Wednesday, October 13, 1999
Formula fight latest in HMO debate
Cost-benefits bill dies in Statehouse
BY MICHAEL HAWTHORNE
Enquirer Columbus Bureau
COLUMBUS — An infant girl is the latest symbol in the battle between health insurance companies and groups frustrated with HMOs that deny coverage for medical treatments.
A Dayton-area couple urged state lawmakers Tuesday to order insurance companies to pay for special baby formula their daughter needs to survive.
Three hours after the couple appeared at a Statehouse rally, House Republican leaders discovered they did not have enough votes to pass legislation requiring a cost-benefit analysis of new health insurance mandates. The bill, sought by business and insurance interests, was abruptly yanked from consideration.
While GOP leaders insisted there was no tie between the events, they reflected two sides of the volatile health-care debate raging in Washington and at Statehouses across the country.
“Based on the national debate go ing on, people are reading more things into this than perhaps they should,” House Speaker Jo Ann Davidson, R-Reynoldsburg, said afterward.
Legislation requiring coverage for special infant formula, which costs $35 to $45 a can, is one of several bills that would impose new insurance mandates. Others would require coverage for treatment of osteoporosis, mental-health counseling, dental anesthesia and birth control.
Lydia and Ed Bogan of West Alexandria, said they are spending $1,200 a month to feed their 23-month-old daughter after their insurance compa ny refused to pay for Neotate, a formula for babies with severe food allergies.
Their insurer, United Health Care of Ohio, said the formula is an over-the-counter product that isn't covered by the Bogans' insurance policy.
Business and insurance interests support a measure that would create a 15-member panel to screen proposed insurance mandates before they reach lawmakers. The bill also would require an independent review that weighs the costs of each new mandate against the benefits.
Sponsoring Rep. Dale Van Vyven, R-Sharonville, said the panel would provide a thorough, unbiased analysis of the various mandates proposed during each session of the General Assembly.
“We're trying to move the process along more quickly,” said Mr. Van Vyven, an insurance agent.
Others contend new insurance mandates would not be necessary if HMOs covered treatments recommended by physicians.
Rep. Betty Sutton, D-Barberton, called Mr. Van Vyven's bill a stalling tactic that would enable legislative leaders to sidetrack health-care bills without a committee vote.
“In reality, this bill is not about good government,” she said. “This is, upon closer examination, the latest installment in special-interest protections for the insurance industry.”
After several Republicans joined Democrats in signaling their opposition to the measure, Ms. Davidson hastily assembled a closed-door meeting of GOP lawmakers to discuss the bill. When lawmakers returned to the House floor, Mr. Van Vyven obtained permission to delay the vote.
Lawmakers will try to work out a compromise and bring the measure back next week, but there are no plans for a vote on the infant-formula bill, Ms. Davidson said.
The debate comes as managed health care is under attack nationwide. Last week, the U.S. House approved legislation that would allow patients to sue HMOs in state courts when denied coverage. California, Texas and a handful of other states have approved similar right-to-sue measures.
In Ohio, legislative leaders stripped an explicit right to sue HMOs from similar legislation after insurance and business interests complained it would drive up insurance costs and force employers to cut benefits.
Instead, patients will be allowed to appeal to independent medical experts.
“These are problems that shouldn't be solved through government mandates,” said Kelly McGivern, director of health-care policy for the Ohio Chamber of Commerce. “There are a dozen mandate bills pending before the General Assembly. If one passes, it opens the door for the others.”
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