Doctors call it the Patient Protection Act. HMOs call it an "any-willing-provider" law.
Soon, it will be Texas Gov. George Bush Jr.'s call as to whether the controversial measure, recently approved by the state Legislature, becomes law.
Although other states have passed similar legislation, proponents describe the Texas bill as the most comprehen-sive reform package affecting HMOs and their relationships with hospitals, physicians and patients.
Bush has until June 18 to veto, sign or allow the bill to become law without his signature. Last week, Statehouse officials said he was still undecided amid an escalating campaign by both sides.
The Texas Medical Association spearheaded the bill's push through the Legislature. It is designed to give consumers more information about their health plans as well as give physicians and hospitals more information about why they're selected or dropped from a provider panel.
Being dropped from an HMO provider panel-called deselection-is a point of contention with the TMA, which is suing Aetna Life Insurance Co. over the deselection of 37 Texas physicians last year. The case provided the TMA with a real-life example to use in lobbying for the bill.
"There's been a tremendous amount of disinformation" surrounding the bill, said Connie Barron, the TMA's associate director of legal affairs. As an ex- ample, she cites HMOs' labeling of the bill as an "any-willing-provider" law. Any-willing-provider laws require plans to accept providers if they meet specific criteria, which "blows up plans' ability to use capitation," she said.
This bill is different, she said, adding, "We never meant for (the Patient Protection Act) to be an anti-managed-care piece of legislation."
Yet, many HMOs are interpreting it that way. Last month, the industry ran a full-page ad in the Austin American-Statesman saying the bill would cost consumers and businesses millions of dollars because its requirements would raise costs and premiums.
Patrick Feyen, president and chief executive officer of PacifiCare of Texas, says the legislation wouldn't fly in other industries. "If an oil company decided a certain supplier provided a better product at a better price, the company could make the decision to change suppliers," Feyen said.
PacifiCare, which covers 66,000 commercial enrollees in Texas, said the bill "doesn't allow competition to drive the system."
Throughout its journey, the legislation kicked up controversy. At one point, some HMOs and hospital-based health plans, such as those sponsored by Scott and White Memorial Hospital in Temple and Harris Methodist Health System in Fort Worth, were exempted. "We felt if anyone were to be exempted, we should be exempted," said Patrick Spears, senior vice president at Harris. However, when other exemptions were dropped Harris dropped its push to be exempted as well, he said.
An exemption remained in the bill for plans affiliated with medical schools. Barron said she was unsure how many plans that would affect.
`We never meant for (the bill) to be anti-managed care.' Connie Barron