Wednesday, October 06, 1999
HMOs' liability up for debate
Boehner bill among main options
BY PAUL BARTON
Enquirer Washington Bureau
WASHINGTON — The House today opens debate over what rights patients should have in battling their health plans — a debate that could affect the coverage of at least 200,000 Tristate residents.
Divisions are sharp between those who want to give patients more rights to sue their HMOs and similar plans, and those who warn that such lawsuits could drive up costs and result in loss of health insurance for millions of Americans.
The opposing forces are well represented in the Cincinnati area.
Take Dr. Paul Chirlin, a physician who practices in Springdale and Mason and has seen his share of patients hassled by managed health care plans. Those harmed by their decisions to deny coverage, he contends, should have the right to sue.
“I don't think it's a lot, but if it happens to one, it is one too many,” he said.
On the other side is Bill Boehm, head of Connector Manufacturing Co. in Hamilton, who provides health insurance for his 465 employees. If his company's health plan can be sued, he said, his employees are likely to find themselves with higher costs and less coverage.
“If they say they are going to sue my insurance company, they are really suing my company,” he said.
The stakes are particularly high for about 200,000 area residents, the Greater Cincinnati Chamber of Commerce estimates.
That's the number covered by health plans of 5,000 area small businesses that would likely have to drop their coverage if Congress gives patients the right to sue health plans, the chamber estimates.
Employer-provided health plans are currently immune from liability under a 1974 law.
At a minimum, said Ginny Reid of the chamber, “More lawsuits and additional mandates only serve to increase premium costs.”
But Cincinnati-area trial lawyers have a quite different view.
“There wouldn't be an explosion of litigation,” said Brett Goodson, president of the Hamilton County Trial Lawyers Association. “But it is going to make HMOs responsible, and that is what they want to avoid.”
One of the major players in the House debate will be Rep. John Boehner, R-West Chester, author of one of three major bills to be voted on.
Mr. Boehner, head of a House employee-employer relations subcommittee, has been working all year to try to give patients more recourse in appealing the decisions of HMOs without exposing employer-provided health plans to unlimited liability.
Mr. Boehner has called for giving patients the right to appeal decisions to an independent review board of physicians and medical experts.
HMOs that did not abide by the board's decision could be fined $5,000 a day.
Giving patients external review, he contends, will “still ensure that patients get the care they need when they need it most.” Patients, he said, “need care, not court.”
Lawsuits, Mr. Boehner said, will just cause many employers to drop coverage and add to the 44 million Americans who have no coverage, a figure that has increased by 1 million over the past year.
Mr. Boehner's bill is the only one of the House proposals that would not expose health plans to unlimited liability.
“It is already exceedingly difficult for small employers to provide health benefits for their employees,” Mr. Boehner said. “And if Washington throws in the threat of lawsuits, there won't be a single small employer in America who will be able to take that risk.”
The trial lawyers don't buy that argument.
“Maybe they should be more prudent in how they handle their business affairs,” Mr. Goodson said. “That is a ridiculous argument.”
The Senate this year passed a bill similar to Mr. Boehner's that would protect health plans from unlimited liability. It was criticized as too weak by President Clinton and congressional Democrats.
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