New HMO lawsuit bills stir debate in 2 states
Texas and Missouri are the first states to give members of HMOs the legal right to sue their plans over perceived access restrictions to care. Similar legislative bills pending in 17 other states and the U.S. Congress have all sparked debate over the new developments.
Advocates of the new laws believe they can only help health care. Lisa McGiffert, a health analyst at the Texas Consumers Union says, "This allows patients trapped within the insulated HMO review process the option of an unbiased review." Similarly, John Bracken, past president of the New York Bar Association, says the bills "make health care organizations accountable."
In contrast, opponents say the laws will only hurt health care. "Legislation takes health care decision making not to a medical panel, but to a jury," said Larry Atkins, MD, head of the Corporate Health Care Coalition.
Maxine Fass, general counsel for the Health Insurance Plan of Greater New York adds, "Managed care on the defensive is no managed care at all."
Consumer lawsuits have been hindered previously by both the Employee Retirement Income Security Act of 1974 and the Corporate Practice of Medicine Doctrine. Texas and Missouri legislators bypassed these rulings by allowing HMO members the freedom to sue if they feel threatened by the withholding of what they deem " necessary care." t
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