[Congressional Record (Bound Edition), Volume 149 (2003), Part 6]
[Extensions of Remarks]
[Page 7798]
[From the U.S. Government Publishing Office, www.gpo.gov]




  THE WOMEN'S OBSTETRICIAN AND GYNECOLOGIST MEDICAL ACCESS NOW ACT OF 
                          2003 (THE WOMAN ACT)

                                 ______
                                 

                          HON. SUSAN A. DAVIS

                             of california

                    in the house of representatives

                        Thursday, March 27, 2003

  Mrs. DAVIS of California. Mr. Speaker, today, I am reintroducing the 
Women's Obstetrician and Gynecologist Medical Access Now Act, the WOMAN 
Act. This bill will ensure that every woman has direct access to her 
ob-gyn.
  I believe women should not need a permission slip to receive ob-gyn 
care. Unfortunately, that is the reality faced by many women when they 
need to see their doctor. Numerous managed care plans require women to 
visit their primary care physicians before seeking the health care 
services they need from the providers they want. Denying direct access, 
or forcing women to jump through numerous bureaucratic hoops to see 
their ob-gyn is not acceptable treatment.
  The WOMAN Act recognizes that women have different medical needs than 
men and that ob-gyns, in many cases, have the most appropriate medical 
background to address these needs. My legislation removes the barriers 
complicating women's access to their doctors. Women will no longer have 
to contend with the gatekeeper system that can prevent or delay 
appropriate care.
  It is easy to understand what a difference direct ob-gyn access makes 
in women's health care. Imagine, for a moment, a woman in San Diego who 
works 45 hours a week and has limited sick and vacation time. Now, 
imagine she has an urgent medical problem requiring an ob-gyn visit. On 
Monday, she calls from work to make an appointment with her primary 
care physician. If she is lucky, she gets an appointment for the 
following morning. She takes time off Tuesday to go see her doctor. Her 
primary care doctor agrees she should be seen by her ob-gyn and gives 
her a referral. Tuesday afternoon she returns to work and calls her ob-
gyn for an appointment. The doctor is in surgery on Wednesday, but they 
offer her an appointment on Friday morning. On Friday she takes another 
morning off from work and finally, after almost a week, gets the care 
she needs. The unnecessary referral process resulted in her taking an 
extra morning off work and delayed her proper medical care by 5 days. 
The patient, employer, primary care physician, and health plan provider 
would have saved money and time if the patient had been able to go 
directly to her ob-gyn.
  An American College of Obstetricians and Gynecologists/Princeton 
survey of obgyns showed that 60 percent of all ob-gyns in managed care 
reported that their patients are either limited or barred from seeing 
their ob-gyns without first getting permission from another physician. 
Nearly 75 percent also reported that their patients have to return to 
their primary care physician for permission before they can see their 
ob-gyn for necessary follow-up care. Equally astounding is that 28 
percent of the ob-gyns surveyed reported that even pregnant women must 
first receive another physician's permission before seeing an ob-gyn.
  The public overwhelmingly supports direct access to ob-gyn care. A 
survey conducted by the Kaiser Family Foundation and Harvard University 
found that 82 percent support direct access legislation and 63 percent 
would support it even if their health insurance costs increased. When 
asked about a range of health policy issues another Kaiser survey 
discovered that women rate direct access to ob-gyns as their second 
priority.
  While serving in the California State Assembly, I heard from many 
women who experienced the same problems I have outlined today. After 
meeting with women, obstetricians and gynecologists, health plan 
representatives, and providers in the State of California, I wrote the 
state law allowing women direct access to their ob-gyn. That law was a 
good first step; however, it still does not cover the almost 5 million 
Californians enrolled in self-insured, federally regulated health 
plans. This means that if a woman lives in a state with direct access 
protections, like California, she may not be able to see her ob-gyn 
without a referral if she is covered by a federally regulated ERISA 
health plan. This also means that one in four insured families are not 
protected by state direct access to ob-gyn laws.
  I believe the time has come to make direct access to an ob-gyn a 
national standard.
  I urge you, Mr. Speaker, and all of my colleagues to pass this 
critical legislation quickly into law.

           Women's Ob/Gyn Medical Access Now Act (WOMAN Act)


                              Bill Summary

       Grants Direct Access: Gives women direct access to an OB/
     GYN or a participating family practice physician or surgeon 
     designated by the plan or issuer as providing OB/GYN 
     services. Prohibits plans or issuers from requiring a 
     referral or prior approval.
       Plan Considerations: Plan can set reasonable communication 
     requirements between OB/GYNs and primary care physician. Plan 
     can set reasonable utilization protocols, as long as those 
     protocols are the same for OB/GYNs as they are for other 
     physicians, such as primary care providers. (cannot be more 
     restrictive for OB/GYNs)
       Notification for ERISA plans: Requires group health plans 
     to comply with the notice requirements for ERISA when they 
     modify their plan to comply with the rule.

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