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Baucus Co-Op Plan Would Gut State Laws; Consumer Watchdog Report Calls for 'Prior Approval' Rate Regulation in Health Reform, Not Deregulation of State Consumer Protection Laws
Date:9/8/2009

"public option" in a national health reform plan. Enzi likened the co-ops to his 2006 proposal for "association health plans," embodied in his bill S. 1955, which would have exempted health policies from oversight by state laws and courts. The measure failed in the U.S. Senate.

The major problems of the Enzi approach to health insurance co-ops include:

** Loss of state benefit mandates would allow exclusion of preventive treatments and exams, prevent early diagnosis of disease and evade Patient Bill of Rights laws passed in nearly every state. Denying access to such basic preventive care makes treatment more costly to the policyholder and ultimately to taxpayers, who pick up the bill when individuals cannot pay outrageous out-of-pocket costs.

** State laws providing consumers the right to appeal a coverage denial to an independent panel of physicians, a right to a second opinion, and assistance from state regulators when coverage is denied would all be lost under the Enzi approach.

** Individual patients who currently have the ability to hold insurers financially accountable for injuries caused by the denial or delay of necessary care would lose those rights if they joined the Enzi co-op.

Legal Accountability: The Missing Link

The Consumer Watchdog report also discusses the need to increase the legal accountability of health insurance companies, a concept supported by Congressional Democrats in 2001 and championed by Senator Edward Kennedy. A 2001 bill authored by Kennedy passed the Senate but died in the House.

Currently, for patients who receive health coverage through a private employer, HMOs and health insurers face no financial consequences for mishandling claims. Under the Employee Retirement Income Security Act (ERISA), lawsuits are removed to federal court where victims can only recover the cost of the proce
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SOURCE Consumer Watchdog
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