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Health Care Reform:

Health Insurance & Affordable Care Act

Study Suggests HMOs Get Bad Rap

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"Common sense thinks that the [managed care] industry should have agreed to [some reforms] a long time ago," Rother tells WebMD. "They've made themselves the target unnecessarily."

The congressional negotiators announced agreements on three relatively minor provisions. First, they agreed that parents may designate a pediatrician -- and in some cases, a non-physician pediatric provider --- as the primary care provider for their children. But that right only applies if the plan allows enrollees to designate their own primary physicians.

The House and Senate also agreed that patients may go to the nearest emergency room to stabilize their condition without prior authorization and without financial penalty. The lawmakers reached a deal that made it harder to exclude providers from their network.

But huge areas of disagreement remain in the congressional talks, including over how many Americans should benefit from the legislation, the proper appeals processes for patients with grievances, and the possible right to sue one's health plan.

 

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