ALBANY, N.Y. (AP) - A new lobbying effort pits hospitals and a consumer group against HMOs, with both sides warning of higher costs for New Yorkers.
'While health insurance companies continue to make record-breaking profits, small and large employers suffer from huge annual increases in their employees' premiums,' said William Mooney Jr., president of the Westchester County Association. 'Our health care infrastructure is dissolving around us as greedy health insurance companies exploit employers with outrageous premiums and exploit health care providers by reduced reimbursements.'
The Westchester-based group includes the Hospital Association of New York State, the Nassau-Suffolk Hospital Council, and some business associations.
The group wants the Legislature to create a 'Health Care Community Reinvestment Fund.' It would require insurers to put a high percentage of the premiums they receive into a state fund. The money could be used to help hospitals and physicians improve information technology, to streamline and improve treatment, and to recruit doctors in hard-to-serve urban and rural areas.
The coalition also seeks to require insurers and HMOs to pay physicians and hospitals within 15 days for electronic claims and within 30 days for paper claims. The proposal would increase fines for late payment to doctors and hospitals.
But insurers say the attack on what the Westchester group claims are 'record-breaking profits' would only result in a 'tax' that will hit small businesses hardest.
'We just think it's an attempt to further regulate a heavily regulated industry,' said Leslie Moran of the New York Health Plan Association. 'We think it would create a more unlevel playing field in favor of doctors and hospitals.'
She also contests the Westchester group's claim that insurers and HMOs are raking in exorbitant profits. Much of the profits, she said, are the results of a state law that requires insurers to set aside greater reserves after past years of near insolvency by some insurers.
As for the fund, Moran disputed the assertion that insurance premiums paid by New Yorkers should go to help hospitals pay for equipment.
The Health Plan Association, however, would be interested in working to make payments faster. But to do that, hospitals and physicians would have to improve their own record of late payments and processing, Moran said.
'When you get a bill six months after the service is provided, you have a short time to check it out,' she said. 'Plans have a responsibility to make sure the services were provided and it was medically appropriate and necessary.'
Arthur Levin, of the Center for Medical Consumers, supports the Westchester group's proposals.
'The HMO reform proposals are aimed at making health insurance companies more patient-centered and more responsible in how they reinvest surplus premium dollars to provide better access to health care for New Yorkers.'
A year ago, a report by the Senate's Democratic minority reported that HMO profits increased 93 percent to $1.3 billion from 2001 to 2005, while premiums increased 20 percent. Premiums collected by HMOs totaled more than $1 billion above the cost of medical payments, according to the report, and profits totaled more than $5 billion.
The Westchester group's proposals are being pushed in Senate and Assembly committees.
The scheduled end of the legislative session is June 21. The 2007-08 state budget adopted April 1 cuts $1 billion in Medicaid spending, most of which went to large hospitals.
The funding is being used to expand outpatient and preventive care, which is less expensive and can result in better care under a plan pushed by Gov. Eliot Spitzer.
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