STJ decision unites Senate against limiting treatments in health plans — Senate News

After the recent decision by the Superior Court of Justice (STJ) on which treatments health plans are required to offer, the reaction of several senators was immediate and incisive against the so-called exhaustive role for health plans coverage.

With the decision of the STJ, health plans start to cover only the treatments that are on the list of the National Supplementary Health Agency (ANS). This threatens the maintenance of various patient treatments. Senators from the base of the government and the opposition ended up uniting against the decision; they defend that the ANS list is just an example.

Senator Zenaide Maia (Pros-RN) was one of the first to react, condemning the measure when speaking at the Senate Plenary on the same day that the STJ’s decision was made, June 8. Senator Mara Gabrilli (PSDB-SP) also criticized the change.

— This absurd loss that we had ends up affecting not only thousands of people with disabilities in the country, but also people with autism, people with rare diseases and people with other chronic diseases. All these citizens are at risk of having their therapies excluded from the plans’ coverage. These people will be helpless, as will many other patients who are being treated for serious illnesses such as cancer or degenerative diseases. We talk about resources for Brazilians to stay alive. Imagine the direct impact on the lives of millions of families, who are already trying to pay the high cost of a health plan in our country. When we say that the taxing role kills, it is not an exaggeration. This decision does affect the lives of many people,” said Mara Gabrilli in plenary, also on June 8.

Senator Jean Paul Prates (PT-RN) pointed out that, now, the agreements will be obliged to cover only the procedures listed by the ANS. Before, the list was considered a guide, and patients got treatments outside the list by going to court. He believes that the issue will end up being decided by the Federal Supreme Court (STF). “With the change, if you are not on the list, you will not be covered by health plans. And this should be the guideline for all instances of Justice, removing the possibility of patients getting the procedures even when the case is judicialized”, summarized Jean Paul.

In turn, Senator Eduardo Girão (Podes-CE) said he was surprised by the decision of the STJ, which, according to him, “favors powerful health plans by penalizing those with disabilities and rare diseases”.

Senator Eliziane Gama (Citizenship-MA) stated that the change will harm “thousands of families who benefited from health treatments that were not included in the ANS list of treatments. A difficult decision to accept and which generates a lot of insecurity for health plan users. Unfortunate!”. Senators Alvaro Dias (Podemos-PR) and Paulo Paim (PT-RS) released statements to the same effect.

bills

Senator Fabiano Contarato (PT-ES) also reacted immediately to the STJ’s decision: on June 8, he filed PL 1.557/2022. This bill determines that the ANS list will be a “minimum basic reference for assistance coverage by health plans”. On Twitter, Contarato said that “we cannot allow the population to be harmed for the sake of profit from health plans! I filed PL [projeto de lei] which guarantees that the list of procedures and medications provided by the ANS is only a minimum, explanatory reference, and not an exhaustive list! Those who pay are entitled to adequate treatment, and it is not the health plans that should define this, but a qualified medical staff!”.

So far, eight other bills have been introduced by senators and senators, all along the same line: to prevent the National Supplementary Health Agency’s list of diseases from being exhaustive. Through social networks, the reactions of parliamentarians swelled, uniting governmentists, oppositionists and independents. There are also older projects that deal with the topic.

Senator Romário (PL-RJ) stated that the decision of the STJ “could cost the lives of many people, in addition to the immense negative impact that thousands of patients and their families will face when their therapies and medications are suspended”. For him, it is “a real setback in guaranteeing the rights of the Brazilian population”. Romário presented PL 1.575/2022, a bill that guarantees coverage of treatments that are not listed in the ANS.

“Leaving the decision about people’s health in the hands of companies is totally unacceptable. It is doctors, therapists and other health professionals who need to decide and recommend what is best for each patient. Health plans are responsible for complying with the recommendations and covering the procedures indicated by the doctor accompanying the beneficiary, even if not provided for in the list, as long as there is a technical basis”, added Romário.

Senator Paulo Rocha (PT-PA) also criticized the change: “More money for billionaires. Luis Felipe Salomão, Villas Bôas Cueva, Raul Araújo, Marco Buzzi, Marco Aurélio Bellizze and Isabel Gallotti, ministers of the STJ, have just approved the spree of medical agreements. An absurdity! Profit over life”.

When regretting the decision of the STJ, Senator Randolfe Rodrigues (Rede-AP) said that the “health plan lobby” will harm more than eight million Brazilians. He defended the approval of PL 396/2022, presented by him at the beginning of the year, which establishes that the role of the ANS is not exhaustive and that health plans are obliged to cover procedures, medicines and events “necessary for the best health care of the consumer or beneficiary”.

Senator Paulo Paim (PT-RS), who also criticized the decision of the STJ, presented PL 1.594/2022, a bill that ends the tax role.

In turn, Senator Jorge Kajuru (Podemos-GO) pointed out several ways to solve the problem without harming the population: “It is necessary to change the decision of the STJ that exempts health plans from paying for treatments that are not on the ANS list. Appeals can be made to the Federal Supreme Court (STF), a project can be submitted to the Senate, and the ANS can be asked to update the list of procedures. Fighting for health is fighting for justice”. He presented PL 1,579/2022, a bill that, among other objectives, prohibits the imposition of limits on the coverage of multidisciplinary treatment.

Another senator to file a bill was Eduardo Girão (Podemos-CE). He presented PL 1,592/2022, which provides that the list of the National Supplementary Health Agency will be “minimum reference for the assistance coverage of health plans”.

Also on social media, Senator Mecias de Jesus (Republicans-RR) spoke out against the exhaustive list of procedures. He presented PL 1.570/2022, a bill that guarantees the expansion of coverage of plans when necessary, even when the treatment is not on the ANS list.

PL 1,571/2022, a bill presented by Senator Rogério Carvalho (PT-SE), determines that the list of health procedures and events edited by the ANS will have an “exemplary character”. With the same purpose, PL 1,585/2022, by Senator Rose de Freitas (MDB-ES), and PL 1,590/2022, by Senator Flávio Arns (Podemos-PR) were presented.

Agência Senado (Reproduction authorized with reference to Agência Senado)

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