AARP Official Weighs In on Patients’ Rights

The New York Times on Nov. 26 spotlighted John Rother, director of legislative and public policy for AARP, in its "Five Questions" series. The topic of discussion was the new patients' rights rules issued by President Clinton last week, which apply to those individuals covered by private insurance. The rules, which "promise quicker decisions" for patients involved in disputes with managed care companies and allow patients the right to appeal when insurance claims are denied, are slated to take effect in 2002. Rother said the rules would be beneficial to consumers and should pose "no big problem" for insurers, since "most well-run health plans" already comply with these regulations. The Times questions and Rother's answers are highlighted below:

• "What difference will the rules make to the public?" Rother stated that the regulations will be a "major step forward toward fairness for most consumers." Rother added that the rules will establish both "reasonable time limits" and "expedited internal appeals inside the plan for resolving complaints." In addition, any disputes will have to be reviewed by an "appropriately trained professional" -- not a "bureaucrat or a clerk." Rother also noted that the regulations' provisions for disclosure allow patients to "actually get some information about who is making these decisions and on what basis."
• "Might these rules be overturned by Congress or the new president?" Although he hopes Congress will allow the rules to take effect, Rother said that their future could "depen[d] on which administration is elected." However, he added, "They are final rules. It would be very unusual for a secretary of labor to reopen final rules. As a practical matter, it would be up to Congress."
• "Do these rules help or hinder the chances that a new Congress will enact a patients' rights law that may include a right to sue health plans?" Although Rother believes Congress "still needs to resolve" the issue of patient litigation, he said that he does not think the current rules will have a "great impact" on future consideration of the issue. "[The current regulations] do not and cannot address external review such as lawsuits," he added. Rother noted that the recent elections resulted in an "increase in the support for a stronger protection law, especially in the Senate," which has previously blocked the House-passed Norwood-Dingell patients' rights bill (H.R. 2723) that included a right-to-sue provision.
• "Industry spokesmen say the new rules will add to legal and other expenses of health plans and could lead to higher premiums and more people joining the 40 million without coverage. What do you think?" Rother stated that health plans "are already subject to similar requirements under Medicare and the accreditation requirements of the National Committee for Quality Assurance." He added that additional compliance costs will probably be "minimal" and are likely to occur "only in plans that are not already accredited by NCQA."
• "Some Wall Street analysts say that the costs of complying will overwhelm smaller health plans, which are already financially strained. Isn't that bad for consumers?" Stating that most "well-run" health plans currently meet most of the requirements, Rother added that if a health plan was unable to meet the guidelines, "they would not be, in all probability, in a good position to serve consumers very well." (Freudenheim, New York Times, 11/26).