The battle over managed care has moved to the House of Representatives. AAMFT needs your help to pass the strongest bill.
Legislation to provide federal protections for consumers with private health insurance is again on the congressional calendar. In the last Congress, both the House and Senate passed managed care bills, but were unable to reconcile the differences in conference. Ultimately, the debate deadlocked over how to hold a managed care provider liable for harm caused by delay or denial of necessary care.
In the 107th Congress, the Senate debated patientsí rights and passed the Bipartisan Patient Protection Act of 2001 (S. 1052) sponsored by Senators Edward Kennedy (D-MA), John Edwards (D-NC) and John McCain (R-AZ) on June 29, 2001. S. 1052 was the strongest of the patient protection bills and supported by AAMFT.
The battle now moves to the House of Representatives. In the House, Representatives Ganske, Dingell, Norwood, and Berry introduced a bill (H.R. 2563) identical to the Senate-passed version of S. 1052. AAMFT supports this bill over rival legislation (H.R. 2315) sponsored by Representatives Fletcher (R-KY) and Peterson (D-MN). A careful analysis by AAMFT of both bills concluded that the benefits to MFTs and their clients in H.R. 2563 outweigh risks and benefits associated with H.R. 2315.
WHAT'S IN THIS LEGISLATION
Both the Ganske-Dingell-Norwood-Berry bill (H.R. 2563) and the Fletcher-Collins bill (H.R. 2315) vastly improve the managed care system. Some of the provisions of interest to AAMFT that are in both pieces of legislation include:
- Prohibition on discrimination against providers;
- Access to specialty care;
- An independent review process for determination of medical necessity decisions;
- The ability for people with special health care needs and chronic conditions to continue to access their health care professionals after employers change plans;
- Some ability to hold managed care plans accountable in court for harmful plan decisions; and
- Guaranteed access to emergency care services.
WHAT'S THE DIFFERENCE?
Although both House bills (H.R. 2563 and 2315) provide substantial improvements to the health care system, the Ganske-Dingell-Norwood-Berry bill provides stronger protections. Significant provisions in H.R. 2563 that are not found in the Fletcher-Collins bill include:
- A uniform federal floor of protections to all Americans with private health insurance, allowing states to enact more protective standards;
- A fair, speedy and genuinely independent external review process when care is denied;
- Mandates to ensure health care providers receive prompt payment of claims;
- The ability to hold a managed care plan accountable in state and federal court when plan decisions to withhold or limit care result in injury or death; and
- Inclusion of severely mentally ill in clinical trial participation.
The American Association for Marriage and Family Therapy (AAMFT) endorsed and continues to support the Ganske-Dingell-Norwood-Berry version of managed care legislation (H.R. 2563) and urges members to do the same.
ACTION NEEDED NOW
The Ganske-Dingell-Norwood-Berry bill (H.R. 2563) will be on the House floor this week (July 23, 2001). Now is the time for Representatives to hear from their constituents about the importance of providing a comprehensive package of protections to health care consumers. Public pressure is urgently needed to pass the strongest patients' rights bill (H.R. 2563).
WHAT YOU CAN DO
Dial 1-877-703-9491 (toll-free) to identify and contact your Representative and urge him/her to vote YES on the Ganske-Dingell-Norwood-Berry bill (H.R. 2563) without amendment. You can also find the name and contact information of your legislator by using the "Congressional Directory" located at the bottom of the "Policy and Advocacy" section in the "Members Only" portion of the AAMFT website (www.aamft.org)
Keep your message short and to the point. Suggested statement is:
Hello, my name is (name) and I am a constituent and marriage and family therapist from (city). I urge you to support the Ganske-Dingell-Norwood-Berry managed care bill without amendment. As a mental health professional, I am convinced that this bill provides the greatest protections to my clients and all Americans. Thank you for your attention in this important matter.
Managed care reform remains an issue of the utmost importance to health care providers and patients alike. The opportunity to improve managed health care is in the critical stages and MFTs must respond. Members need to contact their Representatives today, before the opportunity is lost. Donít let the chance to obtain real patient protection pass you by!