Dear Editor:
What could be the final battle in the crusade to pass meaningful HMO reform was fought in the US Senate during the closing days of June. A bi-partisan Patients’ Bill of Rights passed the Senate, guaranteeing medical protections for the 2.3 million New Jersey residents enrolled in the HMO plans. The vote of 59 to 36 is evidence of the widespread support for this legislation, however it now faces an unclear future and a veto threat by President Bush.
For too long HMO reform was one-sided and bottled-up by partisan. A recent national study found that each day of delay on this issue has very real consequences. Every day 41,000 patients experience a worsening of their condition; 35,000 patients have needed care delayed; 10,000 patients are denied a diagnostic test or treatment and 7,000 patients are denied referrals to specialists.
No issue will touch more families than HMO reform. Today more than 90 percent of working Americans receive insurance from their employer. Most do not have a choice about the type of coverage. This means that many working families are stuck with an HMO despite any concerns they may have with the quality of care they receive. Over 160 million Americans and 33 percent of New Jersey residents are enrolled in an HMO. A vast majority of these Americans are in favor of and are demanding fundamental change in the way HMOs provide care.
Most Americans believe, as I do, that doctors, not HMO accountants, should be in control of medical decisions. Unfortunately, today we are faced with a situation where those decisions are disproportionately in the hands of insurance company bureaucrats. That is why, from patients to doctors, there is unanimity in making some common sense reforms. The legislation passed by the Senate is supported by more than 500 doctor and patient rights groups and will finally extend patient protections to all Americans in an HMO.
Under current practices, many HMOs force a patient with a chronic condition like heart disease to be treated by only the family doctor. The Senate bill will guarantee access to a cardiologist or other needed specialist, even one outside his or her network.
Currently, if a patient is sick or suffers an injury while traveling or on vacation, they must get prior approval from the HMO before going to the emergency room. This new legislation will ensure that a patient could go to the nearest emergency room without having to first get permission from the HMO.
Under current HMO policies, many women must obtain a referral from their primary care doctor before seeing an OB/GYN. This bill will guarantee access to an OB/GYN without a referral. HMOs often force a child with a chronic, life-threatening condition to seek approval from a primary care doctor before seeing a specialist. This bi-partisan bill would ensure a child with cancer, for example, would have the right to see a pediatric oncologist whenever the care is needed.
HMOs typically have the last word when they decide to deny a needed test, procedure or treatment. We will guarantee medical decisions by HMO bureaucrats will be subject to a swift internal review and a fair external review process. Any when reckless medical decisions made by HMOs injure or kill, they are shielded from any responsibility. Now we will finally ensure that all Americans will have the right to hold HMOs accountable in court.
With the passage of this historic legislation, we have put the medical decisions back where they belong, in the hands of you and your physician. This is not a Democratic or a Republican issue. It is an issue of compassion versus profits. The Senate has taken the first step of passing this legislation, and it is now up to the House of Representatives and President George W. Bush to help finish the job. They should do it not to score political points but to protect more than 160 million Americans.
Senator Robert G. Torricelli