PATIENTS’ RIGHTS: GOP Scores, Dems Plot Future Course
"In Washington today, the status quo rules after a long debate in the Senate about health-maintenance organizations and a patient's bill of rights. It doesn't look as if anything is going to change," ABC's Jennings reported (ABC, "World News Tonight," 7/15). After four days of "impassioned efforts," the Senate yesterday passed the GOP patients' bill of rights on a 53-47 vote, "with two Republican defections: Sens. John H. Chaffee of Rhode Island and Peter Fitzgerald of Illinois." A last-minute attempt by Chaffee to forge a bipartisan compromise failed, as did a Democratic measure that would allow patients to sue health plans, the Baltimore Sun reports. Republicans hailed the measure as a step forward in protecting patients' rights. "This is a comprehensive package that will strengthen rights of patients and improve the way HMOs work, without wrecking the American health care system," said Senate Majority Leader Trent Lott (Hosler, 7/16). However, President Clinton issued a veto threat almost immediately, throwing the fate of the measure in doubt. "It has zero chance of going through his desk because it's a fraud," said Vice President Al Gore (Rubin, Los Angeles Times, 7/16).
The "most significant provision" of the final package is one that would create an external appeals process for people in employer- sponsored plans, the New York Times reports. "The bill enforces a decision against a health plan by allowing a patient to obtain treatment outside of a health network if treatment does not begin in the time frame recommended by the reviewer," and health plans "would be held liable for the charges and for a $10,000 fine." For people in employer-insured plans, the bill would also guarantee "insured access to emergency rooms outside a provider network for services related to stabilizing an emergency condition" and for women, "direct access to an obstetrician for pregnancy and child delivery" and "direct access to a gynecologist only for 'routine' care" (Mitchell, 7/16). The bill would also give doctors the authority to "establish a minimum length of hospital stay for women undergoing mastectomies." Another provision, which would apply to "everyone with private health insurance," would ban discrimination based on genetic testing. Finally, the measure would make health insurance 100% deductible for those who buy their own coverage, and make "the cost of long-term care insurance offered through employers ... deductible," as well as expand medical savings accounts (Welch, USA Today, 7/16).
Start Your Engines...
CNN's King reported: "Republicans are winning the Senate battle for their version of a patient's bill of rights. But in the process, Democrats think they have won a powerful political issue to take into next year's elections, a point underscored when they brought Al Gore into Capitol Hill. ... Democrats are encouraged by internal polls conducted by Gore's owns pollster, which shows 69% in favor of the Democratic bill ("Inside Politics," CNN, 7/15). NBC's Ifill reported that Democrats "guarantee that HMO reform will live again, this time as a political issue in Campaign in 2000" (NBC, "Nightly News," 7/15). ABC's Douglass: "Democrats would like this issue to campaign on, which is why some are not completely sorry they lost" (ABC, "World News Tonight," 7/15). Senate Minority Leader Tom Daschle (D-SD), on whether he'd prefer the bill to die now to have it as an issue in 2000: "There's no doubt that three-fourths, or more, of the American people support our position and have advocated for passage of our bill. But obviously we'd like to have the accomplishment. We always think good government is good politics. In this case we'd love to pass a bill into law" (CNN, "Inside Politics," 7/15).
Put On A Happy Face
The Los Angeles Times reports that the fight over patients' rights pitted providers against "the health insurance industry, HMOs and employer groups, who spent millions of dollars on a lobbying and advertising campaign to defeat it." Jack Lewin, executive director of the California Medical Association, said, "I am disgusted and frustrated by the fact that a very strong special interest can have such a grip on our Congress." He added that the final bill "actually strengthens the hand of investor-owned HMOs over patients." However, Sen. Bill Frist (R- TN), the only physician in the Senate, said, "This is a victory for patients, with improved access to health care for Americans. It achieves a balance (for) doctors and patients ... with a cost that does not hurt access to care." The Los Angeles Times reports that "Republicans received tacit support from the business community and insurers, who were on hand throughout the debate in a marble-floored room a few feet from the Senate chamber to help review amendments and buttonhole lawmakers." Nonetheless, the managed care industry said it was still uncomfortable "with even the Republican bill's specific requirements to guarantee coverage of emergency and specialist care." American Association of Health Plans President Karen Ignagni said, "We have thought for some time that the concept of independent review of health plan decisions is an essential building block for public trust." But, she said, "We are concerned about the amount of micromanagement that has been added to the bill" (7/16).