Managed Care

State governments want to ensure access, quality, and consumer protections in the health insurance marketplace.

At the same time, State lawmakers support a legal framework in which health plans can organize delivery systems to improve quality and control costs. Lawmakers remain committed to retaining the state flexibility that managed care delivery systems provide as we reform state health care systems.

Is Managed Care Being Undermined?

So-called "any willing provider" legislation and other legislation that would restrict the ability of health plans to improve quality and control costs may undermine state health care reform efforts and could roll back significant state-by-state progress in this area.


This type of legislation is problematic because it has the potential to undermine the efforts of managed care organizations to control costs and limit the size of networks to achieve maximum efficiency. These legislative proposals arise from good motives—the desire to preserve existing patient-provider relations and to safeguard patients' access to care or choice of provider from arbitrary decisions by health plans to exclude or drop providers from their networks. These are legitimate goals that need to be addressed through vehicles that do not threaten the cost, quality, and access advantages that well-designed managed care delivery systems can provide.

More and more Americans receive their care through health delivery networks. Establishing these networks requires new approaches to cooperation among providers and businesses that heretofore had been competitors. Congress and the Administration must work with the states to accommodate this new health care environment while ensuring that competition remains in the marketplace.