BI’s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.
To search specifically for more than one word, put the search term in quotation marks. For example, “workers compensation”. This will limit your search to that combination of words.
To search for a combination of terms, use quotations and the & symbol. For example, “hurricane” & “loss”.
WASHINGTON-Three years after the collapse of the Clinton administration's sweeping plan to overhaul the nation's health care system, a new congressional drive is under way to revamp the system.
Unlike the Clinton effort, whose launch triggered a massive lobbying campaign to defeat it, the new legislative proposal-known as the Patient Access To Responsible Care Act of 1997, or PARCA-has attracted little attention.
Yet PARCA, with more than 200 co-sponsors in the House of Representatives, including liberal Democrats and conservative Republicans, enjoys far more congressional support than the Clinton measure ever mustered. Rep. Charlie Norwood, R-Ga., introduced the measure.
The burden PARCA would inflict on employers and group health care plans, however, may exceed that of the Clinton plan, critics of the proposal contend. The legislation makes little distinction between self-insured employers and managed care plans.
"It is, in many ways, more prescriptive than-and as damaging as-the Clinton Health Security Act," said Rep. Harris Fawell, R-Ill.
"Employers should be paying attention to this bill because the ramifications, if enacted, could be potentially catastrophic," says Chip Kerby, a principal with William M. Mercer Inc. in Washington.
Concludes Charles Weller, a partner with the law firm of Baker & Hostetler L.L.P. in Cleveland: "I think it will end group health care plans as we know them."
Among other things, PARCA, also known as H.R. 1415, would:
Allow employees to sue employers in state court and recover damages-including punitive damages-applicable under state law for personal injuries incurred in connection to services they received through their health care plans.
These liability provisions in the legislation specifically would amend the Employee Retirement Income Security Act, which pre-empts state rules and laws that relate to employee benefit plans. Under ERISA, employees can recover only actual damages and in some cases legal expenses.
PARCA, say critics, would expose employers to legal action-and potentially huge damage awards-for actions over which they had no or little control.
For example, an employer that contracted with physicians to set up a health care network could face liability if a physician made a mistake and injured an employee.
"ERISA was set up to maximize the amount of money that would go to pay for benefits. This bill would maximize the amount of money that would go to the plaintiffs' bar. It is a trial lawyers' bonanza," Mr. Weller said.
However, a new version of the bill Rep. Norwood introduced last week would preserve the ERISA shield against damages awarded under state law if an employer did not exercise "discretionary authority to review and make decisions on claims for plan benefits." This may provide only limited protection, because many employers may review decisions made by plan administrators involving very large claims, said Henry Saveth, a Mercer principal in Washington.
Make self-funded employers responsible for establishing health care quality improvement programs. These programs would have to "systematically and continuously assess and improve" the health of every participant in its health care plan.
Critics say they have no idea how employers could run such programs; noting, for example, that for such a program to work, employers would have to know the health status of employees before hiring them-information they would certainly lack.
Require employers to evaluate at least once a year all health care professionals that apply to be in their networks. The bill does not specify evaluation standards; such standards would be developed based on the advice of professional associations, health professionals and providers.
Even if its network was full, an employer still would have to go through the evaluation process of health care professionals that applied, significantly adding to its administrative costs.
Take away from employers the right to decide which health care services it will cover. Under the measure, employers and other providers of health care plans could not discriminate in the participation, reimbursement or indemnification of a health care professional certified under state law.
That provision could require employers to reimburse those providing services employers never intended to provide.
"Some states license naturopaths, homeopathic practitioners, massage therapists and many others not ordinarily covered in many reputable health insurance plans," Tom Emerick, vp of benefits at Wal-Mart Stores Inc. in Rogers, Ark., told a congressional panel last month.
Erode employers' ability to establish preferred provider networks. Under the measure, an employer that selects a hospital and its accredited physicians to be in its network could not bar other physicians from being in its network because they were not affiliated with or did not have admitting privileges to the hospital with which it contracted.
That provision, says Mr. Weller, would cripple employers' ability to select physicians on the basis of quality, innovation, cost and service.
Have the government decide how much of a point-of-service plan premium employers could shift to employees.
In addition, one provision bars discrimination against health care plan participants on the basis of "anticipated need" for services.
"It appears that the government and the courts could be involved in deciding what services are medically necessary," Rep. Fawell said.
In all, "This is the worst piece of health care legislation introduced this congressional session," said Neil Trautwein, manager of health care policy at the U.S. Chamber of Commerce in Washington.
"It is a dastardly bill," concludes Leslie Pryor, senior director of government relations at the National Assn. of Wholesaler-Distributors in Washington.
Supporters of the measure, though, look at it differently. Rep. Norwood says the bill is a response to a managed care industry that wants "all of the power and none of the responsibility."
"Today, there is simply no public policy establishing minimum patient protection for self-insured managed care plans in this country because Congress has not completed its work," Rep. Norwood adds.
But from an employer perspective, "It is a wish list by the medical community on what to do about everything they do not like about the health care system," said James Cole, manager of health programs at Franklin Electric Co. Inc. in Bluffton, Ind.
How widespread support for the measure is at this point is unclear. Mr. Weller says many congressmen who have signed on to the bill as co-sponsors did so as a response to the public backlash against certain managed care practices. But few congressmen have any idea what the measure actually would do, he says.
"A big education effort is needed. We are trying to educate members that the bill goes much too far," says the NAW's Ms. Pryor.
What could work against the bill's chances, notes Mr. Saveth, is growing comparisons to the measure to President Clinton's failed effort.
"The Republican leadership is saying that this sounds a lot like 'ClintonCare' and that we have to be very careful" in this area, Mr. Saveth added.
But employers need to get more involved in the lobbying effort against the measure, some say.
"I hope we do see a greater level of effort among the employer community. These are not small issues," Mercer's Mr. Kerby said.