PATIENTS’ RIGHTS: To the House, James
As the Senate hands patients' rights legislation off to the House, several Republican House members are expected to try to force a vote on a tougher bill, the New York Times reports. While the House GOP leadership hopes to advance a package of HMO reforms proposed by Rep. John Boehner (R-OH), Reps. Greg Ganske (R-IA) and Charlie Norwood (R-GA) are "talking openly" about teaming with Democrats to pass a bill that would allow a limited right to sue health plans and cover all managed care enrollees, not just those in self-insured plans. It would also create an independent appeals process, require health plans to allow out-of-network doctor visits for an additional fee and "prohibit penalties against doctors who seek additional care for patients." Norwood and Ganske "made it clear that [they] would break with [their] party on a procedural vote to get their proposals considered." Reps. Tom Coburn (R-OK) and John Cooksey (R-LA), two other physicians, figure to join the mini-rebellion. The Times notes that the rebels "are pinning their hopes" on negotiations between House Commerce Committee Chair Tom Bliley (R-VA) and ranking member John Dingell (D-MI). "I think the possibility of agreement is pretty good," said Norwood (Clymer, 7/18). CongressDaily/A.M. reports that both the Commerce Committee and the House Education and the Workforce Committee, on which Boehner sits, will both attempt to move bills to the floor before the August recess (7/19).
Scope of Coverage at Issue
Few people enrolled in HMOs would benefit from the Senate bill passed last week, the New York Times reported Saturday. Not only does the bill apply only to those 48 million Americans enrolled in self-funded plans, but most of that number "get their health care through traditional fee-for-service arrangements or through loosely organized forms of managed care that are less restrictive than the HMOs." Craig Copeland, a research associate at the Employee Benefit Research Institute, said "only a small number of the 48 million people are in HMOs --at most 10%" (Pear, 7/17). And the Philadelphia Inquirer reports that the "Senate's action came only after dozens of states ... had enacted their own patients' bills of rights in recent years" (Ginsberg, 7/18). Mike Batte, New Mexico's acting superintendent of insurance, said, "We feel like we have some of the strongest set of patient protections in the country. A lot of people here feel that the regulations we already have in place exceed what they're talking about in Washington." Former New Mexico Gov. Garrey Carruthers, now head of Cimarron Health Plan, said, "I don't know where the federal government was when we were doing all this. Once again, I think this demonstrates Congress is about two years behind developments" (Baca, Albuquerque Journal, 7/16).
Viva Las Vegas
The Republican Governors Association, meeting last week in Las Vegas, echoed several of the same points. Arizona Gov. Jane Hull (R) said, "The more the federal government gets into it, the worse it gets. I'm concerned if the federal government gets into it, they're going to raise the cost of medical care so we have more and more uninsured." Virginia Gov. Jim Gilmore added, "I believe it's a state issue. I think you're seeing that particularly Republican governors are addressing these issues decisively. We're able to make policy and get it through our Legislatures, so we avoid some of the difficulties you see when you try to make it a national issue, when really it's most appropriately handled at the state level" (Morrison, Las Vegas Review- Journal, 7/16).