Clinton and Gore Try to Side-Step Congress

Congress has been passing health care reform back and forth, but no agreements have been reached. Now that the legislative session is about to come to a close, it is clear no new laws will be passed in the area of health care reform this year. But that isn’t stopping President Clinton.

The New York Times yesterday revealed Clinton’s plan to release a new set of health care rules for patients in time for the November election. The mandates, which will be issued by the Department of Labor, will include these provisions:

  • Health plans will have 15 days to decide whether a claim will be covered, 72 hours if the claim is of an emergency nature. The plans will have 30 day to rule on an appeal.

  • Denials of claims will be required to be accompanied by specific reasons for the denial, including policies, guidelines, or other criteria used in making the decision.

  • If a health plan refuses to authorize an operation, the act is the equivalent of denial of a claim and may be appealed by the patient.

  • No benefits may be reduced or terminated by a health plan without first notifying the patient, and the patient is entitled to a hearing before the change occurs.

  • Persons hearing appeals relating to medical claims must seek the testimony of an unbiased medical expert on any question involving medical judgment.
  • The Department of Labor claims it has the authority to issue mandates such as these under the rules of the 1974 Employee Retirement Income Security Act, which regulates health and pension benefits. DOL officials claim they are ready to issue the mandates as soon as they get the word from the White House, and that they have been advised that they will receive that word prior to the November 7 election.

    Republicans in Congress arguing against the mandates claim that such rules will force the cost of health insurance to skyrocket and the result will be fewer Americans will be able to afford health insurance. Insurance companies and employers claim the cost of these mandates will be two to three times that which the Clinton administration is estimating.

    Should George Bush be elected, he would have the ability to alter these regulations, however he has let similar rules take effect in Texas.

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