Minnesota's Patient Protection Bills

Date: March 9, 1999
Bills: SF 953, SF 52, and SF 967
Committee: Senate Health and Family Security Committee

Mr. Chair and Members of the committee: My name is Twila Brase. I am a registered nurse and President of Citizens' Council on Health Care, a citizen resource on health care policy and practice located in St. Paul.

I am pleased to come before you today to present our analysis of the various patient protection bills. The thrust of my message is patient empowerment. It is very clear that the authors of these bills have heard the complaints of the people including denials of care, ethical conflicts, misleading provider lists, and the "faith walk" consumers take when they sign on the dotted line for a product they can't and aren't allowed to see.
However I am concerned by the frequent use of words with no concrete definitions, such as "prevailing practice," "timely manner," "needed" "appropriate." These are words that the legal profession within the health plan can manipulate to the disadvantage of the patient as has often occured with the term "medical necessity." As before, who decides?
In addition, forbidding health plan discrimation against physicians will not be successful unless the law can guarantee that no physician can be de-selected for any reason by an HMO. De-selection is the real fear of every physician and health care professional. Without that protection, the behavior and decisions of practitioners are controllable by those with power to deprive them of their patients and livelihood. One possible answer was debated at length last year: the Any Willing Provider bill which was strongly opposed by HMOs. Perhaps it could be considered again this year.
Interestingly,these bills all seek to manage the managed care company, potentially increasing bureacracy between patient and practitioner. However, until the root of the problem &emdash; market consolidation and tax inequity&emdash;is removed, I believe you will see annual legislation to deal with every conceivable legal loophole used against patients. Why not just give people the power to not choose managed care? To have real insurance rather than pre-paid health care with no guarantee of access?
Employers are already moving in that direction as they switch from defined benefits to defined contributions. Why not consider improving selection options for those dollars? You could encourage the return of the 60% of insurance companies that have left Minnesota by revamping the utilization review act, repealing the prohibition on for-profit HMOs, and granting a comprehensive state tax deduction for health care expenses, just as Congress is considering on the federal level.
The HMOs have testified that this bill would be the death of HMOs, however, because of managed care Medicaid and MinnesotaCare, we do not expect, at the end of the day, that the legislature will actually bring about the demise of managed care. If that were the intent of the bill, there could be a full repeal of the Utilization Review Act (M.S. 62M).
Assuming therefore that HMOs and managed care are going to be around for awhile, and that many Minnesotans like them&emdash;at least until they get sick&emdash;we suggest that you give Minnesota's HMOs some competition to treat their enrollees with care. Real protection is money in the pocket of patients to choose or not to choose managed care. As legislators, you can help bring these choices back to people who currently have neither choice nor the power that comes with it.
Citizens' Council on Health Care would like to suggest one more patient empowering option: a medical saving account for the upcoming defined contributions, for both the employed and the unemployed, and the self-employed. It seems we are hearing about savings accounts for everything. Education. Social Security. Why not medical care? We respectfully recommend that within this bill you include patient protection that does not leave patients dependent on the time constraints, litigation capability, interpretive definitions, and value judgments of others, but gives patients options outside managed care's creative delay and denial system.
With that kind of option, the rest of this legislation may prove totally unnecessary within a few years. And for that, I'm sure, we could all be grateful. Thank you.