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1996 proved to be a year of defensive maneuvers for the Consumer Coalition and its allies. The attacks on Medicare and Medicaid by the Republican Congress was a rallying cry for consumer interests. Thanks to the Clinton Administration and election year politics, we enter 1997 with both programs and existing consumer protections largely intact.

Another, at least partial, victory for consumers was passage of the Kennedy-Kassebaum bill. Albeit a modest proposal that does little to address the real needs of the uninsured, it did signal the willingness of Congress to move forward on incremental health insurance reforms. The Kennedy-Kassebaum bill also signaled public awareness of managed care quality concerns. The bill included a provision allowing women a 48 hour maternity stay in hospitals. President Clinton, recognizing the growing anxiety with managed care, announced he would form a President’s Commission on Consumer Protection and Quality in the Health Care Industry.

Congress’ New Year's Resolution on Health Policy

Last year’s health policy themes and legislative initiatives set the backdrop for 1997 and a newly elected Congress. In reality, little has changed. With both political parties committed to balancing the federal budget, reducing Medicare and Medicaid expenditures becomes the immediate priority for Congress and the Clinton Administration. Also high on the radar screen will be managed care’s emergence as the dominant form of health care delivery and financing. Both of these federal health priorities present risks and opportunities for the Coalition as we work to protect, assure and improve the quality of health care for all Americans.

Medicare

A Republican Congress will continue to push for the privatization of Medicare and expanded health plan choices for Medicare beneficiaries. In this context, the need for adequate quality and consumer protections will be paramount, representing a real opportunity to advance Coalition interests. Consistent with its model legislation for managed care, the Coalition will be advocating for a comprehensive system of quality accountability, including: rigorous internal plan standards for any private plan doing business with Medicare; an independent enrollment system; public access to comparative performance data to help inform beneficiary choice of plan; an independent grievance and appeals process; an external review and improvement program; and a expanded beneficiary assistance and ombudsman initiative.

Medicaid

The governors will, in all likelihood, press their agenda of maximum state flexibility to administer and run Medicaid free of federal mandates. The Coalition, once again, will actively work to maintain existing consumer and quality protections, including nursing home standards; the Medicaid managed care waiver process that sets important federal quality and consumer participation standards; and external quality review.

Managed Care

On a more positive note, the 105th Congress might well consider enhanced oversight of managed care in the private sector. ERISA remains a largely unregulated program, particularly as it relates to needed consumer rights and protections. Growing public anxiety might force Congress to find the political will to advance important consumer and quality protections. The Coalition will be working aggressively to pass grievance, appeals and remedy rights in private sector managed care plans.

In 1997, as in previous years, the Coalition will join forces with other consumer coalitions when our interests and agendas overlap. Other coalitions that we are actively working with include the Health Security Campaign, the Medicaid Strategy Group, and the Long Term Care Campaign. Brian Lindberg, Executive Director, and Andy Webber, Senior Associate, will take the lead in directing the Coalition’s federal advocacy efforts.