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Health Care Reform:

Health Insurance & Affordable Care Act

Washington's Plan For HMOs

The latest HMO laws being haggled over in Congress.

WebMD Feature

Many members of Congress want to make it easier for you to appeal a decision made by your HMO. President Bill Clinton wants the government to help you pay for prescription drugs if you are in Medicare. The U.S. Department of Health and Human Services wants to keep your computerized medical records confidential.

At every turn, someone in Washington is trying to do something to change -- and maybe even improve -- health care. Current ideas on Capitol Hill range from schemes to completely overhaul Medicare to prohibitions against assisted suicide. But only three proposals that will have a noticeable effect on most of our lives are likely to become laws in the near future.

The Patient Protection Act

The public has become disenchanted with the managed care industry. According to Lou Harris and Associates, only 34% of Americans now think the industry is doing a good job. Physicians are also critical: In a poll taken for the Kaiser Family Foundation, more than 75% of doctors said managed care lessened a patient's ability to receive necessary services and drugs.

In response, Congress is considering a number of restrictions on the managed care policies that have upset many people. The restrictions are grouped together and called a patient protection act or a patient's bill of rights. Depending on Congress's final decision, such an act may guarantee:

  • insurance coverage for treatment at any emergency room,
  • direct and easy access to specialists when you are seriously ill,
  • coverage of drugs that are not on your HMO's approved list if the drugs are prescribed by your physician,
  • a timely appeal before an outside panel if an HMO declines to pay for certain medical services, and
  • the right to sue a managed care plan if its refusal to cover medically necessary services compromises your health.

Prescription Drugs

The cost of prescription drugs is on the rise. Health insurance premiums climbed a little more than 5% between 1998 and 1999, and most of the increase was caused by the price of prescription drugs, according to the Hay Group, a health care consulting firm. At the same time, many managed care organizations -- including those serving seniors on Medicare -- are dropping prescription drug payment from their benefits.

The Clinton administration and many members of Congress agree that senior citizens, at least, need some form of federal assistance to pay for prescription drugs. But the specifics are hotly debated. Clinton wants to help all Medicare beneficiaries, while many members of Congress prefer to limit this to seniors with low incomes. The administration wants to add a subsidy of as much as $2,500 a year to pay for drugs. Others would rather create a tax deduction or fund state assistance programs.

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