Wednesday, May 19, 1999
HMO plan may bar lawsuits
Some legislators leery of Taft's proposal
BY MICHAEL HAWTHORNE
Enquirer Columbus Bureau
COLUMBUS — Ohioans denied health coverage by their HMOs could appeal to independent medical experts under compromise legislation unveiled Tuesday.
During the fall campaign, Gov. Bob Taft vowed to make health maintenance organizations liable for their decisions. But soon after the new governor introduced his plan, Republican legislative leaders stripped out the liability provision at the behest of influential business and insurance interests.
Mr. Taft isn't likely to win a bid to reinsert the provision. Sponsoring Rep. Randall Gardner, R-Bowling Green, noted House Speaker Jo Ann Davidson and Senate President Richard Finan also oppose HMO liability, which they contend would drive up health care costs.
“If you've been around for a while, you understand you can't get very far without the support of these important people,” Mr. Gardner said. “But I think this is still good public policy.”
The latest version of the proposal would require patients who have been denied coverage to appeal first to their HMO. If patients aren't satisfied, they could ask the state Department of Insurance to review whether the recommended treatment is covered under their insurance plan.
Disputes over treatments costing $500 or more could then be sent to newly created panels of medical experts that would review the cases and make binding determinations about whether the treatments should be covered.
Life-threatening cases would be decided within seven days and all others within 30 days.
Rep. Dale Van Vyven, R-Sharonville, said the procedure set up under the revamped bill would help patients get answers more quickly than they would by suing their HMOs.
“I feel we have something that will be very good for Ohioans,” said Mr. Van Vyven, chairman of the House Health, Retirement and Aging Committee.
The panel starts hearings on the proposal today and plans to vote on it late next week.
Doctors, lawyers and consumer groups argue the fear of being sued would make HMOs more likely to pay for early, more affordable care. They have tried to sway reluctant legislators with emotional stories of patients whose requests for treatments have been turned down.
Rep. Betty Sutton, D-Barberton, said if Mr. Taft supports HMO liability, he should use his influence to persuade GOP lawmakers to join Democrats who plan to offer such an amendment in committee and on the House floor. “We have to believe Bob Taft has the leadership to get this done,” Ms. Sutton said.
Most supporters, though, acknowledge they are unlikely to win support from a Republican-controlled General Assembly that already has moved to curb liability lawsuits.
Even the Ohio State Medical Association, a key backer of the liability provision, has said it will support reforms that don't include the power to sue.
So has Mr. Taft.
“I'd like to see liability in there,” the governor told reporters. “On the other hand, there are many good reforms in that legislation.”
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