CENTER ON DISABILITY AND HEALTH
1522 K Street,NW, Suite 800
Washington, DC 20005
Telephone: (202) 842-4408
FAX: (202) 842-2402

September 8, 1999

Dear Representative:

The Center on Disability and Health is devoted to health care reform that enables persons with disabilities to get the health care they need to live healthy, independent and productive lives in the community. With a national Board of Directors representing different sectors of the diverse disability community, the Center on Disability and Health has been working to develop standards of care that ensure equal access to quality care for all persons. Since most people with disabilities get their health care through private insurance-- not Medicaid or Medicare, consumer protections in private managed care plans are essential to ensure that persons with disabilities receive the health care they need, especially when market forces drive health plans to compete primarily on the basis of price-- rather than on the basis of quality.

The patient protections proposed in H.R. 2723, the Bipartisan Consensus Managed Care Act of 1999, would encourage managed care plans to compete on the basis of quality by holding them accountable to certain quality standards including: (1) access to appropriate specialty care whether or not the health plan has the capacity to provide covered services within its network; (2) access to an independent external appeals process anytime a denial for benefits is based on a decision that the service is not medically necessary or appropriate; and (3) access to fair remedies if a health plan decision causes harm and did not comply with an external reviewer’s decision.

Without these consumer protections, many managed care plans may be tempted or pressured to deny medically necessary care as an expedient way to contain costs, encourage disenrollment of higher cost patients, and maximize profits. Admittedly, the Patients Bill of Rights ignores the critical issue of how to ensure that adequate payments are available to health care providers to pay for medically necessary care. At some point mechanisms for cross-subsidization will be needed to ensure that all people get the health care that they need. But H.R. 2723 is an important first step requiring all private managed care plans to provide covered services whether a frightened patient goes to an emergency room, needs access to a specialist within the health plan, or needs a referral to an out-of-network provider.

Contrary to misinformation by the insurance industry and some employers, managed care liability is not a threat to employers who provide health care that meets appropriate medical standards. If employers cannot afford to provide appropriate health care, then Congress has a responsibility to recognize the need to create a national health insurance system or empower states to develop a universal coverage plan that can ensure that all people get the health care which they need, whether it is funded through tax subsidies to low wage employers, or a combination of income and corporate taxes.

With at least 21 Republican co-sponsors for H.R. 2723, who together with most Democrats represent a clear majority in support of the modest protections in this long overdue health care legislation, it is hard to see why the American people will be tolerant of Republican leadership trying to block a vote in the House on meaningful consumer protections. Weaker protections combined with Medical Savings Accounts (MSAs) and lesser standards for Multiple Employer Welfare Arrangements (MEWAs) threaten to undermine the leverage and oversight which is necessary to ensure equal access to quality care for all Americans. Please support H.R. 2723 and work to enact it into law.

Sincerely,