Consumers are key to battling the abuses of managed care

By Rebecca A. Clay

When Russ Newman, PhD, JD, called for clearing the way for health-plan enrollees to sue managed-care companies for negligent care, the reaction of the audience at the January Families USA conference revealed that consumers were with him and ready to fight.

According to Newman, APA?s executive director for professional practice, the cheers and ovations he received stood in marked contrast to scattered criticism that the association is not aggressive enough on the issue of managed care.

'The irony is that some people claim that APA is soft on crime, that we are acceding to or accommodating managed care,' says Newman, adding that the consumers at the Families USA event were much more energized than he thought they would be. 'For them,' he says, 'our message was a rallying cry.'

As Newman discovered, consumers have rallied behind the Patient Access to Responsible Care Act (PARCA) and other managed-care reform legislation. APA is already working with consumer groups in a coalition that hopes to make patients? health and safety?not the bottom line?the number-one priority of managed-care companies. And Newman and other APA staffers are looking for additional ways to channel consumers? energy into the fight for a common cause.

Consumer activism

The Center for Patient Advocacy in McLean, Va., is typical of the grassroots groups gearing up for the battle to get PARCA passed. A nonprofit organization representing patients? interests, the center has 50,000 members across the country. Its goal is to educate patients about managed care and other health-care issues and transform patients who have experienced problems into citizen lobbyists working for health-care reform.

Thanks to a recent spate of publicity about the center in magazines like Ladies? Home Journal, Good Housekeeping and Shape, that mission has become easier than ever. The center now receives 75 to 100 calls a day from consumers with managed-care-related problems ranging from the merely frustrating to the life-threatening.

'We had one caller who knew she had a serious mental health problem, but her primary-care physician said she was just under stress and didn?t need to talk to anyone about it,' reports Terre McFillen Hall, the center?s executive director. Other callers report being socked with enormous bills for emergency-room care of problems that seemed life-threatening but turned out not to be. Others have been denied bone-marrow transplants that represent their last hope. Still others have realized too late that their plans simply don?t cover mental health services.

The center sends callers brochures on topics like what to ask managed-care plans before joining and how to appeal decisions once you?re in, plus citizen lobbyist kits that include sample letters to Congress and other resources.

The strategy works, says Hall. When the center learned that managed-care companies were evicting new mothers from the hospital almost immediately after giving birth, for instance, it rallied its forces and got 75,000 postcards delivered to targeted members of Congress. That support helped convinced legislators to pass the Newborns and Mothers Health Protection Act of 1996, which forced managed-care companies to allow at least 48-hour hospital stays for new mothers.

'We have a great staff that could lobby Congress every day, but what really makes a difference is when members of Congress hear from their constituents,' says Hall.

She believes health-care provider groups working alone aren?t as effective because legislators sometimes suspect them of being motivated primarily by financial concerns. 'If legislators see that average, everyday citizens aren?t getting the health care they need, that makes a big difference,' she says.

A united front

Joining forces with grassroots groups like the center will be critical to PARCA?s success, agrees Douglas Walter, legislative counsel in APA?s Government Relations department.

'If you look at the state level, when states have passed managed-care legislation it has always been because consumers and providers united,' he says. 'That same rule is going to apply to the national level. Consumers can?t do it alone, and providers can?t do it alone.'

APA is already working with a number of consumer groups, he adds. APA has joined Families USA, the Center for Patient Advocacy and dozens of other consumer, provider and labor groups in advocating for federal quality standards. In November, for instance, APA and scores of other groups signed a letter to President Clinton commending him for the work done by his Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Although pleased by the commission?s call for a Health Care Consumer Bill of Rights, the letter urged the president to go even further and work for enforceable, federal standards.

APA has also joined a coalition called the Health Umbrella Group that has made the passage of such standards its goal. The group includes consumer coalitions ranging from the Breast Cancer Legislative Group to the Interfaith Religious Coalition to the Leadership Council of Aging Organizations.

Getting consumers interested in the issue has never been easier, says Walter, noting that consumer and provider groups alike are working to avoid a repeat of the universal health-care reform failure of 1993.

'A lot of the consumer and provider groups got burned by the insurance industry with the ?Harry and Louise? ads and the rest of the massive campaign against the Clinton reform plan,' Walter explains. 'When they heard that the insurance industry was gearing up for another multimillion-dollar campaign to kill any chance of managed-care reform, the various coalitions united to create a counter-voice. They don?t want to lose again.'

To foster an even greater spirit of cooperation between consumers and providers, APA?s Practice Directorate is thinking about sponsoring a series of townhall meetings around the country. Organized in conjunction with state and local psychological associations, these meetings would allow APA to continue educating the public about managed-care issues and to really work together on this issue.

'The opposition is strong, intense and putting a lot of money into this fight,' says Newman. 'Consumers and providers will have to fight this battle together. It?s going to be a tremendous fight, but one I think we can win.'

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