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Baucus Health Plan Won't Rein in Health Insurer Price Gouging of Middle Class; Consumer Watchdog Calls for 'Prior Approval' Rate Regulation in Health Reform
Date:9/16/2009

The Baucus plan fails to close a loophole in existing law that bars many Americans from holding health insurance companies and HMOs financially accountable. 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 procedure or service denied in the first place -- no damages or penalties are allowed. As a result, HMOs and insurers are largely free to deny access to care without fear of reprisal or financial consequences.

** Explains why efforts to use health insurance cooperatives ("co-ops") as a vehicle to gut state consumer protection laws would be devastating to consumers and business owners. The Baucus plan would would open the door to deregulation of health insurance by allowing insurance companies that participate in "health care compacts" to choose the weakest state law to govern all their policies, regardless of which state the policies are sold in. The loss of state health benefit requirements could allow exclusion of preventive treatments and exams and prevent early diagnosis of disease, though apparently the state where the consumer lives would retain some authority to address market conduct, unfair trade practices, network adequacy and consumer protection standards.

Consumer Watchdog is a nonpartisan consumer advocacy organization with offices in Washington, D.C. and Santa Monica, CA. Find us on the web at: http://www.ConsumerWatchdog.org.


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SOURCE Consumer Watchdog
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