Supreme Court Decision on HMO Lawsuits May Renew Congressional Debate on Patients’ Rights Legislation
A bipartisan group of senators on Tuesday said a Supreme Court decision this week that limited the ability of patients to file suit against HMOs in state court will renew debate over patients' rights legislation, but congressional Republican leaders said that lawmakers likely will not pass such a bill this year, the AP/San Francisco Chronicle reports (Sherman, AP/San Francisco Chronicle, 6/22). The Supreme Court on Monday ruled that patients cannot file suit against HMOs in state courts when they experience injuries as a result of administrative decisions related to treatment. In the case, which involved a 1997 Texas law, two state residents separately filed suit in state court against their HMOs, Aetna and Cigna Healthcare, over allegations that the companies made decisions related to treatment that resulted in injuries.
In the Aetna case, Juan Davila received a prescription for Vioxx from his physician, but the rules of Aetna Health, a division of Aetna that operated his HMO, required Davila to take two less-expensive medications first. Davila had an adverse reaction to one of the medications that required him to receive care in the emergency department for bleeding ulcers. In the Cigna case, Ruby Calad underwent a hysterectomy, and although Cigna HealthCare of Texas, a division of Cigna that operated her HMO, specified coverage for only a one-day hospital stay, her surgeon recommended a longer stay. A hospital-discharge nurse employed by Cigna did not approve the longer hospital stay, and Calad was readmitted to the hospital several days after her discharge with complications from the hysterectomy. Both Davila and Calad filed suit in state court under state HMO laws. The case involved a dispute over whether the Employee Retirement Income Security Act of 1974 preempts state laws that allow patients to file suit against HMOs for administrative decisions related to treatment that resulted in injuries. According to the Supreme Court, the Aetna and Cigna cases were subject to ERISA, not state law, because they involved administrative, not medical, decisions (California Healthline, 6/22).
A bipartisan group of senators on Tuesday held a news conference to call on lawmakers to renew debate over patients' rights legislation, which Congress failed to pass in 2001 (AP/San Francisco Chronicle, 6/22). The House and Senate passed separate patients' rights bills in 2001 but could not resolve differences in the legislation. Rep. John Dingell (D-Mich.) on Monday introduced patients' rights legislation identical to the bill that the Senate passed in 2001. The bill would allow patients to file suit against HMOs in state court for unlimited damages or in federal court with damages limited to $5 million (California Healthline, 6/22). At the news conference, Sen. John McCain (R-Ariz.), co-author of a patients' rights bill that failed in the Senate in 2001, said that he hopes to renew negotiations with the Bush administration on the issue, adding that patients should have "the right to remedy insurance disputes in the courts if all other means are exhausted."
Sen. John Edwards (D-N.C.), who also attended the news conference, said that the issue of patients' rights remains "enormously important" (AP/San Francisco Chronicle, 6/22). He added, "At a time when the Bush administration is pushing millions of seniors on Medicare into HMOs, it is more important than ever to put healthcare decisions back in the hands of patients and their doctors" (Russell Chaddock, Christian Science Monitor, 6/23). Senate Minority Leader Tom Daschle (D-S.D.) said, "It's time for Congress to act" on patients' rights legislation (CongressDaily, 6/22). Presumptive Democratic presidential nominee Sen. John Kerry (Mass.) added that such legislation "has bipartisan support, and it could become law tomorrow if the Bush administration was not standing in the way" (AP/San Francisco Chronicle, 6/22). Gary Claxton, vice president of the Kaiser Family Foundation, said that the Supreme Court decision "moves the bar of who can get redress toward the HMOs and away from consumers. It looks like something that the Congress will now have to deal with."
However, according to the Monitor, "any move" to pass patients' rights legislation this year faces "time constraints," with few legislative days left in the 108th congressional session, and "it's unclear what the vote count is." In addition, the Monitor reports that the "political climate" on health care has shifted since 2001, from a focus on patients' rights to "greater public concern over health care costs and access" (Christian Science Monitor, 6/22). Rep. John Boehner (R-Ohio) said the prospects for passage of a patients' rights bill in the House this year are "zero" (CongressDaily, 6/23). House Majority Leader Tom DeLay (R-Texas) said that supporters of patients' rights legislation are "more interested in lining the pockets of trial lawyers than giving access to health care to the American people" (AP/San Francisco Chronicle, 6/22). White House press secretary Scott McClellan said that President Bush supports patients' rights legislation, but he "did not commit to renewing an effort to pass" such a bill, CongressDaily reports (CongressDaily, 6/22).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.