
