31 Oct Sweating The Details: Health Reform Supporters Fret Over HHS Rules

Publicly, consumer and patient advocates continue to cheer wildly for last year’s health care law.

Behind the scenes, however, some worry that they are losing a few key battles to the insurance and business communities.

They point to a long-sought provision in the law that entitles patients to an external review if an insurer won’t pay for a medical service, but charge that recent regulations limit its effectiveness. One of their biggest gripes? It allows insurers to choose their own “external” reviewers.

“Advocates who have dealt with the external review process believe that it’s pretty clear that if [a reviewer] is being chosen by an employer [or insurer] it’s not independent,” said Timothy Jost, a professor at Washington and Lee University School of Law.

While consumers should be happy with some regulations, including one requiring health plans to summarize in simple language what their policies cover, Jost notes that other rules “feel like somebody from the Chamber of Commerce got to somebody in the administration.” He points to regulations that he believes are “more friendly” to employers and insurers than to individual consumers.

Erin Shields, a spokesperson for the Department of Health and Human Services, said the administration is balancing multiple interests as it implements the law. “The Affordable Care Act provides some of the most important protections for health care consumers in history,” Shields said. “As we implement these protections, we are working to ensure a balanced approach toward all stakeholders including patients, caregivers, doctors, hospitals, employers, and insurers to ensure that our system continues to provide world-class care effectively.”

By Mary Agnes Carey and Marilyn Werber Serafini