Chapter 9.B (or 3.B) -- Insurance Regulation and Managed Care
Many elements of health insurance regulation will become federalized
as a result of comprehensive health care reform. For instance,
the federal law adopts several managed care "patient protection"
provisions relating to choice of primary care physicians, access to
emergency care, and coverage of "alternative" (non-physician)
practitioners (such as chiropractors and licensed naturopaths).
Also, it requires the new health insurance
exchanges to enforce numerous requirements for participating insurers
to be certified as "qualified health plans." And, it sets limits
on how much of insurance premiums can go toward corporate profit and
administrative overhead. See updates to subsection A for additional information.
The American Association of Health Plans web site has a variety of information about HMO quality and the debate over regulation. For contrasting sources that collect HMO horror stories and negative news clippings, cartoons, etc. see: http://harp.org/ http://www.hmopage.org/ http://www.dranonymous.com/
See also Man Succumbs To 7-Year Battle With Health Insurance, The Onion (Sept. 22, 2008).
The physician who Debra Moran sought out for treatment has the following website promoting her success with restorative microsurgery for treatment of peripheral nerve paralysisthis: http://jkterzis.com/
An excellent textbook on health insurance economics and regulation generally is is Michael A. Morrisey, Health Insurance (2008).
On HMOs, see Jan Coombs, The Rise and Fall of HMOs: An American Health Care Revolution (2005).
A thorough, in-depth primer on health insurance regulation is Timothy Jost, The Regulation of Private Health Insurance (2009).
Return to home page.