Broad anti-managed-care legislation failed in most states last year, an indication public officials view managed care as a way of solving access and cost problems, the Blue Cross and Blue Shield Association concluded in a report released last week.
The report warned, however, that this year "lawmakers will continue to refine managed care in response to provider and consumer grievances."
That warning already is coming true in a number of states, including Massachusetts, New Hampshire and New Jersey (See related stories, p. 64).
The Blues association surveyed its 59 independent plans at the close of their state legislative sessions to prepare the report.
In 1996, "old-fashioned any-willing-provider bills were introduced in a third of the states and uniformly rejected," the report said. Such laws require plans to accept any provider that meets their participation criteria.
One of the most comprehensive state any-willing-provider laws enacted in the country, passed by the Arkansas Legislature in 1995, was recently struck down by a federal judge (Feb. 10, p. 6).
Instead, the report said, "relatively minor bills" in some states allow direct access to some specialists and 17 states banned so-called "gag clauses." The study also found "a new generation of mandated-benefit bills that seek to legislate the medical policies of health plans became popular," including legislation to require insurers to pay for 48 hours of maternity hospital care, the report said.
In four states, health plans and provider groups reached voluntary agreements on some of those issues, avoiding legislation, the report said.
This year, the Blues association expects some states "to take a broad regulatory approach . . . by bundling the issues of provider contracting, grievance procedures and quality assurance into a single reform proposal." Other states will target single issues such as disclosure of provider financial incentives.
Lawmakers in at least four states are expected to address mandated coverage of emergency services, mental healthcare parity and minimum hospital stays for mastectomies.
Several states are likely to require legislative approval for not-for-profit health plans to convert to stock or mutual companies and for the conversion of not-for-profit hospitals and Blue Cross and Blue Shield plans, the report said.
Meanwhile, state regulators will study the regulation of provider-sponsored networks seeking to contract directly with employers, the report said.