WHEREAS:

Over 85 percent of working families and half of Medicaid beneficiaries are enrolled in HMOs and other forms of managed care, while the number of Medicare managed care enrollees is growing by over 100,000 each month; and

WHEREAS:

Three out of four HMOs are for-profit plans, covering two out of every three enrollees; and

WHEREAS:

Managed care plans and other insurance companies that put profits ahead of patients often block access to needed services and specialists, refuse to pay for emergency room care, overrule treatment decisions by health care professionals, discriminate against health care providers who provide high-cost services or serve vulnerable populations, and engage in other cost-cutting measures that jeopardize health care quality; and

WHEREAS:

Arbitrary limits by managed care plans have contributed to an 18 percent drop in the average length of hospital stays over the last five years, while patients receive fewer home health visits and one in three are not warned about "danger signals" or possible side effects from early discharge; and

WHEREAS:

Increased reliance on managed care in Medicaid and Medicare is having a negative effect on some safety net health services and the ability to provide quality care to all beneficiaries; and

WHEREAS:

Over 50 percent of consumers believe that the health insurance system has gotten worse over the last four years, 45 percent have either personally experienced problems with managed care or know someone who has, and only 10 percent believe that managed care plans put patients ahead of profits; and

WHEREAS:

A near majority of health care professionals (45 percent) believe that quality is getting worse, but one out of four are afraid to speak out on the job about their concerns because of the threat of retaliation; and

WHEREAS:

Managed care plans that reduce premiums by lowering quality and restricting access to needed services create pressure on higher-quality plans to reduce quality in order to be competitive, leading some not-for-profit plans such as Kaiser Permanente to call for federal patient protection standards; and

WHEREAS:

The President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry has recommended comprehensive standards to protect all patients against abuses by managed care and other health insurance companies; and

WHEREAS:

Over 85 percent of consumers, including union members, support patient protections and 78 percent believe that their own families would benefit as a result; and

WHEREAS:

Independent cost studies conducted for the Kaiser Family Foundation by Coopers & Lybrand concluded that comprehensive patient protection standards would increase the average annual family premium by only $31 to $40, or less than 1 percent; and

WHEREAS:

Over 40 states have enacted at least some of the protections recommended by the President’s Quality Commission. While these laws generally cover public employees in those states, many do not apply to the 125 million Americans in private sector employment-based plans because of the Employee Retirement Income Security Act (ERISA).

THEREFORE BE IT RESOLVED:

That AFSCME strongly supports federal legislation to enact comprehensive patient protection standards that improve health care quality while assuring access to affordable care; and

BE IT FURTHER RESOLVED:

That AFSCME will fight to include strong health care worker protections in federal legislation and regulations, understanding that front-line workers are the best defenders of high-quality care; and

BE IT FURTHER RESOLVED:

That AFSCME will continue its efforts to protect and improve safety net health services at the federal and state levels; and

BE IT FINALLY RESOLVED:

That AFSCME will educate both our membership and the general public on the need for comprehensive patient protections for all consumers, including Medicare and Medicaid beneficiaries.

SUBMITTED BY:

Henry Nicholas, President and Delegate 
Victor Garcia, Secretary and Delegate 
1199 NUHHCE/AFSCME