PATIENTS’ RIGHTS: Coburn, Shadegg Introduce Bill

      Conservative House Republicans yesterday introduced a wide-ranging HMO reform bill that would allow patients a limited right to sue, adding their names to the several Republicans already bucking the leadership on this issue. Introduced by Reps. Tom Coburn (R-OK) and John Shadegg (R-AZ), the bill would allow patients to sue if they suffered physical injury at the hands of a health plan. Before taking action in court, however, patients would be required to exhaust all appeals processes, including a plan's own administrative appeals process and an independent review by a panel of medical experts. HMOs would be forced to pay only if they failed to exercise "ordinary care," and made an "incorrect determination" that a procedure was not medically necessary or was not a covered benefit. Damages for pain and suffering would be capped at $250,000, or double any economic loss, and punitive damages would be proscribed unless a plan acted with "conscious, flagrant indifference to the rights or safety" of a patient. Rep. Van Hillary (R-TN), who supports the bill, said, "It allows patients who have been truly wronged to have a jury trial in federal court."

Hastert Still Not on Board
      House Speaker Dennis Hastert (R-IL) has promised a vote on the bill this month, but continued to hold out on an outright endorsement. Supporters urged him to back it, suggesting they may otherwise defect in support of Democratic proposals or the Norwood-Dingell bill (Pear, New York Times, 9/10). CongressDaily/A.M. reports that "at least a half-dozen Republicans all but threatened to bring to the House floor a bill that would let patients sue health plans in at least some situations" (Rovner/Morrissey, 9/10). "It's going to happen whether the leadership decides they like this bill or not," said Coburn. Rep. Lindsey Graham (R-SC) added, "This is an issue that can hurt us politically. I hope our leadership got the message. Do the math. They're losing control of this issue." Hastert spokesperson John Feehrey said the speaker is "still committed" to working it out. He said, "The speaker has been working on this issue for many years. It's a difficult issue that requires a delicate balancing act" (AP/Milwaukee Journal Sentinel, 9/10).

Detractors
      The bill took hits from all sides yesterday. Chip Kahn, president of the Health Insurance Association of America, said, "Despite the sponsors' transparent attempts to position their measure as a 'moderate proposal,' this bill is little more than 'Dingwood II,' and is as politically motivated as all of the other so-called 'patient protection' bills currently before Congress" (release, 9/9). American Association of Health Plans President Karen Ignagni said, "Congress can't continue to have it both ways. It's time for members of Congress to choose whose side they are on. Congress either supports keeping coverage affordable through a system of external review or they can cast their lot with the trial lawyers" (release, 9/9). Adrienne Hahn, legislative counsel for Consumers Union, called the bill "unacceptable, because it does not provide the consumer with full compensation for injuries that result from the mistakes of a managed care plan" (New York Times, 9/10).

Coburn on His Way Out
      The Wall Street Journal today published a profile of Coburn, who will voluntarily leave Congress next year after three terms. Disillusioned, he said, "A lot of people will be happy when I'm gone." He criticized Washington career-ism, saying, "I think Congress no longer represents the majority of Americans. Congress represents special interests and itself. It's an elite ruling class." The HMO issue has led him to conclude that the GOP are is just as addicted to special interests as Democrats. "Republicans are not what they say they are," he said (Farney, 9/10).