PATIENTS’ RIGHTS: GOP Leadership Relents on Right-to-Sue
Backed into a corner on HMO reform, the House Republican leadership signaled Friday that it will back a broader proposal to regulate health plans, which includes allowing patients to sue their HMOs for care denials. House Speaker Dennis Hastert (R-IL) promised a floor vote next month on new legislation authored by Reps. Tom Coburn (R-OK) and John Shadegg (R-AZ) (AP/Baltimore Sun, 8/7). "I've got a commitment signed in blood from the entire leadership at 1:45 in the morning," said Coburn. John Hart, a Coburn spokesperson, added, "What's significant is the leadership of the House has for the first time recognized that the will of the majority supports giving people the right to sue their HMO" (Hudson, Washington Times, 8/7). "While stopping short of endorsing" the bill outright, Hastert said "he backs the basic principles" and would bring it to a vote (Eilperin/Goldstein, Washington Post, 8/7).
CongressDaily reports that the legislation will come to the floor in the form of two bills -- one focusing on patients' rights, the other on health care access. The patients' rights bill, which would apply to all 161 million Americans in employer-based health care, would mandate an independent review process to settle coverage disputes. Plans would be fined $1,000 per day without limit should they disregard the reviewer's recommendations. While the bill stipulates no definition of "medical necessity," leaving the reviewer beholden to a plan's standards of what it covers, "Coburn said health plans under his proposal will be required to spell out in greater detail what they do and do not cover." The bill would also change ERISA to allow patients to sue if physically harmed. Punitive damages would be prohibited if a plan provided care, and employers would not be liable.
The access provisions adhere closely to an earlier Shadegg bill, and "would require employers to offer their employees at least two health plans -- and as many as four -- and force employers offering health care to provide employees with a tax-exempt 'premium voucher' that would allow them to purchase a health plan not offered by the employer" (Morrissey, 8/6). Shadegg said, "It is critically important that we give Americans choice in selecting their health care plan and this legislation does so. ... This legislation gives Americans the ability to choose the health care plan that best meets their needs and provides that all Americans, including the uninsured, have access to quality care" (release, 8/6). The Washington Times reports that both "the Norwood and Coburn camps are predicting victory" when Congress returns from recess, "although sources on both sides privately acknowledge it could be a very close vote" (8/7). Wall Street Journal columnist Paul Gigot said, "I think it's going to take everything the leadership has to stop what will be passing a Democratic bill." Further, "it is going to be very hard for the Republican Senate ... to resist some kind of bill particularly with the president beating up on them" (PBS, "NewsHour with Jim Lehrer," 8/6).
From the Editorial Pages
Taking Republicans to task, an Arizona Daily Star editorial says the dissidence among the Norwood-led faction "is the kind of refreshing leadership the consumer needs in order to win better treatment. ... Americans are tired of the inadequate but politically convenient Republican remedies for managed care coverage. The industry will fight back true reform, but with a little help from Republican dissident friends, the public might finally arrive at something closer to what it needs" (8/9). But a Las Vegas Sun editorial cautions: "Even with House Speaker Dennis Hastert's support of the right to sue HMOs, don't count out the influence of the insurance industry -- a big contributor to Republican candidates -- that will try to strong-arm GOP lawmakers to vote its way. The clout of the industry already was demonstrated in the Senate, which last month defeated similar legislation. If, however, the House does pass a patient's bill of rights it could put pressure on the Republican-led Senate to rethink its position and adopt genuine reforms. This will be a critical test for Congress to see whether lawmakers can muster the courage to say no to the insurance industry and do what's right for patients" (8/8).