PATIENTS’ RIGHTS: GOP Prevails Again
In a "sharp contrast to the party's disarray on gun control earlier this spring," Republicans yesterday "showed that they were calling the shots in the Senate's managed care debate" (Mitchell, New York Times, 7/15). A day after defeating several Democratic amendments to the Patients' Bill of Rights, Senate Republicans offered many of their own versions of the same issues. In a four-part en bloc amendment that will see more action today, Republicans included a provision that would allow women to seek "routine" gynecological care without first going through a primary care gatekeeper, CongressDaily/A.M. reports. It also states that an HMO "may" allow OB/GYNs as primary care doctors, "compared to the Democrats' language that an HMO 'shall' allow an OB/GYN as the primary care provider." The other provisions replace a Democratic emergency room care measure with a proposal requiring plans to decide within an hour how to cover post-stabilization costs; call for direct access to specialists; and allow a 100% tax deduction for long-term care. Democrats denounced the Republicans provisions as "shell" amendments with little substantive language. But Sen. Bill Frist (R-TN), one of the Republicans' chief health care legislators, said, "We protect the unprotected and regulate the unregulated" (Rovner/Morrissey, CongressDaily/A.M., 7/15).
States' Rights Conundrum
By a 52-48 tally, Republicans also rejected an amendment that would extend the proposed protections to all 161 million Americans enrolled in HMOs, instead opting to apply them to the 48 million individuals covered under employer-based "self-funded" plans that are not regulated by states (O'Rourke, Nando Times, 7/14). Sen. Edward Kennedy (D-MA) said, "These reforms are supposed to protect patients against HMOs and insurance companies. But people with insurance coverage with HMOs are not covered by the Republican bill." But Sen. Rick Santorum (R-PA), stressing that states are better situated to regulate HMOs, said, "This is about arrogance. It's about people thinking we'll decide. We here in Washington think we're enlightened and know what's best for you" (New York Times, 7/15). However, the majority did pass an amendment by Sen. Olympia Snowe (R-ME) that would let doctors determine how long a woman should be hospitalized after breast cancer surgery, which would apply to all 161 million Americans with private health insurance (Hess, Philadelphia Inquirer, 7/15). That vote effectively replaced a measure that would have "extend[ed] routine health care coverage to dying patients enrolled in clinical trials" (McDonald, Houston Chronicle, 7/15).
Sen. John Chafee (R-RI) said he will try to introduce compromise legislation that will "embrace most of the Democratic proposal." But a spokesperson for Senate Minority Leader Tom Daschle (D-SD) said "it appeared unlikely Chafee would be able to win enough Republican support for a proposal that would keep all 45 Democrats on board" (Hosler, Baltimore Sun, 7/15). As such, many began to toll the bell for the demise of patients' rights. CBS' Bob Schieffer said, "The Democrats' plan to overhaul HMOs with the patients' Bill of Rights is dying a slow but certain death in one of the most partisan debates ever." Dr. Thomas Reardon, president of the American Medical Association, said, "The Senate has now said that insurance company profits come first and patients come last. This is a real setback to patients" (CBS, "Evening News," 7/14). HHS Secretary Donna Shalala said, "The stakes are very high here. I think the Democratic bill is the minimum. There's no room for compromise between a sham bill and a real Patients' Bill of Rights" (MacDonald, Hartford Courant, 7/15).
Kaiser Chief Slams Liability
Appearing at the National Press Club yesterday, Kaiser Permanente Chief Executive Dr. David Lawrence said allowing patients to sue their doctors could "backfire," giving health plans even more control over medical care. He said, "What we're worried about is that it provides an incentive for the health plans to become more deeply involved in the medical practice, the very thing consumers are worried about. It's kind of a myth that [the right to sue] is going to solve much of a problem, and it has some real down sides" (Sample, Raleigh News & Observer, 7/15). That statement is bolstered by a new study by the Tillinghast-Towers-Perrin consulting firm that estimates a sizeable increase in malpractice premiums if Congress votes to let patients sue. Warren McPherson, chair of the Physician Insurers Association of America, said, "It's clear that plaintiffs' attorneys want to turn providers against the plan and each other. With the deep pockets of managed care companies and the negative sentiment against managed care espoused by most potential jurors, trial lawyers will have as many health care providers in court rooms as there are in treatment rooms" (release, 7/13).
Odds and Ends from the Tube
PBS' Online "NewsHour with Jim Lehrer" features RealAudio coverage of yesterday's congressional action, as well as links to both the Republican and Democratic bills. CNN's "Inside Politics" featured a profile of American Association of Health Plans President Karen Ignagni.