Battle over health-care reform: HMOs: Patient frustration builds as Annapolis' grievance law is closely watched by other states.

November 14, 1998

NATIONAL health care reform died this year in the U.S. Senate on procedural grounds, squeezed out by election politics and extensive and expensive lobbying by insurance companies and businesses. Legislation giving patients the right to sue their health maintenance organizations was killed by Senate Republicans.

In Maryland, Gov. Parris N. Glendening late in his re-election campaign threw his support behind legislation allowing patients to sue HMOs, though he got scant backing from Democratic leaders in the General Assembly.

They pointed out that the legislature in the spring approved a grievance law for patients to protest HMO medical decisions to ZTC the state insurance commissioner. If this process works as envisioned, it would be far preferable to opening the door to endless courtroom litigation. That would only drive out some HMOs, drive up HMO rates, delay patient compensation, diminish customer choice and enrich attorneys.

Only Texas and Missouri allow patients to sue HMOs, and this happened only after fierce legislative fights. But consumer frustration with managed care plans is building. It will be back on Congress' agenda next year.

The state of health care programs troubles many Americans. They watch in alarm as costs go up and, as they perceive it, quality goes down. Until these perceptions are changed, consumer pressure on the health-care industry will continue to grow.

Studies show deep confusion among all socioeconomic groups. Consumers are getting fed up with managed care. Chief complaints are denial of care, inappropriate care, payment disputes, and delays in getting prescriptions and specialty care. And people are disturbed about feeling helpless in an area so private and essential.

Maryland's appeals and grievance process, which begins in January, will be watched closely. If it fails to work well, tougher laws affecting the delivery of managed care may be coming out of Annapolis and Washington.

Pub Date: 11/14/98

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