No more HMO mandates

October 07, 1997

A PRESIDENTIAL advisory panel on health care was in Chicago recently exploring what the federal government should

do to ensure quality medical care for Americans.

Here's our prescription: As little as possible.

That's because President Bill Clinton made it clear two years ago, when he appointed this panel, that they are to develop a patient "bill of rights." Sounds good. But what that really means is a long list of mandates that Congress and/or the executive branch will impose on managed-care plans.

Democrats in Washington are itching to join the regulatory frenzy sweeping the country's state capitals. In the last two years 36 states have passed more than 280 laws requiring health maintenance organizations to provide specific coverages -- from mental health benefits to 48 hours of hospitalization following childbirth -- or to desist from certain practices, such as paying bonuses to HMO doctors for limiting patient access to more expensive specialists.

It matters little that most HMO members, responding to surveys, say they are satisfied with their plans. Or that "drive-through" deliveries and mastectomies are rare and almost never required by HMOs. Liberal lawmakers are lining up to get tough on abuses more imagined than real.

Some of the most craven grandstanding has taken place in Illinois, where more than 40 bills have been introduced to regulate HMOs. One "bill of rights" pushed by Illinois' powerful fee-for-service physician lobby would have put HMOs effectively out of business. It didn't pass, though legislative hearings continue and at least one lawmaker has vowed to regulate HMOs "body part by body part."

The saving grace in all this is that state laws don't apply to most group health-insurance plans at large companies. They are regulated instead by the federal government's permissive ERISA employee benefits law, and so far a Republican Congress has had better things to do than micro-manage them.

But the temptation has been too much for the Clinton administration, which has been rattling off do's and don't's for HMOs participating in the government's Medicare and Medicaid programs.

Now comes the president's advisory commission, bent on drafting a "bill of rights" covering private, ERISA-regulated insurance plans, particularly HMOs.

No doubt the panel will be told several HMO horror stories. Here, however, is the scariest of all: Every time a mandate raises the cost of insurance by 1 percent, 200,000 Americans lose their coverage.

This editorial appeared recently in the Chicago Tribune.

Pub Date: 10/07/97

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