All 50 states have enacted statutory protections designed to help ensure that consumers and patients accessing health care insurance (via health insurance plans licensed and regulated at the state level) are treated fairly by their insurance plan and not denied access to the care – including care provided by doctors of optometry – that they need and are entitled to receive. Most state-level protections have been in place for a period of many years – and, typically, they were enacted by state legislatures in response to well-documented instances of insurance plan abuses that harmed consumers and denied them access to appropriate health care services and/or benefits.
Unfortunately, millions of Americans do not enjoy the protection of these state laws because they receive their health care through insurance plans that operate under the authority of the Federal ERISA statute (Employee Retirement Income Security Act). ERISA plans tend to be large-sized insurance plans offered by multi-state employers. Most ERISA plans are “self insured” plans that adhere to a managed care model of health care.
It is important to note that health insurance plans organized under ERISA are not subject to state enacted patient and consumer protections because ERISA preempts state law. Federal consumer and patient protections (similar to those that exist at the state level) have not been enacted into law. Accordingly, beneficiaries under ERISA plans have no safeguards to protect them against health plan abuses.
Concurrent with the explosive growth of managed care ERISA plans in the 1990s, and a number of well-publicized abuses by the managed care industry, Congress began debating the enactment of a Federal “Patients Bill of Rights” to establish a set of Federal protections fully applicable to ERISA plans. In previous sessions of Congress, both the U.S. Senate and the House have each separately approved patient protection bills. However, no final Patients Bill of Rights has been enacted into law.
In an effort to ensure that the new 110th Congress would make this a priority issue, Rep. Charlie Norwood (R-GA), a longtime champion of a comprehensive patients’ bill of rights, re-introduced his legislation in February 2007. Although Rep. Norwood died a few days later, his re-introduced bill – designated HR 979 – is serving as a starting point for discussions in Congress about health care legislation. Rep. John Dingell (D-MI), another longtime patients’ bill of rights champion, and a leading voice in Congress on access to care issues, is the original co-sponsor of HR 979.