No doubt about it, managed care is sweeping the country, and while it has done a fair job at containing costs, in some cases MCOs are clearly out of control, and families are suffering. We need to make sure that doesn't happen here.
In the ten years that I have been involved in the legislature as a staffer, lobbyist, and legislator I have witnessed managed care organizations oppose one patient protection measure after another. Not only is one insurer, BCBSMT, exempt from state taxes, they have rolled up huge reserves, using their non-profit status to do it. I have witnessed BCBSMT fight bills that would allow physicians to discuss treatment plans with their patients, as well as financial incentives in their contracts; and saw them work behind the scenes when a bill sought to allow patients their choice of physicians.
The MCOs most recent opposition was to a bill that would have made MCOs who put profits ahead of patients be held to the same standards that the physicians who treat them must meet. If a patient and physician agreed on a treatment plan that an independent physican felt was necessary too, a managed care company would be obliged to pay for the treatment or be held liable in court. The way it is now, a patient and his physician are just plain stuck if the MCO refuses.
Because attempts at reform were met with the charge that any reform would force companies to increase their premiums, I decided to take a look at what the biggest insurer, BCBSMT, reported to the Insurance Commissioner. Their financial statement reveals huge compensation increases to their officers, an enormous marketing and advertising budget, and a travel budget that exceeds a million dollars.
Because of my extensive involvement with healthcare issues over the last decade, I decided to take a closer look at the internal workings of MCO dealings and contract practices. The public deserves to know these facts, the next time premium increases roll around. Legislators need this information, so that they can question the threat for a premium increase every time a legislative reform is proposed. Benefit managers need to know so that when they decide where to insure their employees, they can be assured that those families will have the best healthcare possible at a price that they can afford.
The last ten years fighting for the rights of healthcare consumers have taught me a lot. One of the most important lessons is that when right is on your side, you can tangle with the big guys and win. The reforms I mentioned above were bitter battles, but for the most part the citizens were protected, in spite of the best efforts and the big money spent by the MCOs.
Here at ACHE we will work with patients, physicians and businesses statewide to wiN the quality healthcare all Montanans deserve. It will take hard work and homework, so please join us. There is a lot of work to be done.

M. Susan Good

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