HMO legislation is aimed at protecting patients; consumers and providers call for regulation; the managed care industry would disagree

Article Abstract:

More consumers call for regulation of managed care plans and health maintenance organizations as the percentage of people covered by such plans increases. The percentage of people covered by managed care plans went from 55% in 1992 to 74% in 1996. Many consumers have reservations about managed care's cost-control methods, and according to a 1996 survey 54% favored more consumer-protection regulation. State legislatures have responded with much activity, and a coalition of consumers and providers supports additional federal regulation.

Health maintenance organizations

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Selective contracting still upheld: a majority of courts continue to hold that exclusive contracts between care providers and networks do not violate antitrust laws

Article Abstract:

Most courts considering antitrust challenges to contracts between health care providers and networks of professionals find such arrangements to be legal and pro-competition. The Justice Dept and the Federal Trade Commission both express more concern about overinclusion than about exclusionary contracts. To succeed, an antitrust challenge must almost always show that the defendants have actual market power, which is difficult because purchasing power in that field is so diffuse.

Interpretation and construction, Health care industry, Antitrust law, Physicians, Medical professions, Contracts

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With suits mounting, courts face the question of whether a managed care organization can be an employer under the Americans with Disabilties Act

Article Abstract:

The application of the Americans with Disabilities Act (ADA) to health insurance is an evolving area of the law. The EEOC has issued an Interim Guidance on Application of ADA to Health Insurance, and the agency's case load has increased greatly with a large influx of ADA cases. The problem for managed care organizations is that the ADA defines 'employer' and 'covered entity' so broadly that they would seem to qualify as employers even though all they do is provide benefits.

Remedies, Discrimination against disabled persons, Handicapped discrimination, Employment discrimination

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