American Health Line

The U.S. Supreme Court yesterday upheld state laws that allow patients an independent second opinion when an HMO denies coverage (See story 1). The following is a summary of editorials and organizations’ reaction.

Editorials

-Philadelphia Inquirer:
Although the court’s decision is “reason to cheer,” Congress “needs to act” on federal patients’ rights legislation, the editorial states.

However, the Inquirer concludes, “[W]ithout the immediate prospect of a federal patient law, the Supreme Court has done well in backing states’ efforts to heal patient-HMO rifts” (Philadelphia Inquirer, 6/21).

-San Francisco Chronicle:
The Supreme Court’s decision is “welcome,” the editorial says. Second opinions are an “essential element of sound medicine,” according to the Chronicle. Still, the editorial concludes that the ruling “is no substitute for a national standard set by Congress” (San Francisco Chronicle, 6/21).

-USA Today: The ruling is a “modest victory” for patients, and it exposes the “lack of progress” by lawmakers in crafting federal patients’ rights legislation. The editorial concludes, “The Supreme Court did its job on behalf of HMO patients this week. Now it is the lawmakers’ turn” (USA Today, 6/21).

Organizations

-AARP:
CEO Bill Novelli said, “AARP is pleased that the court has held that states can require an independent review of HMO decisions to deny health benefits. … But these state protections do not cover everything. Every managed care enrollee deserves the right to independent review. In order to guarantee fairness, patients need access to objective and independent review of an HMO’s decision” (AARP release, 6/20).

-Families USA:
Executive Director Ron Pollack said, “The Supreme Court’s decision is a victory for families confronting unjust denials and delays of health care from their HMOs. … For two reasons, however, this decision underscores the need for a national patients’ bill of rights. This is because today’s decision provides no relief for people in the eight states that have not created impartial hearing rights. More importantly, even in the 42 states that have established review panels, federal law prevents those panels from handling appeals for people who receive their health coverage from an employer who self-insures … and their access to an impartial appeal will only occur if the national patients’ bill of rights becomes law” (Families USA release, 6/20).

-Foundation for Taxpayer and Consumer Rights:
Executive Director Jamie Court said, “This case had the potential to undo all the hard-earned gains of the HMO patients’ rights movement. … Today’s decision protects the status quo of the states’ medical review process, but a federal patients’ bill of rights is needed to establish a judicial review process that punishes HMOs in the same way other corporations must pay when they are reckless or malicious” (Foundation for Taxpayer and Consumer Rights release, 6/20).

-Health Insurance Association of America:
Dr. Donald Young, president of HIAA, said, “The Supreme Court’s decision today will add greater cost and complexity to health insurance coverage. … [H]aving 50 different state standards governing how external review is practiced will mean people covered under a multistate plan will not have the same benefits. The great danger is that with costs already skyrocketing, employers navigating varying state laws may be forced to reconsider whether they will offer health insurance for their employees” (HIAA release, 6/20).

-Healthcare Leadership Council:
President Mary Grealy said, “This Supreme Court decision increases the urgency for Congress to act to make health care more, not less, affordable and accessible. The last thing working families needed was a court decision that will undoubtedly raise health care costs through increased regulation. What they need now is a Congress intent on accessible coverage rather than on generating more costly mandates and litigation” (Healthcare Leadership Council release, 6/20).

-National Association of Manufactures:
NAM criticized the court’s ruling, saying it is “fundamentally inconsistent” with ERISA. NAM Director of Employment Policy Neil Trautwein said, “The … decision cuts a hole into ERISA uniformity and creates the potential for a crazy quilt of state regulation that will increase the cost and complexity of benefit administration. … [The decision is] certainly not going to improve the quality of anybody’s health care” (National Association of Manufacturers release, 6/20).