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President Clinton signed off on the federal "Consumer Bill of Rights and Responsibilities" in late November, promising to work for implementation of its recommendations.
The bill of rights, a draft of which received a mixed review from APA last October (Psychiatric News, November 21, 1997), does not have the force of law. But President Clinton said he would take several steps to see that it spurs changes in how consumers interact with health care providers.
From APA’s perspective, the bill of rights’ two major shortcomings are insufficiently strong medical record confidentiality protections and failure to address the issue of mental health care parity. The bill of rights does endorse universal access to health care as a goal, but not a right.
Clinton said he would ask Congress to implement the bill of rights’ recommendations, ask private health plan administrators to comply with its provisions voluntarily, and order federal agencies to see that it is applied to all beneficiaries in federal health programs. If applied to federal health program beneficiaries, it would cover 3.1 million military personnel, 2.8 million federal civilian employees, and approximately 76 million people covered by Medicare and Medicaid. Clinton asked all federal agency health plan administrators to adopt the provisions of the bill of rights if possible and report back to Vice President Albert Gore on where they think legislation would be needed to allow them to implement the provisions.
In contrast to the process that surrounded the President’s initial effort to overhaul health care, which died in Congress in September 1994 following two years of acrimonious debate, the process surrounding the development of the Consumer Bill of Rights and Responsibilities was open and bipartisan, and involved a range of stakeholders including business, health care providers, and consumer representatives. Only one member of the commission, a small-business owner from Arizona, voted against the final bill, complaining that it would impose unacceptable costs on business.
According to an analysis from the Lewin Group Inc., a health care consulting firm, the costs of two key proposals, information disclosure and external appeals, would be relatively modest. Lewin estimated that the monthly cost of information disclosure would range from $0.59 to $2.17 per insured person. The lower figure assumes a three- to five-year phase-in, during which information would become more widely available and the technology of providing that information would improve, according to the analysis.
The estimated monthly cost per insured person of providing external appeals to disgruntled patients would be only 3/10 of a cent to 7 cents.
Although the bill of rights is only indirectly relevant to psychiatry, its goal of providing consumers with a range of guarantees would help protect mental health consumers within the constraints of their plan. In addition to better information and the right to appeal, the bill of rights recommends more choice within health plans, access to emergency care with assurance it will be paid for if any "prudent layperson" would deem an absence of medical attention dangerous, and protection against discrimination in delivery of health care services based on race, ethnicity, national origin, religion, sex, age, sexual orientation, genetic information, source of payment, or mental or physical disability.