HMO debate: What's in it for you?

Both Republicans and Democrats are offering plans to give managed health-care patients basic rights  MESSAGE BOARD: The politics of health care  ALSO: Senate to begin debate on patients' bill of rights CNN & Company: Should HMOs be Held Accountable Under a Patients' Bill of Rights?  IN-DEPTH SPECIAL: The HMO Debate VIDEO CNN's Carol Lin reports on the differences between the Republican and Democratic versions of the patients' bill of rights Windows Media 28K 80K Democrats Republicans Sue HMO Yes, if care is denied No, lawsuits drive up costs "Medically necessary coverage" Let doctors decide Let insurers decide Easier access to emergency rooms, specialists For everyone who has private insurance For 48 million Americans who are in federally-regulated employer-funded plans exempt from state rules which protect patient's rights

July 12, 1999
Web posted at: 11:13 a.m. EDT (1513 GMT)

In this story: Consumer protection Ads seek to influence RELATED STORIES, SITES

LAUREL, Maryland (CNN) -- Jeanne Mignon dreads going to a doctor for anything -- and she blames managed care.

As the Senate takes up proposals this week to define patients' rights, the Maryland mother of two hopes the outcome is legislation that would level the playing field between insurance companies and people like her.

Republicans and Democrats each have their own plans labeled a patients' bill of rights, although there are major differences between them.

In both cases, the aim is to give patients basic protections under health maintenance organizations, or HMOs, and other managed-care plans that have come to dominate U.S. medical care.

Critics of managed care say people have been injured or even have died because they were denied necessary care by cost-conscious HMOs.

In the end, Republicans, who enjoy a 55-45 Senate majority, are virtually certain to pass the bill they prefer -- one that is more limited than the Democrats' plan but still offers many patients some new powers in dealing with their HMOs and other managed-care plans.

Along the way, Democrats will offer as many as 20 amendments -- each targeting a different piece of the package -- forcing GOP senators to support their plan or risk looking like they don't want to protect patients.

Consumer protection is just what Mignon is looking for.

In a run-in with her managed-care provider -- when her son Robert's head wound needed stitches -- Mignon says she was forced to drive for hours to get him to their primary-care physician for treatment.

"I was forced by the managed-care system to do what the physician said, or receive no coverage," she told CNN. "And not knowing how serious his injury was, I didn't dare take that risk."

Consumer and patient groups largely back the Democrats, although they recognize that the Democrats, as a minority party, cannot pass their own version and hope through amendments to try to work out a compromise that may not satisfy everyone but can attract enough votes to pass.

Mignon says she wants more legal protection for health-care consumers

Some Republican and industry skeptics say they don't think the Democrats really want a bill as much as they want a political issue, but consumer groups say they hope legislation does pass.

"The most important protections should be part of a real patients' rights bill -- and I stress the word 'real,'" said Ron Pollack, executive director of Families USA, a health advocacy group that backs the Democratic approach.

"A fake patients' rights bill is not going to be helpful for the vast majority of people," he added.

As Congress debates possible health care mandates, insurance and business groups are spending millions on advocacy advertising.

They hope to convince consumers that Democratic provisions would raise premiums and make insurance unaffordable, adding to the ranks of America's 43 million uninsured.

The American Medical Association has countered the insurance industry's advertising frenzy with print ads

In one of the ad campaigns, HMOs hoping to repair their battered image feature doctors who swear their patients get excellent care.

Organizers insist the HMO ads are not aimed at influencing lawmakers, but rather convincing people that the horror stories they've heard do not represent everyday reality.

"This is standing up for ourselves and saying, 'Hey, we've got a good product that's serving the consumer,'" said Chip Khan, president of the Health Insurance Association of America, one of several industry groups that have come together under the Coalition for Affordable Quality Health Care.

Each ad ends with the tag line: "Today's managed health care -- there's a lot to feel good about."

The American Medical Association, which is lobbying lawmakers on behalf of doctors, has already spent over $200,000 in print ads to counter the insurance industry media blitz.

The Republican bill is a patient's bill of rights in name only, argues Dr. Nancy Dickey of the AMA. "A nice title doesn't promise good protections," she told CNN.

Medical Correspondent Eileen O'Connor, Correspondent Jonathan Karl, The Associated Press and Reuters contributed to this report, written by Jim Morris.