PATIENTS’ RIGHTS: Democrats Introduce Own Bill, Bash Rival Proposal
Democrat lawmakers in both Houses yesterday introduced legislation they say "would protect patients by regulating the practices of health insurance companies" and HMOs. While supported by "consumer groups, labor unions and the American Medical Association," the measure was opposed by "Republican leaders of the House and the Senate," according to the New York Times. Introduced by Sen. Tom Daschle (D-SD) and Rep. John Dingell (D-MI) -- who "made it clear they saw the effort to regulate managed care as a winning political issue for Democrats in this year's congressional elections" -- the bill delineated "a long list of patients' rights." The bill would give patients a greater choice of doctors, better access to specialists and "the right to participate in trials of experimental drugs," the Times reports. Regarding one of the most contentious issues in managed care reform, the bill would allow patients to appeal their HMOs' denial of treatment through an independent board comprised of federal or state officials. And, while the measure "would not create a new right to sue under federal law ... it would allow patients to sue and recover damages under state law." The bill would also require states to create an ombudsman program to serve at patients' advocates (Pear, 4/1). The bill would also ensure that health insurance would cover emergency room care that a "prudent lay person" considers appropriate, the AP/St. Paul Pioneer Press reports (Burrell, 4/1).
The Times reports the Democrats "have little hope of getting their bill on the floor" of either Houses so they "plan to offer it as an amendment to one or more bills on the Senate floor, forcing Republicans to vote on it again and again" (4/1). CongressDaily/A.M. reports Gephardt "flatly predicted" at a news conference, "We may have to go to a discharge procedure to get this bill to the floor." And Kennedy also said he and others "would likely seek to append their bill to another measure on the floor rather than try to wind their way through committee, 'probably right after the break'" (Rovner, 4/1).
The Democrats' bill, which, according to Labor Secretary Alexis Herman, "includes every protection recommended by the presidential advisory committee, has the backing of President Clinton (Times, 4/1). Writing from Botswana, Clinton sent a letter to Daschle and Gephardt commending them on their bill. "This bill represents a critically important step towards enacting a long overdue 'Patients' Bill of Rights" that Americans need to renew their confidence in the nation's rapidly changing health care system," Clinton wrote (White House release, 3/31). House Minority Leader Dick Gephardt (D-MD) said the bill "allows patients to enforce their rights" and makes health plans "legally accountable for decisions that lead to serious injury or death" (Gephardt release, 3/31).
"Now that they have their own bill," CongressDaily reports, "Democrats come out with their strongest statements yet bashing" Rep. Charlie Norwood's (R-GA) Patient Access to Responsible Care Act (PARCA), "which so far has been the leading managed care measure." Dingell said his bill "does not just give providers a right to bill -- it gives patients a bill of rights." As CongressDaily notes, the Democrats' bill does not go as far as PARCA in "amending" a federal law (Employees Retirement Income Securities Act) that prevents patients from suing their health plans. "We believe these matters ought to be decided in the states," said Kennedy (Rovner, 3/31). Norwood said that "Democrats who are criticizing his managed care regulations bill as too favorable to providers 'don't understand the nuances.'" Norwood told CongressDaily/A.M.: "None of them standing up there understands the relationship" between a physician and patient. He also criticized the Democratic bill for not being tough enough on the provision in ERISA preventing patients' right to sue. "We broke it. We should fix it," said Norwood referring to ERISA. Norwood also said he is drafting a "PARCA-lite" bill "that takes into account the comments and criticisms his measure has drawn" (4/1). However, Norwood did commend the Democrat bill for "at least" acknowledging the "ERISA pre-emption of state medical malpractice laws (Norwood release, 3/31). Indeed, the Times notes the Democrat bill "is unlikely to become law in its current form," but it will "nudge the debate toward more regulation, putting pressure on Congress to pass some type of patient protection bill this year."
Too Much Regulation
Senate Majority Whip Don Nickles (R-OK) "said he was distressed to see 'members of Congress putting on lab coats and prescribing by law treatment for all of America" (4/1). And the American Association of Health Plans said the Democratic bill "moves in the wrong direction" by increasing costs, adding new layers of government bureaucracy and undermining health plan quality activities. The AAHP called the bill a boon to "trial lawyers and other special interests at the expense of working families" (AAHP release, 3/31). And the Health Insurance Association of America said it would lead to higher health insurance premiums and raise the number of uninsured Americans. HIAA COO Chip Kahn said, "The proposal is little more than a transparent, election-year guise of consumer protection, arrogantly assuming a 'Washington knows best' attitude that would mandate the most minute details of health insurance and HMO regulation" (HIAA release, 3/31).