Democrats said today they would press the General Assembly to subsidize prescription drugs for the elderly and disabled, allow patients to sue health maintenance organizations and give patients more freedom to choose doctors.
The health care proposals are likely to rekindle the last session's debate over expanding patients' rights while controlling health care costs. Similar debates are underway in Congress and dozens of states, including Maryland.
The Virginia Democrats, a minority in both houses of the General Assembly following last fall's elections, said immediate action is needed to address health issues that have generated intense concern from constituents.
Sen. Mary Margaret Whipple (D-Arlington) urged approval of the party's proposals because they would help "put decision-making authority in the hands of individual citizens and their families."
"Choices in doctors and being able to hold HMOs accountable empowers people to be able to make more of their own medical decisions," she said.
Last year, the General Assembly approved legislation that provides new safeguards for people enrolled in managed care plans. But it nixed a Democratic proposal to allow patients to sue their health insurance plans if they believe they have been denied needed service.
Mark A. Miner, a spokesman for Gov. James S. Gilmore III (R), said he would not comment without seeing proposed legislation.
Some other Republicans were quick to dismiss the Democrats' proposals. They said allowing patients to sue would drive up insurance premiums, leaving some lower-income residents unable to afford coverage.
S. Vance Wilkins Jr. (R-Amherst), the speaker of the House, said the measure would "make your insurance cost more, your premiums go up and you can't afford it. . . . If I thought it would add to the medical care, I would consider it."
Walter Cherniak, a spokesman for Aetna U.S. Healthcare, whose HMO insures about 190,000 in Virginia, said allowing patients to sue would force Aetna to carry liability insurance and boost costs.
"The ability to sue HMOs would do nothing to improve the quality of care that Virginians receive," Cherniak said. "What they would do is continue to drive up premiums for everyone."
Congress has been considering patients' rights measures, including the ability to sue HMOs. But as debate in Washington has continued, states have started taking up the measures on their own.
In Maryland, House Speaker Casper R. Taylor Jr. (D-Allegany) opened this year's legislative session by submitting an expansive package of health care proposals aimed at ensuring coverage for children and the working poor.
Included are proposals that would greatly expand the number of people eligible for the state's children and family health care program and guarantee coverage for people who otherwise would be classified as "high risk."
House Majority Leader John A. Hurson (D-Montgomery) has submitted a measure to prevent insurance companies from denying coverage to children born with disabilities.
Although Democrats control Maryland government, the bills are likely to find a better reception in the House than in the Senate, and their chances of becoming law are unclear at this early stage in the session.
Only California, Georgia and Texas have enacted laws allowing patients to sue their HMOs, said Richard Cauchi, a policy specialist with the National Conference of State Legislatures. But 33 states indicated in December that they would consider such measures this year, he said. Many states also are considering--or already have approved--the other measures proposed by Virginia's Democrats.
Under the proposals unveiled today, Democrats called for spending $10 million a year to subsidize prescriptions for those over 65 or disabled. Eligibility would be linked to income. Democrats want to fund the program using a portion of the state's share of the national tobacco settlement.
Under the Democrats' proposal, insurance company clients who suffered harm would be able to file suit following an HMO's decision not to provide coverage. Lawmakers said that measure was needed to hold insurers accountable.
"Right now," said Del. Vivian E. Watts (D-Fairfax), "the only thing there is accountability to is the bottom line."
Democrats also called for legislation that would force HMOs to pay doctors out of their network the same amount they pay doctors in their network. HMOs would not be able to penalize policyholders for using doctors out of networks.
Legislation approved last year created a managed-care ombudsman to assist policyholders with appeals against health insurance providers. Since that office was created in July, ombudsman Thomas S. Bridenstine said, it has helped residents with 114 appeals.
"We're talking the person through the process, sometimes suggesting strategies to use in their appeal," Bridenstine said.
Beginning in July, policyholders can demand a hearing before an independent panel overseen by the state bureau of insurance. The panel's ruling would be binding on all parties.
Staff writer Matthew Mosk contributed to this report.