Congress Views Bills To Control Managed Care

The US Congress now seems likely to set standards for healthmaintenance organizations, although employers oppose any new rules for fear this would get in the way of their controlling costs for employee benefits through managed care. Also, HMOs say they want to protect consumers but do not want any more regulations.

Congress says it is acting in response to constituents' complaints. Senator Edward Kennedy who, with Representative John Dingell, has introduced a plan to regulate managed care and protect patients' rights, says profits rather than better health has become the priority for many MCOs. Some Members of Congress also feel legislation is needed to protect doctors' abilities to exercise professional judgement.

Congress is undecided how comprehensive to make these rules or how to enforce them. It is virtually certain to pass piecemeal legislation setting standards for specific services if managed care does block comprehensive regulation, said Sen Kennedy. HMOs say complaints are only anecdotal, but they have adopted voluntary standards; Congress applauds this as self-regulation but says it will not stop it from trying to set enforceable federal standards.