March 3, 2000 (Washington) -- More than 70% of Americans, regardless of political affiliation, support a patients' bill of rights with a right to sue managed care companies, according to national surveys. But that specific provision remains one of the major divides between the House and Senate managed care reform bills passed last year. In an appearance Thursday, President Clinton -- joined by consumer and medical interest groups -- emphasized that the House bill, which offers the right to sue, is "so far ... the only bill that can make its way to my desk." Clinton noted that "this is not a partisan issue anywhere else in the entire United States."
While the Senate bill has no comparable provision, Senate Republicans have acknowledged that some right to sue is inevitable.
Hammering out a final "patients' bill of rights" by the end of the month is the goal, according to House/Senate conference committee chairman Sen. Don Nickles, R-Okla. "We're going to work real hard" to meet that "aggressive" timeline, he said at the panel's first meeting Thursday. If the conference committee can get agreement, Congress would send President Clinton a bill to sign into law.
Staffers are already close to deals on several items. For example, aides have agreed on language that will allow parents to designate a pediatrician as a primary physician for their children. And a Nickles spokeswoman tells WebMD that staffers are close to agreement on standards to guarantee coverage of emergency room visits and to allow women direct access to ob/gyns during pregnancies and in other situations.
"I feel very positive about it," Rep. Charlie Norwood, R-Ga., tells WebMD. "There is no reason this can't happen." At the same time, he acknowledges, "In this town, anything can blow up on you." Norwood was a chief architect of the House-passed bill, but Republican leaders kept him off the conference committee in favor of lawmakers who back less aggressive legislation.
Despite the early progress, numerous negotiations remain over, for example, general patient access to specialists, allowing patients to go out of managed care doctor networks, permitting individuals to continue seeing a physician even if the doctor stops contracting with a health plan, and giving patients access to drugs not on a plan's formulary.
And there are even huger differences between the two bills beyond the right to sue. The scope of the House bill, for example, is far larger than that of the Senate. It would cover all 161 million Americans with employee-sponsored health insurance, while the Senate would largely apply to just 48 million Americans -- those in plans that are not governed by state laws. Senate Republicans have argued that states should regulate the other health plans.
The two bills also have major differences in the appeals processes they would establish for individuals over care denials and other grievances.
Significant haggling over the details is certain, but the question is, according to conferee Rep. Bill Thomas, R-Calif., "Can the Senate come far enough for the House to accept it?"
If the Senate comes, it may be kicking and screaming. The Senate Republican Policy Committee put out a document touting estimates that the House bill would jack up premiums so much that 1.2 million Americans would lose their coverage. The policy committee was citing data generated through employer and insurance groups.
And Nickles said Thursday that the top consideration for a final bill was that it "do no harm," such as raising costs and increasing the number of uninsured Americans. "Let's try to take the best of both bills," he said.
The conference committee plans to hold its second meeting on March 9.