Democrats Urge Bush to Support Patients Rights Bill
Hoping to "regain some legislative momentum," congressional Democrats yesterday urged President Bush to support the Bipartisan Patient Protection Act unveiled last week, the Washington Times reports. House Minority Leader Dick Gephardt (D-Mo.) and Senate Minority Leader Tom Daschle (D-S.D.) sent a letter to Bush, "pressing" him to "sign on" to the bill, which would allow patients to sue HMOs, with a $5 million cap on damages awarded in federal court (Scully, Washington Times, 2/14). "The country has been waiting long enough for this bipartisan legislation," they wrote, adding, "We certainly do not condone unnecessary or frivolous litigation. But meaningful legal liability with speedy and serious consequences is the only way to deter managed care plans from trying to maximize profits by denying medical care needed by patients as determined by their doctors" (Daschle/Gephardt release, 2/14).
However, Republicans argue that the liability provision would "dramatically increase" the cost of health insurance, forcing some companies to drop coverage for employees. Bush also said that he remains "wary of opening the door to large lawsuits," although he expressed a "willingness to work with Democrats" on patients' rights legislation. Still, Republican leaders said that they would not allow Democrats to "pressure" them into "quick action" on the issue. "I think it's going to be worked out," House Majority Leader Dick Armey (R-Texas) said, adding, "I think now we've got a president who not only knows the right way to get it done, but will lead us in getting us to that."
Senate GOP leaders and "sympathetic" Democrats have begun efforts to craft a new patients' rights proposal, a process that could "take much of the year" (Washington Times, 2/14). Led by Sens. Bill Frist (R-Tenn.) and John Breaux (D-La.), the lawmakers hope to assemble a separate bipartisan patients' rights bill that Bush would support. "I'm taking the principles President Bush issued last week and trying to put together a bipartisan bill," Frist said, adding, "If it's not bipartisan, [Bush] doesn't want it." Frist admitted that some of the provisions outlined in the "Principles for a Bipartisan Patients' Bill of Rights," which Bush issued last week, remain "not entirely clear," but he said, "[T]hey do knock out every bill we've seen to date." Breaux said that he hoped to include a provision requiring patients to "exhaust appeals processes" before suing HMOs. While he called the plan to draft a new patients' rights bill a "secret," he admitted that Frist has led the effort.
In addition to GOP opposition, the bipartisan patients' rights bill has also prompted criticism from managed care industry officials, who called the legislation "actually worse in some respects than its predecessors," CongressDaily/A.M. reports. American Association of Health Plans President and CEO Karen Ignagni "charged" that the bill would force many employers to stop providing health insurance and would "threat[en]" the health insurance system "as we know it." She added, "What you have here is an issue of runaway liability, with great cost to patients." According to AAHP Vice President for Policy Rick Smith, "It's a compromise, perhaps, but the question is: Who is the compromise with?" Rep. Greg Ganske (R-Iowa), one of the bill's chief sponsors, "insisted" that "concessions have been made." He said, "It is a major concession on the part of Democrats to put a $5 million cap on [federal] damages. I think we've made significant progress on this bill." In addition, Ganske "accused" the managed care industry of "moving the goalposts" on patients' rights legislation. "We're seeing a shift on the part of the HMO industry in the debate because now they know there's going to be a bill," he said, adding, "They're trying to move everything into federal court and mold the outcome" (Rovner, CongressDaily/A.M., 2/14).
In addition, a new Hewitt Associates study released Monday found that an "increasing number" of self-insured employers -- "getting nervous" about potential exposure to liability -- may drop health plans for their employees, the Chicago Tribune reports. The annual survey of 600 national employers revealed that 46% of companies that sponsor health plans would likely stop providing coverage "if their liability is expanded," up from 36% last year. "Some employers would get out of the business of sponsoring a company health plan," Hewitt's Dave Fortosis said, adding, "That doesn't mean they would get out of subsidizing health care. (Employers) would have some financial stake but would be more likely to say: Here is some money, go buy your own health coverage." According to the American Medical Association, however, self-insured employers' "fears are unwarranted." AMA President Dr. Randolph Smoak said, "Unless an employer makes a medical decision -- and that is about as rare as hen's teeth -- the employer would not have liability. There is a huge amount of misinformation about what this bill would do." In addition, Smoak said that employers would likely not revise their employee benefits during a period of low unemployment, adding, "Health coverage is a perk that is high on (employee) expectations when they are job hunting." However, Hewitt's survey suggests that the "threat of lawsuits" may prompt self-insured employers at least to consider alternatives to offering employer-sponsored plans, such as offering employees a "set amount" of funds to purchase their own health coverage -- known as a "defined-contribution" plan. Hewitt reported that 22% of employers nationally have considered such plans. "The defined-contribution approach is likely to become more appealing to organizations as health care costs continue to rise, legislation looms and consumer satisfaction declines," Jack Bruner, head of Hewitt's health management practice, said (Jaspen, Chicago Tribune, 2/13).
The New Republic reports that although President Bush defeated Sen. John McCain (R-Ariz.) -- one of the chief sponsors of the bipartisan patients' rights bill -- in a "bitter" primary fight last year, the Arizona senator has bounced back for "round two," proving that "the two men still can't stand each other." Last week, McCain "thumbed the White House in the eye" and announced his support for a patients' rights bill that Bush opposes, sending the White House into "panic mode." Bush adviser Karl Rove last Monday "summoned" Reps. Charlie Norwood (R-Ga.) and Greg Ganske (R-Iowa) to the White House to persuade them to "drop their sponsorship" of the legislation and "back out of a McCain-dominated press conference" set for the next day. In addition, according to the McCain camp, White House Chief of Staff Andy Card called Republican senators and asked them not to back the legislation in a "coordinated White House effort to weaken GOP support" for the bill. However, the New Republic reports that the effort "apparently backfired" and only boosted media coverage of McCain's "day in the sun," adding, "Needless to say, the McCainiacs have only been emboldened." One McCain adviser said, "The White House wanted to remove Republicans from this compromise legislation in an effort to try to isolate John from the rest of the party so they can say McCain was only trying to embarrass the president. ... Their efforts to isolate McCain only make him stronger." Bush has "tr[ied] hard" not turn the patients' rights "battle" into a "personal" fight, telling reporters, "I am pleased that Senator Kennedy and Senator McCain have come together to offer a plan" (Lizza, New Republic, 2/19).