Feb. 6, 2001 (Washington) -- A coalition of Republican and Democratic lawmakers have given the patients' bill of rights a face-lift in hopes that it will finally make it through Congress after five years of trying. However, a number of opponents, including President George W. Bush, see some serious warts in the proposal introduced on Capitol Hill on Tuesday.
The biggest issue is a provision of the "Bipartisan Patient Act of 2001" that would allow patients to sue their health plan in state court for medical decisions, like denial of treatment, or in federal court for questions of coverage, such as eligibility for the plan. The damage cap would be a maximum of $5 million.
President Bush backed away from the proposal, even though it is modeled after the Texas law that he suggested could be a national model during his campaign. "We can't have a patients' bill of rights that encourages and invites all kind of lawsuits. The ultimate effect would be to run up the cost of business," Bush told The Associated Press. "I'm a little concerned about the size of the cap on punitive damages."
White House Press Secretary Ari Fleischer said the president is still committed to a patient protections bill, including the right to sue HMOs, within limits. "He also believes that it is important to have a patients' bill of rights, but not a lawyers' right to bill," Fleischer said.
Despite White House hesitations, the American Medical Association supports this latest proposal. "We are extremely pleased to see this effort go forward. ... We came within one vote of getting it in the last session of Congress. ... We are strongly supportive," Richard Corlin, MD, AMA president-elect, tells WebMD. "Patients deserve and need this kind of protection," he says. The AMA says HMOs have put profit before quality care.
However, the HMO lobby says the bill rests on the mistaken view that the courts are the best place to resolve healthcare disputes. "These lawsuits would lead to higher medical costs for consumers at a time when rising costs are already a topic of growing concern," said American Association of Health Plans President Karen Ignani in a prepared statement.
"I think that it's instructive to note that in the state of Texas, since their law has been passed, there have been a total of 10 -- 10 litigations," responded Sen. John McCain, (R-Ariz.).
Earlier Tuesday, a group of Republicans and Democrats presented their plan, which they suggested could be the prescription that would break legislative gridlock on the issue. "Our nation has been, if I may use the word, patiently waiting for many years -- and too many years. Congress has failed to pass a patients' bill of rights that would grant American families enrolled in HMOs the healthcare protections they deserve," said McCain, one of the bill's primary architects.
McCain, Bush's main Republican rival for the White House, reached out to Democrats to craft the proposal, beating the White House to the punch on this issue, which ranks near the top among voter concerns.
The delegation also included such longtime patients' rights advocates as Sen. Edward Kennedy, (D-Mass.). He told WebMD he was comfortable with the bill's compromise on the right to sue. "This makes sense in terms of still giving the assurances of accountability, ... I think the protections are quite clear," Kennedy said.
Democratic moderates, like Sens. John Edwards of North Carolina and Bob Graham of Florida, also played a key role in brokering the bill, and Republican centrists including Sens. Arlen Specter of Pennsylvania and Lincoln Chafee of Rhode Island also are on board.
In addition to the right to sue, the act would allow access to emergency and specialty care, as well as cover drugs not included in a patient's plan. HMO members also would be entitled to direct access to pediatricians and ob-gyn's without authorization. So-called "gag" orders that prevent doctors from discussing treatments not covered by the plan would be prohibited.
Proponents say that if adopted, the bill would create a speedy internal and external review process for medical claims. Some 160 million Americans with private health insurance would be covered, as opposed to some earlier versions that would limit the number protected to about one-third of that total.
Perhaps most importantly, the provisions of the Employee Retirement Income Security Act, known as ERISA, which have protected health plans from lawsuits, would be lifted. "We are putting all managed care organizations on notice today. There's no longer going to be free rein to them," said Rep. John Dingell, (R-Mich.), who co-sponsored a similar measure with Rep. Charlie Norwood, (R-Ga.), last year.
However, Norwood was a no-show at the news conference unveiling the bill after he and Rep. Greg Ganske, (R-Iowa), met with top White House officials, including senior adviser Karl Rove, to describe the bipartisan plan. Norwood said in a statement, "This may very well be the bill that passes into law, and I intend to support it. ... I simply would like our new president to have the opportunity to provide some input."
Ganske said that during the 3-hour White House meeting, he was told to hold off. And according to Fleischer, the president plans to send a letter to the Hill this week on the issue of patient protections.
Backers of the congressional effort say their bill won't disrupt patient protection plans now in effect in many states, including Texas. "The White House is putting out principles of patient protection that are very similar to what President Bush outlined in his campaign book," Ganske said.