By: Linda Harder
Photography By: Tracey Brown
Maryland Physician Publisher/Executive Editor Jacquie Roth and Managing Editor Linda Harder recently sat down with Attorney General Douglas F. Gansler to discuss his efforts to support physicians and protect consumers. Routinely recognized as a likely candidate for Maryland’s 2014 gubernatorial race, he also comments briefly on that rumor.
Q: You are the first AG to work with physicians to pass the Assignment of Benefits Law, which dealt with assignment of benefits for non-preferred providers. Why did you take on that issue?
Everyone needs a doctor at some point. We want to make sure that doctors have an advocate in state government and that’s the role I took upon myself… doctors have to get more politically active. Planners fashion the debate and shape it as they want it to be. Doctors think they’re immune from it… They think, ‘I’m just here to take care of people.’ I think MedChi has grown in influence in more recent years… some doctors are getting more involved and realize that what happens in Annapolis does indeed affect them and consumers.
Q: Why were you the lead in filing an amicus brief to the U.S. Supreme Court supporting the Affordable Care Act (ACA) ?
We were the lead state in the amicus brief that supported the Patient Protection and Affordable Care Act. Not because we agree with all of the provisions of the act – most of us, like most Americans, haven’t read all of it. Our role in that was to say yes, the federal government does have the authority to address the healthcare crisis and does have the ability to pass laws…
The Department of Justice asked us to take the lead because of our role in some of the cases in the lower courts. We were able to speak from the perspective of states regarding issues of the federal government… The Supreme Court took on four issues… The biggest one was, ‘Does congress have the ability to pass this law?…
Q: What challenges will states face in implementing this law?
The states will have great challenges in implementation. One of the great things about the PPACA is that, from the 30,000-foot level, it’s a federal solution to a national problem, but they give states the ability to fashion the essential services as they choose. I’m on a commission that the governor set up to look at implementation in 2014… Josh Auerbach is our principal counsel at the Department of Mental Health and Hygiene (DHMH) working with Secretary [Joshua] Sharfstein on this issue. So, Maryland is in the forefront. If for some reason it does get overturned over by the Supreme Court, we will still be able to implement much of what is in the act.
Q: What is the likelihood that the Supreme Court will uphold the law?
It should be a 9-0 decision. The federal government can make you pay Social Security and get a driver’s license, they can take your children to die in wars across the world…. clearly, they can have you buy health insurance. But the Republicans made this a political issue… The problem is that everyone needs to avail themselves of the healthcare system at some point… That said, this is perhaps the most political Supreme Court we’ve ever had… and these are difficult cases to defend based solely on jurisprudence. Most people think this will be a 5 to 4 decision, not withstanding the absurdity of the argument.
Q: What are your greatest healthcare accomplishments?
Each legislative session, we try to support at least one MedChi-sponsored bill. Tanning and truth in advertising are two issues that they’ve identified for us. The ‘truth in advertising’ bill is so that you know who you are seeing, what degrees they have, what they’re supposed to be practicing. The bill hasn’t been drafted yet, but the concept is one that we would embrace. We also support MedChi on not having children use tanning booths.
Our Healthcare Education and Advocacy Unit (HEAU) is probably, on a day-to-day basis the thing that affects people the most… It’s the unit that mediates between patients and the insurance companies. The bread and butter of an AG’s office is protecting consumers, especially the small person against the big guy. When the insurance company denies you coverage, you have no recourse. To hire a lawyer to address your claim would cost more than what you’re entitled to recover. The insurance companies bank on that… What the HEAU can do is, at no cost, is mediate; they will come in and ask the insurer why they didn’t cover the procedure… That’s the most important thing we’ve done.
… Kathleen Sebelius [secretary, Department of Health and Human Services] came to our office and was touting our program as a national model. We have a large federal grant to educate patients and providers about the program. Many providers don’t know that they can do it on behalf of the patient. The outreach coordinator has been going to providers’ offices to educate them…
I’m President-elect of the National Association of Attorneys General (NAAG), and one of the initiatives I put forward is the prescription drug take-back program… We’re working on the whole state of Maryland becoming a take-back state so that anyone who has expired prescription drugs in their home, can take them back to the pharmacy where they will dispose of them in an environmentally friendly way… We’re going to try to get all 1200 Maryland pharmacies to participate.
The antitrust exemption for the insurance companies is outrageous. We (NAAG) sent a letter to Congress trying to get that removed in 2010.
The other thing we do is that we’ve brought literally millions and millions of dollars back to Maryland for our cases against the drug companies for off-label marketing and other issues.
One of the things MedChi brought to us early on was the issue of physician ‘tiering’ by insurance companies. Patients were using that ranking to determine where they were going to go for their care… The problem was that the insurers didn’t explain that cost factors were part of that rating. Patients thought that it meant that the doctor was rated the best. We brought that issue to the task force and… insurers were forced to disclose [their methodology] as a result.
Q: What impact has the HEAU had on insurance complaints?
We received 1934 consumer complaints through November 30th. Some of those are not legitimate or are referred to MIA because it doesn’t fall into our jurisdiction. If we can get it and we have jurisdiction over it, we have a great success rate. We mediated 919 of them, and 781 of those had positive results – that’s an 85% success rate. We recouped $961,000 through Nov. 30, 2011 for Maryland consumers… If we had more people, we could do more, and if more people knew to avail themselves of the unit, I imagine those numbers would go up.
Q: Are you planning to run for governor in 2014? To what do you attribute your successful fundraising?
There’s no campaign going on right now… I have two events a year – one in Baltimore and one in Montgomery County – we’ve been doing that for about 14 years and we haven’t changed that component…
I like to think that people in Maryland think we’re doing a good job protecting consumers, protecting and helping doctors is a piece of that. The great thing about our job is we’re against criminals and we help a lot of people in a lot of different ways… Right now, we’re looking at Google’s new privacy statement. all these things add up. I was the first state-wide advocate for same sex marriage and a lot of people think that’s the right thing to do. I don’t have a natural constituency… but we’ve been fortunate to have people support our efforts.
Q: If you were to run for governor, what would your healthcare initiatives be?
I’m not running for governor so I don’t have a platform or whitepaper on that. We have been very involved in healthcare issues such as access. That said, it’s a moving target. We’re in a crossroads right now, from the old way medical services were delivered to having a new way by 2014. Lending a supportive role on the legal side is critical… My overriding message, whatever I run for, is that I am supportive of doctors. I have the utmost respect for them. I think they get into the profession not to make money but to help people… Doctors work really, really hard and for very little money while they learn their trade. I think we ought to make sure that our government supports our doctors.
__________________________________________
Note: HB 585, which regulates the use of physician rating systems by carriers, took effect in 2010. The bill prohibits carriers from using a physician rating system unless the system is approved by a ratings examiner.
Note: The Health Education and Advocacy Unit offers a mediation service to consumers who have a billing dispute with their health care provider or a coverage dispute. File appeals online at www.oag.state.md.us/consumer/HEAU.htm or call 410-528-1840.