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Bipartisan House Passes Strong HMO Patient Protections

WebMD Health News

Oct. 7, 1999 (Washington) -- Consumers and physicians won a major round in the battle over managed care patient protections, as the House Thursday overwhelmingly approved a bipartisan measure that would give patients a range of new rights, including the ability to sue health plans.

The 275-151 vote for the legislation introduced by Reps. Charlie Norwood (R, Ga.) and John Dingell (D, Mich.) also marked a major defeat for GOP leaders, who had pushed a significantly more limited alternative. Sixty-eight Republicans voted for the Norwood bill.

Earlier in the day, Democrats lost only two of their members while picking up 29 Republicans to defeat a substitute bill endorsed by the GOP leadership. Reps. Tom Coburn, MD (R, Okla.), and John Shadegg (R, Ariz.) wrote that measure, which failed 238-193.

Another Republican bill, from Rep. John Boehner (Ohio), included no right-to-sue provision and was torpedoed 284-145. Still another GOP alternative, from Reps. Amo Houghton (N.Y.) and Lindsey Graham (S.C.), lost 269-160.

As its centerpiece, the Norwood bill grants patients the right to sue their health insurance companies in state courts. It also requires that HMOs establish external independent medical review boards for disputed care issues. Plans would pay the costs of reviews, and panel decisions would be binding. Under the bill, a patient could still sue an HMO if a board ruled against them, but that suit would go to federal court.

The close to 300 health provider and patient groups that backed the Norwood plan were jubilant. In a statement, the president of the American Medical Association (AMA), Thomas Reardon, MD, called the vote a "colossal victory for patients."

The issue of patient rights in HMOs carries enormous emotional resonance, which lawmakers played on throughout the day's debate. Before his final floor speech for the Norwood bill, for example, Rep. Greg Ganske, MD (R, Iowa), escorted an Atlanta boy, James Adams, into the chamber. According to Ganske, the boy lost his hands and legs as a result of shoddy HMO handling of a medical emergency.

But for employers and insurers, and many Republicans, the bill would have dire consequences in pushing more health matters into the courts. "It will drive up health care costs and drive up the numbers of the uninsured," said Rep. Ernie Fletcher, MD, (R, Ky.), who backed the Coburn alternative. The Chamber of Commerce blasted the Norwood bill in a statement, saying it would "move medical decision-making to the courtroom, where the only winners are the lawyers."

The Norwood legislation also guarantees patients in a closed network the right of a point-of-service option, direct access to the care of obstetrician-gynecologists, and access to pediatricians. For patients with special conditions, the bill guarantees access to specialists. The bill also requires that plans cover emergency medical services without prior authorization, if a "prudent layperson" thought that such care was necessary. The bill allows a physician to prescribe drugs not on a plan formulary.

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