HMO REFORM: Senators Resurrect Bipartisan Reform Bill
Sens. John Chafee (R-RI) and Bob Graham (D-FL) yesterday re-introduced their largely unchanged bipartisan managed care reform legislation in an effort to stake out a middle ground in the divisive debate. Sens. Joseph Lieberman (D-CT), Arlen Specter (R-PA), Charles Robb (D-VA) and Max Baucus (D-MT) yesterday joined the two senators to introduce the resurrected "Promoting Responsible Managed Care Act." Noting that Democrats and Republicans alike are working to pass a patients' bill of rights, Chafee said that the time is right for a bipartisan bill. "As senators come to realize that we're going nowhere, I believe we'll attract more to our banner," he said. Aside from a broad array of patient protections similar to those offered in the Democrats' bill, the bipartisan proposal offers several enforcement mechanisms to ensure that HMOs are compliant. Key elements of the Promoting Managed Care Act:
- Requires managed care plans to submit report cards;
- Grants HHS the authority to levy $250,000 fines against health plans that fail to comply with the bill's provisions;
- Requires plans to establish both internal and external grievance procedures for patients seeking to appeal care denials;
- Allows patients to sue their health plans in federal court for economic losses, including lost wages and medical expenses stemming from denials of care.
In an effort to appease leaders on both sides of the aisle, the bill allows patients to sue their plans for injuries resulting from denial of coverage, but it restricts collections of economic damages. The move represents a bridge between the Democrats' bill, which would allow litigation in state courts, and the GOP bill that would permit self-insured patients to sue in federal court "for failure to abide by the decision of the external appeals body," but caps the compensation at $100 per day. In addition, Chafee explained that the bipartisan proposal steps up the Democrats' proposal for emergency room care by including reimbursement for "post-stabilization and maintenance care" (Allison Morgan, American Health Line). The Health Insurance Association of America immediately charged that the "compromise" measure "would compromise the right of consumers to obtain affordable coverage" (HIAA release, 2/4).
Measure for Measure
CongressDaily/A.M. reports that Senate Finance Committee Chair Bill Roth (R-DE) and ranking member Daniel Patrick Moynihan (D-NY) said last evening that they will hold a series of meetings to develop their own "consensus managed care bill." In a joint statement, the senators said they wanted to "take a fresh look at all of the issues." The first meeting, to be held today, will include the American Association of Health Plans and the American Medical Association (Rovner, 2/5). The AP/Richmond Times-Dispatch reports that an HMO reform measure is likely to pass Congress this year because of the support of new House Speaker Dennis Hastert (R-IL) and because Democrats picked up five seats -- the margin by which their measure failed last year -- in the mid-term elections. In addition, the fact that bills are being developed through the committee process, rather than "in secret" bodes well for the eventual success of a measure, AP/Richmond Times- Dispatch reports (2/5).