Unprecedented Assault on State HMO “Patients’ Bill of Rights” Movement Unveiled in U.S. Senate Today

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Santa Monica, CA — An over-reaching bill backed by President Bush that would dismantle state oversight of health insurance and hard-won HMO patients’ rights established in 41 states was moved today in the U.S. Senate.

The legislation, S. 1955 (Enzi, R-WY), would override state patient protection rules and regulation of health insurers and replace them with weaker or non-existent “harmonized” federal standards.

Under the bill, any insurer or HMO that chooses to sell a plan through a professional association would potentially be exempt from every HMO patients’ rights law passed in the last decade. A national board would create federal standards that would merely have to “consider… standards followed by a plurality of states.”

Consumer advocate Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights (FTCR) condemned the bill as “national deregulation of health insurance and a frontal assault by health insurers and HMOs on the patients’ bill of rights movement.”

Such “lowest common denominator regulation,” said Jamie Court, President of FTCR, “threatens the gains of the HMO patients’ rights movement, which established standards such as requiring HMOs to provide patients access to second opinions, give women direct access to OBGYNs without having to go through HMO gatekeepers, and to abide by protective standards ensuring that patients have access to medically necessary care.”

The law would allow any HMO or insurer that chooses to participate to ignore:

  • State Laws that Give Patients Access to Independent Review When Insurers Deny Medically Necessary Care
  • State Laws that will Limit the Amount of Money that Patients Must Pay Out-of-Pocket
  • State Patient Privacy Laws that Restrict Access to Medical Records
  • State Laws that Track Patient Complaints Against Insurers that Lead to Investigations by Regulators
  • State Laws that Require Insurers to Be Licensed and Abide by Basic Business Rules
  • State Laws that Set Standards on What Services and Treatments Must be Provided to Patients
  • State Laws Overseeing “Harmful Business Practices” by Insurers
  • State Laws Requiring Insurers to Pay Fines or Penalties when They Harm Patients
  • State Court Actions and State Regulator Intervention

Sponsors of the bill purportedly want to expand “association health plans” — insurance policies sold through business organizations that provide limited benefits, don’t cap the amount patients have to pay out of pocket, and remove them from accountability under state laws, regulators and courts.

FTCR said that the Enzi bill would create a vacuum in the health insurance market by promising cheaper coverage that actually provides no benefit. The plans could be used to lure employers and individuals desperate for affordable coverage away from traditional health insurance.

Dana Christensen, a widow who was insured through an association health plan and owed more than $450,000 when her husband died of bone cancer, spoke out against the plan to expand health plans that “aren’t worth a dime because they allow insurance companies to sell junk policies that don’t protect patients when they are sick.”

Association health plans commonly promise to pay 80% or 100% for most health treatments. But when policyholders get sick they discover that their plan caps the amount it will pay for hospitalization.

The tragic story of Dana and Doug Christensen is part of a new online resource published by the Foundation for Taxpayer and Consumer Rights (FTCR) pointing out the skeletal benefits and new burdens under such high cost health proposals. Visit FTCR’s resource page at:

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The Foundation for Taxpayer and Consumer Rights (FTCR) is a nonpartisan consumer advocacy organization. For more information, visit us on the web at:

Consumer Watchdog
Consumer Watchdog
Providing an effective voice for American consumers in an era when special interests dominate public discourse, government and politics. Non-partisan.

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