HMO REFORM: Senate Bipartisan Compromise Bill to Return
Renewing a search for middle ground in the patients' rights debate, Sens. John Chafee (R-RI) and Bob Graham (D-FL) are expected to re-introduce their largely-unchanged managed care reform bill, CongressDaily reports. The Chafee- Graham bill would apply to all private insurance plans, allowing patients denied care to sue in court but forbidding punitive or pain-and-suffering damages. The plan would also allow the HHS and Labor Secretaries to "levy fines of up to $250,000" on plans that violate the patient protection law, require plans to offer timely reviews for denials of care and mandate disclosure of information about patient outcomes and quality measures. The spirit of compromise is most apparent in the legislation's enforcement clauses, with Chafee and Graham believing "the broader rights to sue for punitive damages in the Democrats' plan have no chance of passing the Senate" and that the GOP "bill's lack of any court remedies" fail to "effectively enforce the patient protections they are trying to enact." The Chafee-Graham plan "would not expand medical savings accounts, as the GOP leadership proposed" (Morrissey, 1/27).
Reardon Weighs In
In other managed care reform news, American Medical Association President-elect Dr. Thomas Reardon said the right to sue for denials of care is a "key ingredient" in any patients' rights legislation. Speaking to the Hampden District Medical Society in Springfield, MA, Reardon said the AMA will "insist" on a right- to-sue clause, full disclosure of costs and coverage by HMOs, an outside appeals process and a "prudent layperson" standard for emergency care. He also predicted that employees' share of health care costs would rise as medical technology pushed up prices, and called for a change in the payment system so workers have a larger say in how employers spend their health care dollars (Kerr, Springfield Union-News, 1/27).