House GOP Leaders Draft Compromise Patients’ Rights Bill

House Republican leaders, "fearing defections" on the patients' rights issue, have drafted a bill that would allow patients to sue health plans in state court in limited cases, the New York Times reports. The provision "goes further than President Bush would like" in allowing lawsuits. Under the legislation, drafted by House Speaker Dennis Hastert and Reps. Ernie Fletcher (R-Ky.), Billy Tauzin (R-La.), Bill Thomas (R-Calif.) and John Boehner (R-Ohio), patients could sue health plans in state courts when the plans refused to abide by decisions made by outside appeals panels. The bill would also allow state courts to decide lawsuits for damages from personal injury, for wrongful death resulting from denial of claims and in some cases of "malpractice under group health plans" (Pear, New York Times, 6/21). In addition, the measure would establish tax-free medical savings accounts and include incentives for small businesses to establish larger insurance pools, provisions "anathema" to many Democrats (Goldstein/Eilperin, Washington Post, 6/21). Hastert said, "If the insurance company goes against the review board, you can go to court immediately. So it gives people the ability to get the health care they need when they need it, and not a prolonged court battle that helps lawyers but really doesn't help patients" (Reuters/BayArea.com, 6/20). Hastert said last week that he hoped to introduce the bill before the July 4 recess, but a Hastert spokesperson said yesterday that he would not likely "bring up the measure that soon" (Washington Post, 6/20).

House GOP leaders "gave grudging approval" to the provision, hoping to "derail a more far-reaching" bill (HR 526) sponsored by Reps. Charlie Norwood (R-Ga.), John Dingell (D-Mich.) and Greg Ganske (R-Iowa). That bill is the House version of a Senate measure (S 283) sponsored by Sens. Edward Kennedy (D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.) (Espo, AP/Philadelphia Inquirer, 6/21). The legislation would allow patients to sue HMOs in state court for denial of benefits or quality of care issues and in federal court for non-quality of care issues. In addition, it would cap damages awarded in federal court at $5 million, but state courts could award as much money in damages as the state allows. House Republican leaders, hinting that they may "lack enough support to prevail" against the Norwood-Dingell-Ganske bill, said that they hoped the new legislation would provide a "fresh compromise" and "win over" lawmakers who have been supporting the rival measure. "You've got to have something to rally around," Tauzin said (Washington Post, 2/7). Rep. Nancy Johnson (R-Conn.) predicted that the bill would "attract moderates" who support the Norwood-Dingell-Ganske measure, adding, "I think it will sell itself" (CongressDaily, 6/20). However, Dingell "promised a fight" when the bill reaches the House floor, concluding, "We'll raise hell, attack the rule ... and probably prevail" (Reuters/BayArea.com, 6/20). Bush administration officials said that they "would not second guess the tactics" of House Republican leaders, adding that the new bill "comes much closer to meeting the president's criteria" than the Kennedy-Edwards-McCain measure (New York Times, 6/21). However, sources said that "it remained unclear" whether Bush will "accept" the new House GOP leadership bill (Washington Post, 6/21).

The Los Angeles Times reports that when lawmakers passed the 1974 Employee Retirement Income Security Act, which limits state court actions against health plans, they "did not intend to take away the rights of ordinary employees to sue" insurance companies and HMOs, according to lawyers and scholars who worked on or have studied the law (Savage, Los Angeles Times, 6/21).