CONTACT:
Brian Lindberg (202) 789-3606
Andrew Webber

Since its inception in 1993, the Coalition has been a strong advocate for public policies and programs that protect and improve the quality of health care for all Americans. Coalition members have always looked to the Medicare and Medicaid programs as useful, albeit incomplete, models for consumer protection and quality assurance. The strong provisions in the existing Medicaid statute for independent beneficiary appeals, external quality monitoring and review, facility and plan standards, data and information reporting serve as a initial benchmark against which other proposals are measured by the Coalition.

Given this history and perspective, it is sadly ironic that the Republican leadership's Medicaid proposal does not come close to meeting the Coalition's standard for a comprehensive quality assurance system. In fact, by creating a block grant system, the proposal effectively eliminates existing federal quality protections for Medicaid beneficiaries.

The Coalition does appreciate and acknowledge that, at long last, consumer protections in nursing homes were retained. However, the obvious next question must be asked: if consumer protection and quality assurance safeguards are appropriate for Medicaid nursing home residents, why not for beneficiaries in all participating Medicaid facilities and plans?

The Coalition's most serious concern regarding the proposed Medicaid legislation is the absence of federal quality protections for beneficiaries enrolled in managed care plans. As more and more states turn to managed care as a panacea for escalating costs, Medicaid beneficiaries are being enrolled in prepaid plans at alarming rates. Consumer protections are needed now more than ever.

Specifically, the Coalition urges Congress to retain the existing federal provisions for independent beneficiary appeals and external quality review (EQRO) of managed care plans. Consistent with Coalition principles, we also urge that all Medicaid beneficiaries be provided a choice of health care plans and useful information to select plans. Finally, given the fiscal incentives of prepaid health care to underserve people, the Medicaid system must have the capacity to monitor beneficiary access to health care services. The federal government could greatly facilitate this oversight initiative by setting federal standards for the establishment of a uniform patient encounter data system for managed care plans participating in the Medicaid program. Such a system would provide a strong foundation for state monitoring of all aspects of patient care, most particularly access concerns.

If for no other reason than fiduciary responsibility demands it, the federal government cannot and must not abdicate its responsibility for assuring and improving the quality of care received by all Medicaid beneficiaries. With the managed care revolution sweeping the country, now is the critical time to expand - not repeal - consumer protection and quality assurance provisions in the Medicaid program. The Coalition joins the Campaign for Health Security in opposing Medicaid legislation - H.R. 3507 and S. 1795.

The Consumer Coalition for Quality Health Care is an advocacy organization fighting for policies and programs to protect, assure and improve the quality of health care for all Americans. Coalition members are a diverse group of consumer and union organizations representing over 30 million Americans.

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