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From June 2001 NASW NEWS Every health care professional organization in the state is a coalition member. By John V. O'Neill, MSW, NEWS Staff NASW in Rhode Island is a lead organizer in an aggressive grass-roots campaign to pass a law to exempt the state's 10,000-plus health care providers from federal antitrust legislation so they may bargain collectively with managed care organizations (MCOs). Hearings were held in the House and additional hearings were scheduled for May in the Senate on the Health Care Fairness Act of 2001, a bill that would allow groups of providers to collectively negotiate fee and non-fee work terms with insurance companies under the auspices of the state attorney general. "This year we have made tremendous progress," said Kate Coyne-McCoy, NASW Rhode Island Chapter executive director. "We had a great hearing in the House, and there is a pretty good chance of passage." Laws to suspend federal antitrust legislation to allow negotiation with MCOs have been passed in Texas and Vermont. However, they apply only to physicians, and in Vermont, only relate to negotiations over fees, said Coyne-McCoy. Legal and other challenges have delayed implementation in those states. The coalition forged in Rhode Island, with NASW and the Rhode Island Medical Society taking the lead, is unprecedented in that every professional organization of health care providers who bill insurance companies is a member, and all their members would be allowed to negotiate contractual issues that directly affect patient care under terms of the Health Care Fairness Act. A similar bill was introduced in the Rhode Island legislature last year, but the medical society was its primary sponsor and it didn't get to the hearing stage. This year, NASW, which has had good working relations with other professional groups, joined the effort, and it was decided to build an inclusive coalition. "I don't think a coalition like this exists anywhere else in the country," said Coyne-McCoy. "If and when we win, it will be because we recognize that there is more that unites us than divides us, so we work together." More than 10,000 brochures were mailed to every licensed health care provider in the state asking them to participate. "I don't think the insurance companies expected us to get this far," said Coyne-McCoy. "This bill has 'legs' and won't go away." Coyne-McCoy and the other key lobbyist on the bill from the medical society have:
The Health Care Fairness Coalition grows out of deep dissatisfaction with the health delivery system in Rhode Island, said Coyne-McCoy. The system is dominated by two large MCOs, Blue Cross/Blue Shield and United Health Plans. They send providers contracts of adhesion, saying they must adhere to the contract from the previous year, a chain that can reach back many years and is confusing. There hasn't been an increase in reimbursement for social workers in 10 years, and the last adjustment was a decrease, she said. "Practitioners are over a barrel," said Coyne McCoy. They have no ability to negotiate the contracts, but if they don't sign them, making a living is difficult. "If I work in any other market — if I sell bread or paper supplies — if I disagree with terms of a contract, I can negotiate. But because of the power and control the insurance system has over providers, I have no voice in this system," she said. "I [have to] take it or leave it." "Providers are finally saying: 'Enough is enough.' I do great work. I deserve to have a voice in the system about the way my patients are treated." Professionals in the coalition besides social workers and physicians include physical therapists, optometrists, podiatrists, psychologists, acupuncturists, osteopathic physicians and surgeons, mental health counselors, dental hygienists, dentists, oral and maxillofacial surgeons, marriage and family therapists, alcohol and chemical dependency professionals, physicians assistants, chiropractors, and members of the medical group management organization. Back to NASW NEWS Contents
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