States Forging Ahead On Healthcare Measures

States are way ahead of the U.S. Congress when it comes to setting standards for managed care. Forty three states and the District of Columbia have passed comprehensive Patients’ Rights legislation and three states Texas Georgia and Louisiana have given health insurance customers the right to sue their HMO.

Ohio is the latest state to pass patient-protection legislation. The state’s Patient Protection Act, signed by Ohio Gov. Bob Taft in mid-July, will give patients more rights when appealing health insurer decisions, establish health insurance information hotlines, allow women direct access to obstetrician and gynecological services without a referral and give $80 million in tax breaks to the uninsured, the elderly and those who have suffered from a catastrophic illness.

The seven other states that have enacted or expanded their patient-protection legislation this year are Georgia, Iowa, North Dakota, Oklahoma, South Dakota, Tennessee and Virginia.

States that have not passed comprehensive legislation establishing better rights for managed care patients are: Alabama, Illinois, Massachusetts, Michigan, Utah, West Virginia, Wyoming.

In 1997 Texas became the first state in the nation to allow people to sue their HMO. To date there have been about five lawsuits filed in the state. This year, two other states followed Texas’ example in giving people the right to sue — Georgia and Louisiana.

Georgia also acted to create a consumer ombudsman’s office that would scrutinize health insurance rates and receive complaints. While the bill was being debated, it was described as a “first-in-the-nation attempt to regulate or control insurance rates,” said Dick Cauchi, a policy specialist with the National Conference of State Legislature’s health care program.

While the final bill “gives (the ombudsman) a statutory hand in the discussion, it doesn’t give the ombudsman the power to control the rates,” Cauchi said.

Georgia is not the first state to create a healthcare ombudsman’s office. Maine, Minnesota, Utah, Vermont and Virginia have either a healthcare ombudsman or a consumer health care division to field consumer complaints against their health care providers.

Other highlights on the health care front in 1999 include:

• Contraceptive coverage: Connecticut, Georgia, Maine, Nevada and Vermont enacted laws this year requiring that health insurers provide comprehensive coverage for contraceptives if they cover the cost of prescription drugs. Last year, Maryland became the first state to pass such legislation.
• Abortion parental notification laws: Florida, New Jersey and Texas passed laws this year that say a physician cannot perform an abortion on an unmarried woman under 18 until at least 48 hours after that minor’s parent or legal guardian has been notified. An exception exists if a medical emergency requires the immediate abortion of her pregnancy. Parental consent or notification laws are in effect in more than half the states and have been upheld by the U.S. Supreme Court under federal constitutional standards.
• Partial-birth’ abortion: Half the states introduced bills to create or amend bans on certain late-term abortions, often referred to as partial-birth’ abortions. The North Dakota and Missouri legislatures approved bans and Montana amended its existing prohibition.

Legislation that affects fewer people, but covers important treatments often not paid for by insurance companies include:

• Lyme disease: Connecticut passed a bill this year requiring insurers to cover the cost of treating this tick-borne disease, which is most common in the Northeastern and Midwestern United States. The disease begins as a rash but in its later stages can cause meningitis, facial paralysis or other neurological problems.
• Port wine facial stains: Massachusetts and New Jersey have bills pending that would require insurers to cover the cost of treating this type of birthmark, which affects about three out of 1000 people and most commonly appears on the face or neck.
• Morbid obesity: bills were introduced in Georgia, New Jersey, Maryland and Virginia this year that would require insurers to cover the cost of treating morbid obesity — often defined as being at least 100 pounds overweight or twice the ideal weight for one’s frame, age, height and gender. Georgia lawmakers passed such a bill, agreeing to require insurance companies to offer this coverage in some of the packages they sell to employers.

NCSL’s Dick Cauchi said legislation like the Georgia measure that seemingly has limited application often becomes a model that other states emulate.

For example, he said, in April 1997, Florida passed legislation to allow a layperson to carry an automatic external defibrillator, a portable electronic device that can treat a person in cardiac arrest.

Since then, 37 other states have adopted similar legislation.