WASHINGTON ó Publicly, consumer and patient advocates continue to cheer wildly for last year’s health-care law. Behind the scenes, however, some worry that they’re losing a few key battles to the insurance and business communities.|By Mary Agnes Carey and Marilyn Serafini, Kaiser Health News
WASHINGTON ó Publicly, consumer and patient advocates continue to cheer wildly for last year’s health-care law. Behind the scenes, however, some worry that they’re losing a few key battles to the insurance and business communities.
They point to a long-sought provision in the law that entitles patients to external reviews if insurers won’t pay for a medical service, and they charge that recent regulations limit its effectiveness. One of their biggest gripes? It allows insurers to choose their own “external” reviewers.
“Advocates who have dealt with the external review process believe that it’s pretty clear that if (a reviewer) is being chosen by an employer (or insurer) it’s not independent,” said Timothy Jost, a professor at Washington and Lee University School of Law.
Erin Shields, a spokeswoman for the Department of Health and Human Services, said the administration is “working to ensure a balanced approach” toward all stakeholders. “The Affordable Care Act provides some of the most important protections for health-care consumers in history,” Shields said.
With more regulations on the way, including one that will define which benefits insurers must include in many health plans, some consumer and patient advocates worry that the appeals rule could be a harbinger of things to come.
One former Obama administration official said there was cause for concern.
“There’s been a growing sentiment (in the administration), and it’s been there from the beginning, even before health reform passed, of bending to business. Now it’s reaching the boiling point,” said the former White House official, who spoke only on the condition of anonymity because of the issue’s sensitivity.
To be sure, how these rules are written can significantly help ó or hurt ó consumers, insurers and businesses, and that presents the White House with a tough balancing act. While it needs to reassure individuals that the law won’t disrupt their current coverage or make it more expensive, the White House also has to appease the employers and insurers who must make that happen.
Even when they feel slighted, consumer and patient groups are reluctant to complain.
“There is a sentiment in the health-care community that they don’t want to push too hard,” said Carmen Balber, the director of Consumer Watchdog’s Washington office.
Consumer advocates are well aware that any controversy surrounding an implementation decision that favors them could be used by opponents as another argument to repeal the law or defeat Obama in 2012.
“They all understand that, if he loses, the law and all of its patient protections, including, of course, all of the insurance reforms and coverage expansions, will be at severe peril,” said Chris Jennings, a health-care consultant who was a senior health care adviser to President Bill Clinton.|