ATLANTA -- Promising to win the fight for HMO reform, Gov. Roy Barnes on Wednesday unveiled a three-pronged attack against the insurance industry aimed at giving patients more choice of doctors and a way to sue for harm caused by adverse decisions.
Mr. Barnes, who hit hard at insurance-owned HMOs during last year's campaign, compared the approaching battle with well-heeled special interests to his gubernatorial race against multimillionaire businessman Guy Millner.
"I'm used to fights with a lot of money on the other side," Mr. Barnes said during a news conference announcing his reform proposals. "You can beat them as long as the people of the state stick with you, and they're with us on this one."
Mr. Barnes' legislative package includes three bills that would:
Require managed-care plans to offer an option allowing enrollees to choose a doctor outside their plan's network, if the physician agrees to provide the same quality of care at the same rate as the network's provider.
Allow patients denied treatment to appeal to an independent review board made up of doctors, whose decisions in favor of a patient would be binding on the HMO. Patients also could sue a managed-care plan in cases where harm already has occurred if they agree to submit to an independent review.
Create the position of a consumer's insurance advocate in the Governor's Office of Consumer Affairs to provide input on issues of insurance regulation and to represent consumers in rate cases.
Mr. Barnes said there's enough time to get the three bills through the General Assembly this year, even though less than four weeks remains in the session. To help speed their progress, two of the bills are being introduced in the Senate, and the other will be introduced in the House.
Mr. Barnes said such basic patient rights as a choice of doctors and the right to appeal adverse decisions to a physician panel are long overdue.
The governor said the cost of the proposed reforms would be minimal. He cited a recent study by the Congressional Budget Office that predicted similar legislation being considered at the federal level would increase health insurance premiums by only 1.6 percent.
But insurers say the legislation could force premiums to rise as much as 17 percent.
Paul Fischer, a family physician with the Center for Primary Care in Augusta, was particularly critical of the bill to allow patients to choose out-of-network doctors. He said it goes against the concept of managed care, a system responsible for curbing soaring health-care inflation.
"Managed-care programs have been able to limit costs ... by making decisions about who provides services," Mr. Fischer said. "To just open it up to anyone would defeat the purpose."
"We don't want to lose the opportunity for managed health care," added Lindsey Thomas, president of the Georgia Chamber of Commerce, which opposes health-care reform. "This is not just something that the legislature can accept as the right thing to do (because it's) what is politically popular."
Anna O'Neil, media affairs consultant for Blue Cross/Blue Shield of Georgia, said company officials would not comment on Mr. Barnes' package until they read the legislation.
HMO officials, fearful of a Barnes backlash, have hired a public relations firm to talk for them.
For his part, Mr. Barnes said he's not trying to abolish managed care, just force HMOs to be as responsible as any other business in Georgia for abuses they might commit. He stressed that the liability provision would prohibit patients from seeking punitive damages.
However, insurers say approving Mr. Barnes' doctor choice proposal would in effect eliminate the cost-cutting benefit of HMOs, which lower expenses by contracting with a set group of physicians.
Dave Williams is based in Atlanta and can be reached at (404) 589-8424 or email@example.com.
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