State legislatures addressed a number of health care issues in their 1999 sessions, and many are revisiting the same issues in 2000. Two prominent issues are managed care reform and expanding access to health insurance.

Proposals for managed care reform ranged from outside review programs for denials of coverage to increasing the ability to sue.

• In 1999, Georgia, Louisiana and California adopted health plan liability reform which allows suits against plans after meeting certain criteria.

• One state, Texas, adopted a law that allows physicians to collectively bargain with health plans through an intermediary.

• Three states enacted "medical necessity" language that forces plans to pay for any care a physician says is necessary, regardless of what the plan language says.

• And nine states have mandated that patients be allowed to remain with the same physician even if he or she has left their health plan, and requires the plan to pay for that care.

States attempted to expand access to health insurance through the Children's Health Insurance Program (CHIP) and tax credits or deductions for health insurance costs.

• At least three states expanded their CHIP coverage, making more low-income children and families eligible for subsidized health insurance.

• Six states created tax deductions or tax credits to make health insurance more affordable for the self-employed and other individuals.

More proposals for managed care reform and external review of managed care decisions are expected, as well as a push for parity in mental health coverage and more initiatives to expand access to health insurance for low-income individuals. Also, physicians are pushing for collective bargaining power in at least nine states.

Source: "1999 Survey of Health Plans, State Legislative Health Care and Insurance Issues," BlueCross BlueShield Association, 1310 G Street NW, Washington DC, 20005.