Over the last three decades, changes in the organization of health care delivery have led to the dominance of HMOs and managed care. Today, more than 90 percent of working Americans with health insurance obtain it through their employer, and many don't have a choice about the type of health insurance that protects their family.

Most employers offer health insurance through an HMO or other type of managed care organization. In other words, despite any concerns Americans have about managed care, many working families are stuck with it.

Democrats are fighting for a Patients' Bill of Rights. Despite opposition from Republicans in Congress, HMOs and the insurance industry, Democrats want to make sure that health insurers are held accountable if they deny necessary services, or do not deliver high quality health care. This means Americans should have:

• Guaranteed access to needed health care specialists
• Continuity of care protections so that patients will not have an abrupt transition in care if their providers are dropped
• Access to a fair, unbiased and timely internal and independent external appeals process to address health plan grievances
• Assurance that doctors and patients can openly discuss treatment options
• An enforcement mechanism that ensures legal recourse for patients who have been harmed as a result of a health plan's actions.