Norwood et al. to Introduce New Patients’ Rights Bill
House supporters of the Senate-passed patients' rights bill (S 1052) will "shelve" the House version (HR 526) of the bill, which they proposed in February, and introduce new legislation today that includes amendments adopted in the Senate last month, the Washington Times reports. Reps. Charlie Norwood (R-Ga.), John Dingell (D-Mich.) and Greg Ganske (R-Iowa) say they hope that the move will prevent House Republican leaders, who oppose the bill, from defeating it by forcing individual votes on every amendment that the Senate added to the bill (Archibald, Washington Times, 7/19). The new bill, like HR 526, 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. The legislation would cap damages awarded in federal court at $5 million, but state courts could award as much in damages as the state allows. To reflect amendments made to the Senate bill, the new House bill would require patients to exhaust an independent appeals process before suing HMOs and would allow employers be shielded from liability by naming an outside designated decision maker to make medical decisions that affect employees.
Rep. Ernie Fletcher (R-Ky.), sponsor of a rival bill (HR 2315), said that Norwood, Dingell and Ganske are introducing the new bill in order to "stem the loss of House support" that occurred after President Bush threatened to veto the Senate bill (Washington Times, 7/19). Under Fletcher's bill, patients could sue health plans in federal court for quality of care issues and non-quality of care issues, but could only sue in state court in cases where health plans refused to abide by decisions made by outside appeals panels. The bill would cap non-economic damages in federal court at $500,000, but state courts could award as much money in damages as the state allows. The bill would prohibit punitive damages. "I think they're trying to make the bill look more like ours in a lot of ways, because they realize we're getting a lot more support now," Fletcher said. House leaders have not decided which bill to bring to the floor for debate, but "probably" will next week. However, supporters of the Senate bill said that if House leaders bring the Fletcher bill or HR 526 to the floor, they would offer the new legislation as a substitute (Washington Times, 7/19).
In related news, USA Today reports that managed care organizations, which oppose legislation that would expand patients' rights to sue HMOs, often file suit seeking reimbursement from patients who receive settlements or damage awards from third parties for injuries that require medical care. Health experts said that a "drive for more revenue" has driven the trend. Roger Baron, a law professor at the University of South Dakota, said, "When things started getting tight, HMOs started really going after these dollars." Ganske called the practice a "dirty little secret of managed care," adding that HMOs sometimes sue for reimbursement for the full cost of medical procedures even when they pay a discounted rate to hospitals and doctors. Health plans say that they "are acting to keep premiums low for everyone." Lou Soccoccio, general counsel of the American Association of Health Plans, said, "An individual should be compensated once for those sets of costs, not twice." While some states limit or bar health plans from suing for reimbursements, health insurers say that a 1974 federal law shields them from state laws. Federal courts have issued "conflicting rulings" on whether state laws apply to HMOs, and the Supreme Court may have to resolve the issue (Welch, USA Today, 7/19).