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August 17, 2001

Sacramento Bee: Bush vs. California: Patients' bill undermines state protections

According to the official scorers in Washington, passing the House's limp version of a patients' bill of rights was a victory for President Bush. But where there are winners, there are losers, too, and in this case they are Californians. The House bill actually would weaken the state system that protects patients against unreasonable denial of care by their health plans.

The House version of the bill makes Californians worse off, by pre-empting the state's new system of medical review.

And that matters even more than all the theological discussion in Congress over suing health plans. When an HMO wrongly denies care, a patient should be able to sue to recover damages. But what the patient needs even more than a court date is a way to quickly reverse the HMO's decision before he dies or gets sicker. California law, which created a system of external independent reviews when treatment is denied and a new agency, the Department of Managed Health Care, to regulate health plans and manage the process, has done just that.

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In place of a system that works for Californians, the House bill would put federal rules in force that would make it more difficult and expensive for California patients to contest, and overturn, faulty health plan decisions.

The House bill would let HMOs pick the independent panels that review denials of care; under California law, the panels are picked by the DMHC. The House bill would let HMOs charge a fee to patients seeking independent review and require patients to submit a written application; under state law, HMOs pay the entire cost and patients can initiate independent reviews through the DMHC without a written filing. The House bill would break up the integrated state system, where the state agency that sets up independent reviews can quickly enforce its findings through regulatory actions against health plans.

The conference committee that will try to reconcile the rival House and Senate versions of the patients' bill of rights needs to take more care.

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