When North Carolina Governor Mike Easley (D) signed “patients’ bill of rights” legislation, the state joined 45 others that have given more legal power to health care consumers.
There’s no gold standard for a patients’ bill of rights, but state measures generally require HMOs to tell patients what services are paid for. Patients also get the right to air complaints and challenge refusals to pay for care. California was the first state to enact a patient’s bill of rights in 1994. To date:
- 48 states prohibit health plans from telling doctors what they can and cannot say to patients;
- 47 states require plans to pay for emergency care;
- 41 states give women direct access (without requiring a referral) to an OB/GYN; and
- 40 states have an appeals process for patients to use if they’re not happy with a doctor’s decision.
Toughest in the Country
State officials say North Carolina’s bill of rights is the toughest in the country. Officials there looked at other state laws and pending federal bills before deciding what their bill of rights would look like.
“We extracted the strongest provisions of all the measures and we even added a few new ones,” says Alan Hirsch, policy director for Easley, who unveiled the legislation last year.
Policymakers decided to give doctors more say in prescribing drugs. Many health plans restrict the drugs they’ll pay for by putting them on a list known as a formulary.
Under North Carolina’s new law, “if a doctor believes a particular drug is needed by a patient, he has the ability to prescribe it” even if it’s not on the formulary, says Hirsch.
Hirsch says in crafting the measure, there wasn’t a lot of discussion about potential congressional action. “We’re not too terribly concerned that Congress would enact a bill that would lower patient protections. We’re reasonably confident our law will stand,” he says.
Federal Proposals Weak
Other states, however, are concerned about what will happen to laws already on the books if a federal patients’ bill of rights measure passes. Some congressional proposals would weaken state mandates.
“The federal patients’ bill of rights is weaker than most of what the states have, and federal lawmakers don’t want to invalidate some of the really good stuff states have done,” says Rachel Morgan of the National Conference of State Legislatures.
“The biggest impact on states is whether they’ll be required to have existing laws certified or whether the feds will grandfather them in,” she says. Full-fledged certification would require the federal government to create a new agency to review what states have done. “It’s a guessing game until Congress gets something in black and white,” Morgan says.
Up to one-third of Americans are largely unaffected by state patients’ rights laws. That’s because most employer-sponsored health plans are regulated by the federal Employee Retirement Security Act (ERISA), and thus are exempt from the state mandates.
Mary Guiden is staff writer for stateline.org