News Bits from MichUHCAN February 1999 Newsletter

The congressional commission on Medicare is expected to propose paying each beneficiary a fixed amount to buy private health insurance. (Beneficiaries could also stick with traditional Medicare.) Private insurers could be expected to either pick up the healthiest, most lucrative beneficiaries or drop out - as they did last year under a similar plan.

Three Republican senators said in January that they're pushing along their HMO "reform" plan during the impeachment trial. The plan provides for medical savings accounts, external reviews, and tax deductions, but doesn't let patients sue their HMO for damages.

Aetna, Inc. will be the nation's largest health insurer, with 22 million members, if it takes over Prudential HealthCare as planned. After the merger Aetna will have almost 60% of managed care members in Huston and 39 percent in Philadelphia. The AMA opposes the merger because of potential effects on doctors' income.

A training video showed Aetna execs telling staff to process claims differently for cases covered by ERISA. ERISA, the federal benefits law, prevents patients from suing their insurer for damages. Claims analysts were told to be more careful with non-ERISA claims since Aetna could be sued over those. Under pressure, Aetna said it will allow external reviews of decisions to deny care in 30 states.