Passage of Patients’ Rights Bill Could Come By Tomorrow
The Senate yesterday moved closer to approving patients' rights legislation, as senators reached a "key compromise" on an amendment to shield most employers from lawsuits, and Democrats successfully fended off several Republican challenges to the measure, the Los Angeles Times reports. Although Republicans yesterday "announced one final push" to change the legislation, it has become "increasingly clear" that they "lack the votes to significantly alter -- let alone stop" the Democratic-backed bill, the Times reports (Miller, Los Angeles Times. The bill (S. 283), sponsored by Sens. Edward Kennedy (D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.), 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, such as those involving violations of their health plan's contract. Damages awarded in federal court would be capped at $5 million, but state courts could award as much money in damages as the state allows. The legislation would also guarantee patients access to emergency and specialty care, and require health plans to inform patients of how the plan is run, how to pay for out-of-network emergency room visits, how to access specialists and how to take disputes to independent appeals panels. "The inevitably of the outcome is increasingly clear," Kennedy said, predicting a final vote by Saturday (Pear, New York Times, 6/29).
The Senate yesterday voted 96 to 4 to approve an amendment sponsored by Sens. Olympia Snowe (R-Maine,) Mike DeWine (R-Ohio), Ben Nelson (D-Neb.) and Blanche Lincoln (D-Ark.) that would provide a "fire wall" for employers against lawsuits by employees, according to Snowe. She said that under the amendment, if companies contract with insurers to administer a health plan, the insurer would "automatically" become the "designated decision maker" and thus be fully liable for medical decisions (Archibald, Washington Times, 6/29). Self-insured employers could also "shift liability to whatever insurance or health care company is hired to administer its plan," the Wall Street Journal reports. However, "[l]arge-self-insured employers who also self-administer their health plans" -- about 6% of all U.S. employers -- would still be subject to lawsuits in state courts. The Senate last night defeated an amendment, 55-45, that would have also exempted this category of employers from lawsuits (Rogers, Wall Street Journal, 6/29). Still, even these employers, including unions, would be exempted if "their plans merely process and pay for claims after treatment is rendered" and don't require prior approval of treatments for employees. In addition, self-insured employers could only be sued over medical decisions, not "contractual or administrative disputes" (Los Angeles Times, 6/29).
Here's a look at some of the other amendments considered yesterday by the Senate:
- Voted 53 to 44 against a proposal by Sen. Susan Collins (R-Maine) that "would have allowed states wide latitude to opt out of federal regulations for workers who are covered by state laws."
- Instead, approved by a vote of 64 to 36 a "compromise" amendment from Sen. John Breaux (D-La.) that would let states maintain their patients' rights laws if they are in "substantial compliance" with the federal version (Dewar, Washington Post, 6/29).
- Defeated, 62-38, an amendment sponsored by Sen. Christopher Bond (R-Mo.) that would have limited lawyers to collecting no more than 15% of a patient's damage award (Koszczuk, Philadelphia Inquirer, 6/29).
- Defeated an amendment by Sen. Arlen Specter (R-Pa.), 58 to 42, that would have required all patients suing HMOs to go through federal courts (Los Angeles Times, 6/29).
Republican senators remain divided on whether to press on with offering amendments in an attempt to make the bill more acceptable to President Bush, who has threatened to veto the measure (New York Times, 6/29). Sen. Ted Stevens (R-Alaska) said, "There comes a time when you realize you are not going to win. I'm sure we're not going to kill this bill" (Hosler, Baltimore Sun, 6/29). But Senate Minority Whip Don Nickles (R-Okla.) said, "I'm not going to be railroaded into passing a bad patient's bill of rights" (Welch, USA Today, 6/29) Still, CongressDaily/AM reports that members of both parties "made some process off the floor" yesterday, as Edwards said that he has reached an agreement with Sen. Fred Thompson (R-Tenn.) on an amendment "requiring patients to exhaust" their health plan's appeals process "before proceeding to court in most cases." Under the amendment, patients could sue only if the appeal exceeded 31 days, and "the results of any appeal would be admissible in court proceedings." The Senate today is expected to vote on "big-ticket amendments on state vs. federal lawsuits and damage award caps," as well as an amendment by Nickles to ban class-action lawsuits against health plans (Fulton/Rovner, CongressDaily/AM, 6/29).
Meanwhile, the Bush administration continued to criticize the Kennedy-McCain-Edwards bill and the senators backing it, with Bush saying it will lead to frivolous lawsuits and drive up health care costs. White House Press Secretary Ari Fleischer, referring to the bipartisan agreement on the non-liability provisions of a patients' bill of rights, said, "The president agrees with 90% of what the Senate is doing. So why can't the Senate send to the president the 90% that everybody agrees on and get a bill signed into law" (New York Times, 6/29). He added, "Why would Congress want to engage in a political activity to passed something they know will not be signed into law?" (Espo, AP/Bergen Record, 6/29). Bush yesterday met again with House Republicans who "may be supportive" of the House version (HR 526) of the McCain-Kennedy-Edwards bill -- sponsored by Reps. Charlie Norwood (R-Ga.), John Dingell (D-Mich.) and Greg Ganske (R-Iowa) -- but also "may be inclined" to support patients' rights legislation sponsored Rep. Ernie Fletcher (R-Ky.) that would provide a less expansive right to sue (Mitchell et al. CongressDaily, 6/28). But House Minority Leader Richard Gephardt (D-Mo.) said he "doubt[ed]" that the administration would "be able to attract enough votes" away from the Ganske-Dingell-Norwood bill, "nearly identical" versions of which have twice pass the House in recent years (Los Angeles Times, 6/29). Sen. Rick Santorum (R-Pa.), a critic of Kennedy-McCain-Edwards, predicted that the House would likely pass a bill that it is equally as "[un]acceptable" to Bush as the Senate bill is, leading to a veto. "The problem here is the House has always passed worse bills than us. If we pass a bill the president won't sign, (then) the House will probably pass a bill the president won't sign. And we won't get a bill" (Baltimore Sun, 6/29).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.