HOUSE BILL REPORT

                 SSB 5854

             As Reported By House Committee On:

                         Health Care

Title:  An act relating to women's health care.

Brief Description:  Requiring that health plans must allow women a choice of primary care providers.

Sponsors:  Senate Committee on Health & Long‑Term Care (originally sponsored by Senators Haugen, Spanel, Wood, Prentice, Winsley, Rasmussen, Hale, Kohl, McCaslin, Fairley, Long, Loveland, Franklin, Roach, Moyer, Quigley, McAuliffe, Drew and Wojahn).

Brief History:

  Committee Activity:

Health Care:  2/28/95, 3/31/95 [DPA].

HOUSE COMMITTEE ON HEALTH CARE

Majority Report:  Do pass as amended.  Signed by 10 members:  Representatives Dyer, Chairman; Backlund, Vice Chairman; Hymes, Vice Chairman; Cody, Assistant Ranking Minority Member; Campbell; Casada; Conway; Crouse; Kessler and Skinner.

Minority Report:  Without recommendation.  Signed by 2 members:  Representatives Morris and Sherstad.

Staff:  John Welsh (786-7133).

Background:    As health insurance moves more rapidly toward integrated delivery systems which attempt to control costs by regulating enrollees' access to certain types of health care providers, many have become concerned that they may lose access to the providers they use most frequently.

A 1993 Gallup poll found that most women consider their obstetrician/gynecologist as their primary health care provider, and the provider from whom they have had their most recent examination.  Almost 80 percent of these women currently access their obstetrician/gynecologist directly, without going through a gatekeeper.  Almost all would object to having to use a gatekeeper.

Summary of Amended Bill: Health insurance carriers must ensure that enrolled female patients have access to timely and appropriate covered women's health services.

Women's health service providers include obstetrician/gynecologists (OB/GYN), family practitioners, physician assistants, nurse practitioners, and nurse midwives.

Health carriers may underwrite separate or additional coverage to permit enrollees access to a provider of the enrollee's choice.

Amended Bill Compared to Substitute Bill:  Sections relating to intent, the designation of obstetrical/gynecological services as primary care, and references to obstetrical/gynecological accreditation are deleted.

Appropriation:  None.

Fiscal Note:  Available.

Effective Date of Amended Bill:  Ninety days after adjournment of session in which bill is passed.

Testimony For:  Polls show that most women see OB/GYN's most frequently and that most consider OB/GYN's to be their primary care provider.  OB/GYN's are trained to refer patients as needed and their referral rate is below that for other types of primary care providers.  Direct access is more convenient for consumers and saves time and money that would be spent on going through gatekeepers.

Testimony Against:   (On the original bill) Many plans now provide direct access to OB/GYN and related providers, but the government should not dictate the configuration of health plans.  This should be left up to market forces and the judgment of plan administrators.  If primary care providers are to be defined, the definition should include many others who might be able to do it as well.

Testified:  Senator Haugen, prime sponsor; Ken Bertrand, Group Health; Dr. Rory Laughery, Washington Academy of Family Physicians; Dr. Judith Page, Group Health - Family Medicine of Yakima; Dr. Robert Pringle and Kathryn Walker, North Cascade Women's Clinic; Dr. Susan Harvey, Seattle OB Gyn Group; and Leena Der Yuen, Washington State OB Association.