States reject ‘body part’ legislation

Group urges federal mandates

If you’ve been concerned by the spate of health care bills making their way through state legislatures across the country, breathe easier. Early indications are that lawmakers are disregarding much of the "body part by body part" legislation that would have imposed mandates on the clinical care of individual patients.

With about one-third of state legislatures now out of session, there’s evidence that lawmakers are reluctant to become involved with the medical delivery system, says Donald White, spokesman for the American Association of Health Plans in Washington, DC.

For example, in Georgia, where more than 200 health care bills were introduced during the current legislative session alone, the state legislature voted against mandating a minimum length of stay for patients undergoing mastectomy. The legislature also rejected bills requiring that managed care companies provide coverage for diabetes education and treatment, and that they schedule appointments for members within four days of a request.

Similar initiatives stalled in Maryland, where 93 health care bills were introduced, including bills that would have guaranteed hospital coverage for catheterization and direct access to OB/ GYNs. A bill that would have required coverage for longer-than-expected hospital stays also failed.

"I do think there has been a bit of a backlash against the body-part-by-body-part legislation," says Gerri Dallek, director of health policies at Families USA, a Washington, DC-based consumer advocacy group. "I think those types of bills were clearly brought on by the HMOs, which were just incredibly rigid. The issue is, how do you get them to be much more responsive to the needs of their enrollees? This year, the trend is to look at managed care with an eye to addressing the broader, underlying problems."

As examples of a more holistic approach to managed care reform, Dallek cites the relative success of legislation mandating the establishment of grievance systems to handle consumer complaints, as well as requirements concerning patient access to information.

Even so, Dallek questions whether state-based health care legislation is the most effective way to address managed care’s perceived abuses. Indeed, given the dizzying number of initiatives proposed over the last year, it can be difficult to keep track of them all, she says. "It’s a patchwork quilt out there," Dallek adds. "I think we’ve seen enough now at the state level to know what are at least partial solutions to the problems. Now it’s time to think about these solutions in terms of federal action to create national standards."

Already, sixteen bills designed to regulate HMOs have been introduced in Congress, including bills forbidding the use of "gag rules" to prevent providers from telling patients about treatments not covered by the health plan. Another would require plans to cover any emergency treatment requested by a "prudent layperson" without prior authorization.

Despite the emergency of federal health care bills, White contends that most have little chance for passage in the near future. "Historically in this country, the health care delivery system and payment system have been regulated at the state level," he says. "That’s where the structures exist. I think that traditional preference will give some federal legislators pause before they open up a whole new legislative area for federal regulatory control."