Ensign unsure of stance on managed-care bill

Art Nadler

Thursday, Feb. 19, 1998 | 10:17 a.m.

To support or not support? That is the question.

Rep. John Ensign, R-Nev., listened intently Wednesday to managed-care health officials and patient-rights advocates argue over the pros and cons of pending federal legislation that would regulate the health-care industry on a national level.

The Patient Access to Responsible Care Act (PARCA), introduced by Rep. Charlie Norwood, R-Ga., and Sen. Alfonse D'Amato, R-N.Y., seeks to toughen conditions under which health maintenance organizations (HMOs) can deny care.

Many states have already enacted such legislation, but federally approved Employee Retirement Income Security Act (ERISA) plans are exempt. These include employers who set up their own plans and self-insure their employees. Many resorts on the Las Vegas Strip self-insure. Medicare plans are also not regulated by states.

The Nevada Legislature passed Assembly Bill 156 that, in part, prohibits insurance companies from deciding what doctors can say to patients, outlaws physician payment incentives for denying medical services and mandates emergency room care if the patient and doctor feel it is an emergency.

PARCA, in comparison, would include everything in AB 156 plus more stringent regulations.

"The more you mandate, the higher the premium costs," Ensign said. "Government is already (regulating) in health care. Do we put more of it in health care, or not?"

Ensign said he is undecided about supporting PARCA.

"Is health care a right? If it is, at what level?" Ensign asked. "We cannot afford it at the highest level to where you get all you want."

Kayla Callas, director of public affairs and regulatory compliance for PacifiCare, and Maria Soldo, chairman of the Nevada Association of Health Plans, both agreed that HMOs in Nevada have been able to live with AB 156. But Soldo questioned whether more regulations were necessary.

"There has to be a federal plan because at the state level, you can't cover ERISA," argued Lawrence Matheis, executive director of the Nevada State Medical Association. "We have to fill the gaps."

Ensign said he expects major political fights over PARCA. Momentum so far, he added, has been to pass the bill.

Dr. Robert Shreck, a Las Vegas family practice physician, said his main concern has been over how HMOs became involved in the relationships between physicians and patients.

"When that relationship is disrupted, there is a loss of quality of care," Shreck said. "Often times, I feel specialists only want to see patients certain times of the day because of the cost factors (as determined by HMOs.)"

Ensign said he felt the forum sparked healthy discussions.

One controversial provision of PARCA, for example, seeks to allow ERISA employees the right to sue their employers or the insurance companies with whom the employers have contracts. Presently, ERISA employees can only sue physicians or hospitals.

Opponents of this provision argue that it would raise premiums and increase frivolous lawsuits.