Health Care Information

Health Care Information for Consumers/Health Care Ombudsmen
S 651 Health Care Consumers Assistance Fund Act
Senate Committee on Health, Education, Labor and Pensions Hearing

March 28, 2001

The March 28, 2001 Congressional Hearing on "Advocating for Patients: Health Care Information for Consumers" has interesting and important ramifications for long term care ombudsmen. Listed below is a summary of the hearing and web sites to access additional information.

Senate Bill 651 Health Care Consumers Assistance Fund Act (introduced in the Senate); sponsored by Jack Reed, RI), co-sponsored by Senator Jeffords (VT), Milkulski (MD), Collins (ME), Wellstone (MN), and Clinton (NY). Purpose: to provide for the establishment of an assistance program for health insurance consumers. Makes available $100,000,000 in grants to states who apply to create for a health consumer assistance office, http://thomas.loc.gov

Hearing
Senators attending the hearing were Jeffords, Reed, Clinton

http://www.senate.gov/~labor/107hearings/mar2001/032801wt/032801wt.htm

Panelists included:

• Ron Pollack, Executive Director, Families USA. Supported the bill note: Families USA conducted a survey of all "ombudsman" programs, including long term care ombudsmen, last fall and will release a report on ombudsmen programs this spring.

• Donna Sutton Fay, Vermont State Health Care Ombudsman, (co-located with the long term ombudsman program). Supported the bill.

• Mary Jane England, President, Washington Business Group, supported the bill with some concerns.

• Charles Khan III, President, Health Insurance Association of America; did not take an official position on the bill; raised areas of concern. Expressed concern that ombudsmen would undermine trust between the consumer and the insurer.

• Bernadette Warren, friend of a person who was greatly assisted by the Maryland Health Care Ombudsman with the Maryland AG's office to obtain fair insurance coverage. Ms. Warren had worked in insurance arena was very emphatic about how the Maryland Health Care Ombudsman had aided her friend (note: the discussed is now in a nursing in Maryland and the family had difficulties finding a long term care facility where they were comfortable placing their loved one).

Issues relating to long term care ombudsmen:

• The word "ombudsman" was used throughout the hearing but the bill itself does not contain this word. The word "ombudsman" was used for many types of consumer education programs as well as specific ombudsman programs such as the long term care ombudsmen.

• There is potential for confusion in distinguishing which ombudsman program is being discussed and there could be potential for confusion in the public about what "ombudsman" to call.

• There is also potential for confusion about what an ombudsman does because insurance companies' use the term "ombudsmen" for paid staff who provide the consumer with information and the term was also used to refer to SHIPP counselors.

• Discussions in the hearing emphasized the role of ombudsmen in pursuing a person's rights; several persons stressed that the people who need a health care ombudsman are often very sick and this limits their own ability to seek their rights.

• There was discussion that having a health care ombudsman cannot replace the need for a patient bill of rights.

• The discussion of health care ombudsmen will raise scrutiny of the long term care ombudsman program. During the hearing, the long term care ombudsman program was referred to several times. Pollak discussed the role of volunteers and that they were not appropriate for health care ombudsmen because of the complexity of the issues. Milkulski said we need to "learn lessons" from the long term care ombudsman program and look at program evaluation, training and standards. Milkulski asked the panelists several times "What are the minimum requirements for an ombudsman to do their job?" Clinton talked about the need for well-trained persons to be ombudsmen and pointed out that Sarah Lawrence College has an innovative program Health Care Advocacy.

• Hollis Turnham, Esq., formerly Michigan State LTC Ombudsman, who now does some consulting for the Center, had worked on the HELP committee and is very familiar with this bill.