Time for U.S. to tackle HMO reform

Published 9:44 pm Wednesday, July 18, 2001

U.S. Representative
As many of you who follow the news closely are undoubtedly aware, the debate over health maintenance organization (HMO) reform has resurfaced.
This certainly continues to be an issue of concern to most Americans, including the nearly 100 million people currently covered by HMOs.  During the Clinton administration, an attempt was made to streamline and improve the health care system in this country.  Although that attempt did not succeed, it did bring greater focus to the problems facing both health care insurers and the patients they represent.
More recently, President Bush stated he feels all Americans should have access to affordable, quality health care. 
This is not an issue of concern for a single political party.  Regardless of differing opinions on both sides of the aisle over how the health care industry should be improved, everyone agrees that something must be done.
A brief history
The modern health care system was created in 1965 in an effort to meet the ever-increasing needs of consumers for quality medical coverage.
While at that time the system was very effective, it has not kept pace with the increasing population, nor has it effectively met the demands for more flexibility and choice.
The most important problem facing the health care industry today is the continuing need of the nearly 43 million uninsured Americans for some sort of medical coverage.  This is indeed a staggering statistic, and a sad situation that no American should have to face.
In addition, there are several areas of debate. Americans are currently paying more for their health coverage than the citizens of any other industrialized nation on earth.  This is due in large part to the fact that insurers have not been able to keep up with the skyrocketing costs of medical care.
Consumers today are in a position to demand more choices and increased quality of care, the current system is limited in its coverage for outpatient prescription medications and patients must endure the added frustration of receiving approval from their primary physicians before being allowed to consult with a specialist.
Finally, HMOs are currently immune from any legal liability which might otherwise be incurred due to medical negligence.
Senate version
The Senate two weeks ago debated and passed the Bipartisan Patient Protection Act of 2001.  The central theme of this legislation was the issue of HMO liability. 
During debate on this bill, some members expressed concern that holding HMOs legally responsible for improper care would result in an increased number of lawsuits and add to the already rising costs of insurance coverage.
As a compromise to the concerns raised during the Senate debate, the legislation requires patients undergo an independent medical review before being allowed to file suit against a provider, limits the number of class action lawsuits which can be filed and continues to allow insurers to exclude coverage of specific items.
House alternative
Several managed care reform bills have been introduced in the House and it is unclear at this time which bill will ultimately be considered.    You can be assured I am committed to voting for meaningful HMO reform, and it is my intention to closely watch the floor debate which should occur in the very near future.
Many of you have called me to share your concerns over the current health care system, and I understand the difficulties you and your families are facing.  You can be assured I will continue to keep your thoughts and opinions in mind as HMO reform legislation is brought before the House for consideration.
Until next week, take care, and God Bless.

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