were enrolled in some sort of managed care health plan (the most common of which are health maintenance organizations, or HMOs, and preferred provider organizations, or PPOs). That's up from 36 percent in 1992. The increase is due in large part to employers shifting their workers away from the traditional an considerably more expensive "fee-for-service" health insurance plans. (About 16 percent of Americans have no health insurance at all.) Candidates in 1998 responded to public furor against managed care with proposals establishing certain "patients' rights." Both parties are promising action on the issue, but Republicans and Democrats are offering different prescriptions.LegislationBoth parties claim they support the idea of codifying what people should get from their health plans, and polls show that no other action by Congress would be as welcomed by the American people. Driving the debate on the issue is a Democratic proposal that would establish "patients' rights" to: Appeal denials of services and benefits by a health plan to an outside body; Access a specialist when needed; Use doctors outside the plan (for a larger fee); Use emergency services if the symptoms justify alarm, even if the problem proves not to be a genuine emergency; Get an understandable explanation of coverage rules; Sue an employer-sponsored health plan for damages. Senate Republicans killed this plan in October, saying that while they too favor patients' rights, the emocratic bill called for too much regulation and would have made HMOs too vulnerable to lawsuits. Democrats vowed to fight for the bill again in 1999.The IndustryAll this comes when the managed care industry is struggling. Many health care plans held their rates at unprofitable levels during a long industry price war in an attempt to grab market share. Now they want to increase their profitability, analysts say. However, they have already reaped the easy savings by squeezing payments to doctors ...
