“As a result of this initiative, many chapters hired lobbyists for the first time, initiated political action committees, held legislative days at their state capitols, trained their members to lobby, and established collaborative relationships with elected officials, key decision makers, and other medical and consumer groups,” Mr. Chaney said.

“It energized ACEP and the chapters, and resulted in an impressive increase in membership during that period,” he added.

The driving force behind much of the success at the state and national levels was the stories of patients, including the following:

• A 46-year-old Detroit woman collapsed in her husband’s arms and was rushed to the hospital by ambulance, but died of cardiac arrest after emergency physicians worked to revive her for 30 minutes. Her managed care plan denied payment for treatment because she did not call for prior approval.
• A 44-year-old Illinois man with chest pain and shortness of breath called his managed care plan for authorization to go to the emergency department. The plan representative told him not to “worry about it.”

One hour later, he was transported to the ED, where he died of a heart attack.

In 1993, Maryland was the first state to adopt its own prudent layperson laws. In following years, a total of 47 states enacted some form of the prudent layperson standard, resulting in coverage of an estimated 207 million Americans.

“State actions were important, but they did not apply to millions of people in health plans covered by the Employee Retirement Income Security Act or the millions of federal employees,” Dr. Gardner said. “That’s why ACEP continued to advocate for a national standard that applies to all health plans, which has finally been achieved.”

acep led a grassroots effort to recruit more than 35 national medical organizations to support the standard.

Intense pressure from ACEP generated responses from health plans to offer to apply the standard voluntarily. Voluntary measures worked to a point but were not enforceable, and the economic pressures of keeping costs down were too great to make a voluntary approach a realistic solution.

Throughout the 1990s, Congress sought to pass patient protection legislation. By the late 1990s, ACEP was successful in its efforts to gain bipartisan agreement that the prudent layperson standard should be included in any version of a patients’ bill of rights.

ACEP led a grassroots effort to recruit more than 35 national medical organizations to support the standard. Several ACEP presidents and other leaders testified before Congress in support of the standard. ACEP’s 911 Network members, through their lobbying efforts, helped garner congressional support for the standard.