APA continues advocacy to boost patient care

It battles the insurance industry?s attacks on proposed health-care protections for consumers.

By Rebecca A. Clay

'Washington,' a recent newspaper ad exhorted. 'Be careful how you play doctor. You might mandate a monster.'

Featuring a picture of Frankenstein?s monster, the ad warned that managed-care legislation under consideration in Congress could create a huge bureaucracy, drive health-care premiums sky-high and cause millions of Americans to lose their health insurance. 'Now that?s scary,' the ad concludes.

What?s really scary, says Peter Newbould, APA?s director of congressional affairs, is the way the ad twists the truth. Sponsored by a group called the Health Benefits Coalition, the ad represents the business and insurance communities? stepped-up attack on the Patient Access to Responsible Care Act (PARCA).

APA and the other 69 members of the Patient Access to Responsible Care Alliance are fighting back with statistics and a media campaign of their own.

A numbers game

PARCA, introduced by Rep. Charlie Norwood (R-Ga.) and Sen. Alfonse D?Amato (R-N.Y.), aims to give managed-care enrollees comprehensive consumer protections, such as guaranteed access to providers outside their plans and the right to sue those plans for harm resulting from treatment denials. Those kinds of provisions have the American Association of Health Plans, the U.S. Chamber of Commerce and other members of the Health Benefits Coalition up in arms, says Newbould. And in their determination not to lose the battle, he adds, the coalition is twisting the facts.

Take the coalition?s claim that PARCA would drive premiums up an average of 23 percent. According to the Milliman & Robertson Inc. study that the coalition commissioned, PARCA could raise premiums as high as 39 percent with midpoint assumptions at 23 percent.

'As with all actuarial studies, the most important thing is the assumptions that have gone into the numbers,' says Newbould. 'The Milliman & Robertson study took the scorched earth route by assuming the absolute worst scenario in every instance.'

To counterbalance those unrealistic assumptions, the PARCA alliance commissioned a study of its own from Muse and Associates. Muse analysts worked closely with the alliance and with Norwood himself to determine how each of the bill?s major provisions would actually affect businesses. With this approach, the study found that premiums would rise a mere 0.7 percent to 2.6 percent.

Counterattacks

The PARCA alliance didn?t stop there. Recognizing that the Frankenstein ads were aimed at members of Congress and their staffs, the alliance developed two 30-second television ads to air in the Washington, D.C., area.

In one ad, a husband and wife discuss the fact that their health-care plan has denied them a service they need. As their baby cries in the background, the scene dissolves into a graphic noting that PARCA would give the couple the right to appeal decisions, choose their own health-care professionals and hold their health-care plan accountable.

The second ad focuses on the Employee Retirement Income Security Act, a 1974 law that exempts self-insured health plans from most state regulation and prevents the 125 million Americans covered under such plans from filing negligence claims against their plans for personal injury or wrongful death. In this ad, a husband and wife discuss a baby who lost eyesight because a managed-care company delayed access to a specialist. The ad ends with a graphic that asks, 'Whose side is your member of Congress on? Yours? Or the insurance companies??'

So far, the PARCA alliance appears to be on the winning side. A recent survey conducted by Harvard University and the Henry J. Kaiser Family Foundation, for instance, found widespread public support for consumer protections of the sort PARCA would provide. More than three out of five people thought consumers should be able to file negligence claims against their health plans, for example. And nearly nine out of 10 thought there should be a law giving people the right to appeal to independent reviewers when they are denied access to medical treatment they think is necessary.

Now APA is working to ensure that PARCA doesn?t lose any of its congressional supporters?or its strength.

'Although PARCA has bipartisan support, the Republicans who most strongly support the bill are the rank-and-file members ,' says Russ Newman, PhD, JD, executive director for practice at APA. 'The Republican leadership is not as supportive, if they?re supportive at all. They?re going to start looking for ways to compromise and dilute this legislation.'

Republican leaders have already peeled off a couple of co-sponsors, says Newman, noting that one policy-maker decided he couldn?t support the legislation at all and the other said he could support it only if certain modifications were made. To keep others from defecting, APA sent participants at its annual State Leadership Conference to Capitol Hill in March with a single mission: educating their legislators about PARCA?s importance (see articles on page 20?23).

'Trying to maintain the strength of the current legislation is important because of the very strenuous attack the opposition has launched against it,' says Newman. 'We?ve got to stand tough.'

Rebecca A. Clay is a writer in Washington, D.C.