Project that expands the list of coverage of health plans will be voted on in the Senate: see what is at stake

Senators, government representatives, the National Supplementary Health Agency (ANS), health plans, doctors and patients’ relatives discussed at a public hearing in the Senate, this Tuesday (23), Bill 2033/22 , which amends current legislation to establish coverage hypotheses for health examinations or treatments that are not included in the list of procedures and events in supplementary health.

Under the rapporteurship of Senator Romário (PL-RJ), the text, already approved by the deputies, obliges health plans to cover therapeutic procedures and treatments outside the list established by the National Health Agency (ANS). The controversy arose from a decision of the Superior Court of Justice (STJ) which, in June, decided that operators should only cover what is on the ANS list.

The expectation is that the matter will be guided in the plenary of the House next Tuesday (30). “We cannot deny these people the right to a dignified existence with less suffering. Many Brazilians pay dearly for health plans to guarantee the best treatment for their families,” said Romário.

patients

For associations linked to patients who use drugs and procedures not yet included in the list, the adoption of the exhaustive list means leaving patients without treatment.

During the debate, the director of the “Moms for Autism Movement”, Letícia Amaral, argued that the project ensures the incorporation of proven effective treatments and medicines. She pointed out that the exhaustive list ends up limiting access to medicines and defended the approval of the text that came from the Chamber without changes.

“The norm cannot be so specific in detail, especially when the law is aimed at a dynamic situation. We’re talking about health. Health science is changing at a fast pace, but who has to say will not be the legislator, but the scientific community. The text leaves no room for quackery. It just gives patients the right to fight for their lives. The PL is not a carte blanche for any medicine. The taxing role kills”, he highlighted in defense of the text.

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Still on the difficulties faced by families, the founder of “The Caterpillar Turns Pupa Institute”Andréa Werner, mother of a child with a genetic syndrome and cerebral palsy, said that she won in court an injunction that guarantees a portable oxygen cylinder, occupational therapy and respiratory physiotherapy for her son.

Andréa gave several examples of mothers who, like her, face a legal battle with health plans that want to suspend treatments that are not provided for in the ANS list.

Other side

The Minister of Health, Marcelo Queiroga, assessed that the text will bring risks to the financial sustainability of health plans. The minister defended the exhaustive role as a way to ensure the incorporation of medicines and therapies with scientific proof and said that the ANS is agile in the incorporation of technologies and new treatments.

“Individual plans are practically no longer offered; collective plans, by membership. So, when choosing to have more procedures, more drugs on the list, there are bound to be costs that will be passed on to the beneficiaries, and some of them will not be able to afford these costs. That is the reality,” he said.

Also contrary to the proposal, the executive director of the National Federation of Supplementary Health (FenaSaúde), Vera Valente, said that it is essential that improvements be made to the text “to guarantee safety to millions of patients”. She defended that the wording of the project guarantees that new drugs and procedures are incorporated “only upon proof of the real benefit”.

“Resources are finite, so deciding on the nature of the role is deciding on the very existence of plans. Expanding the procedure is desirable, but that is exactly why there is a technology assessment process,” he warned.

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