WPCNR'S ADAM IN ALBANY. By Assemblyman Adam T. Bradley, 89th District. January 31, 2007: Governor Spitzer made health care reform and access to health insurance a priority in his State of the State address because, in his words, this investment makes good moral and economic sense. 

We have a moral obligation to take a serious look at how the system delivers care, because too many children and families go without basic, preventative coverage.  And we have an obligation to the taxpayers who are paying for those that are uninsured, because even though an individual lacks insurance, they still receive care in emergency rooms.  

We cannot allow HMO reform to get lost in all the other reform rhetoric floating in Albany.  The HMO – Health Maintenance Organization – system is broken and frequently puts profits ahead of patients.  In New York, health insurance companies are currently making record profits often at the expense of our health care system while the needs of patients, hospitals and physicians are being relegated to the back burner. 

Last year, we made some progress and a bill I sponsored (A.11996 of 2006) became law, but more needs to be done to protect the integrity of patient care.  For example, four Westchester County hospitals that make up the Stellaris Health Network, including White Plains Hospital Center and Northern Westchester Hospital, almost left the Empire Plan because of payment issues.  Unfortunately, physicians credentialed at these hospitals who were in-network received letters from the insurance company telling them they would no longer be treated as in-network physicians because of their affiliation with these hospitals and that they should notify their patients.  Fortunately, a last minute deal was reached between Stellaris and the Empire Plan. 

HMOs should not be able to interrupt an established relationship between physicians and their patients, particularly in cases like this one where physicians and patients had nothing to do with the negotiations between hospitals and insurers.  That is why I sponsored the following pieces of legislation:

·        A.2058 – Provides that an insurer may not terminate a physician’s participation in a managed care plan solely because he or she is only credentialed in non-participating hospitals; and

·        A.1755 – Provides that an insurer may not charge out-of-network rates for an in-network hospital, solely because the patient used an out-of-network physician.

Something just isn’t right in a state that regulates auto insurance premiums but not HMO insurance premiums.  HMOs have been getting away with charging excessive premiums while making record profits.  We must do more to protect the interests of patients and providers against the unfair practices of HMOs.