MANAGED CARE TOPIC OF PANEL

Missouri's new managed-care law is still taking shape, state Rep. Mary Kasten said Friday.

The Cape Girardeau Republican said regulations implementing the law are still being written by the state's health and insurance departments.

The state has been writing managed-care regulations since June, Kasten said Friday at a panel discussion in Cape Girardeau on the managed-care bill.

Kasten held up two lengthy rolls of paper outlining some of the regulations. "It is going to be a paper nightmare, but the intent of it is good," she said.

"This is really a bill in the making," Kasten told the approximately 20 people who turned out for the public forum at Southeast Missouri State University's Crisp Hall.

The forum was sponsored by the Missouri Association for Social Welfare. The statewide association has 2,000 members. The organization includes social workers and retired teachers.

Kasten was one of three panelists. The others were Dr. Karen Yates, an ear, nose and throat doctor in Cape Girardeau; and Chuck Henzi, a health-care consumer who is disabled.

Yates said Missouri's new law is a starting point in regulating managed-care companies. The law is designed to give Missourians more control over their health insurance benefits.

One key provision of the bill requires managed-care insurers to cover emergency room visits for situations that a "prudent lay person" would consider an emergency, such as broken bones or severe pain.

In the past, some insurers had refused to pay for emergency-room visits that they deemed weren't medical emergencies.

Yates likes a provision of the new law that prevents managed-care firms from barring doctors from discussing costly medical options.

The law also prohibits managed-care firms from requiring all patients to go through a "gatekeeper," a primary-care doctor before they can see a specialist.

Yates said that provision is a good one.

Before the new law, managed-care companies could dictate who would provide treatment as well as when and where the treatment would be performed.

While doing her residency in St. Louis, Yates treated a woman who was suffering dizzy spells. She needed surgery. But Yates said insurance regulations and restrictions delayed the operation for six to nine months.

The state law requires the Health Department to analyze and disseminate data on managed-care companies and their health-care plans.

But Yates questioned if such data would provide the information consumers need to know when looking for good managed-care plans. She also questioned the effectiveness of having two different departments monitoring managed care.

Yates said the biggest weakness of the new law is that managed-care firms can be fined only $100 for every violation. They also can be sued, she said.

Henzi talked of the difficulty in getting insurance because of his disability. Henzi has arthritis, which makes it difficult for him to walk.

"I can't stand, but I can do most jobs sitting down," the Cape Girardeau man said.

Henzi worked in a factory but was terminated because of his disability.

He now works part time for the SEMO Alliance for Disability Independence, an organization that is an advocate for the handicapped. He also receives Medicare.

Henzi said managed-care firms refuse to cover some people because of disabilities. He said insurers need to be more compassionate in their health-care policies.

"I feel that HMOs cheapen human life because of the dollar value, and they tie the hands of good physicians," he said.

Kasten said the new law is an attempt by lawmakers to improve the situation. But she acknowledged the law is far from perfect.