PATIENTS’ RIGHTS: Health Plan Liability Debated

      Patients' rights supporters told the Senate Appropriations subcommittee on labor, health and human services yesterday that allowing patients to sue their health plans would not be as expensive as some opponents have maintained, CongressDaily/A.M. reports. Assistant Labor Secretary Olena Berg said her department had "actual experience" showing that people "in plans who already have the ability to sue do not raise costs dramatically." She said, "We don't see a big difference in premiums" between plans covered by the federal Employee Retirement Income Security Act liability prevention and those that are not. Families USA's Ron Pollack also supported changing ERISA so patients have the right to sue their health plans. He told the subcommittee that combining a reworked ERISA law with external appeals processes "could even result in fewer lawsuits because more complaints would be resolved before going to court." Pollack said, "Consumers are interested in front end protections, not just back end" -- a statement CongressDaily/A.M. says means consumers are interested in "not having services denied in the first place rather than being able to sue after a denial results in injury or death."

Manufacturers Drop Health Care?
      Also present at the subcommittee hearing were those who asserted that changing the right-to-sue prohibitions of ERISA "would result in companies dropping coverage or passing costs to employees to such an extent that they would drop coverage." National Association of Manufacturers' Mark Smith said, "You can indemnify all you want, but the costs will come back to the employers" (Rovner, 5/15). Citing a Barents Group survey, Smith told the subcommittee that expanding liability for benefits decisions would increase health care premiums by as much as 8.6%, depriving as many as 1.8 million Americans of health care coverage in 1999. "Some would lose their coverage as a result of their employers dropping it entirely. Others would decide they could not afford the increased cost-sharing that would be passed onto them," he said (NAM release, 5/14). Robert Gallagher of the Association of Private Pension and Welfare Plans also voiced opposition to amending ERISA, saying, "What it would do is turn a rational system for allocating resources into basically a lottery in which a few people, including trial attorneys, would get a lot of money."

Political Shuffle
      CongressDaily/A.M. reports lawmakers are still divided on the issue. Sen. Lauch Faircloth (R-NC) said, "I feel deeply for people who are denied basic rights. But I cannot in any way in good conscience support any approach that would result in more litigation. We already have too much of that." But Sen. Edward Kennedy (D-MA), disagreed, saying, "Every other industry in America can be held responsible for its actions. Health plan decisions can truly mean life or death, and they do not deserve immunity" (5/15).