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June 1, 1994

Law and Medicine

Author Affiliations

Georgetown University Law Center, Washington, DC, and The Johns Hopkins School of Hygiene and Public Health, Baltimore, Md

JAMA. 1994;271(21):1679-1680. doi:10.1001/jama.1994.03510450051028

On October 27, 1993, President Clinton presented to the 103rd Congress the National Health Security Act to "ensure individual and family security through health care coverage for all Americans." Innumerable legal issues are presented by the bill, but the first portion of this review focuses on two1: (1) What exactly is an eligible individual entitled to under the bill? (2) How can hospitals and groups of health care professionals compete in a manner consistent with extant antitrust law?

Eligible individuals are entitled to "medically necessary or appropriate" services under the comprehensive benefits package (section 1141). While the National Health Board is empowered to exclude specific services (section 1154), many determinations as to whether patients can be denied costineffective treatments will be determined by the courts. Although it was considered by the task force, a fair and effective administrative remedy for patients denied treatment was not included in the bill.

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