May 15, 2001 (Washington) -- President George W. Bush indicates he will sign a carefully crafted patients' rights bill that supporters describe as a "middle ground" in the long-running, contentious debate over that issue. But opponents complained the plan is wholly inadequate and vowed to fight it.
The measure was introduced Tuesday on Capitol Hill by a trio of Senate moderates lead by Sen. Bill Frist (R-Tenn.), who is also a doctor. The bill is co-sponsored by Sen. John Breaux (D-La.) and Sen. Jim Jeffords (R-Vt.), chairman of the health, education, labor, and pensions committee,
"This bipartisan Patients' Bill of Rights reflects the principles I laid out earlier this year," said the president in a statement.
Bush said the measure provides protections for all Americans, ensures that doctors and their patients are the ultimate medical decision makers, and holds health plans accountable by allowing patients to sue them, within limits. Whether patients should be allowed take their HMOs to court was a major sticking point in the discussions.
"When it comes to non-economic damages suffered, the president does believe ... that there ought to be a reasonable cap [on the ability to sue an HMO]," said White House Spokesman Ari Fleischer.
However, the bill's key feature is that it has the White House endorsement over a more far-reaching plan sponsored by Sen. John McCain (R-Ariz.), Bush's most prominent Republican rival, and Sen. Ted Kennedy (D-Mass.).
"We are encouraged by it. If you have a document that the White House indicates it would be willing to sign into law, it obviously makes the document much more real in terms of what Congress would do with it," said Breaux.
The bipartisan approach shares many features with the earlier measure, including such things as guaranteed access to the ER despite individual insurance limitations, as well as the right to see an obstetrician or a pediatrician without restrictions.
Rapid external review to resolve questions about whether care was wrongly denied is another key aspect of the new proposal. However, if the health plan doesn't go along with the decision, and a patient is harmed as a result, the victim can take his or her case to federal court where it's possible to win unlimited economic damages as well as up to $500,000 for pain and suffering.
Meanwhile, patients can still sue plans in state court for malpractice claims or poor quality of care.
"What we've tried to do here is reach a middle ground. ... There's an emphasis on helping people before they get hurt as opposed to waiting until they suffer an irreparable injury and allowing them to sue," said Breaux.
However, at a news conference immediately after the one announcing the new bill, Sen. Ted Kennedy described it as "completely inadequate."
"This bill fails to provide the guarantees that all Americans will be covered, because it's riddled with loopholes," said Kennedy. He says if the measure passes, HMOs will still be able to decide who gets specialty care, and prescription drugs could be priced out of reach.
Kennedy also complained that the appeals process would be stacked in favor of HMOs since they would appoint the doctors who hear the appeals, and patients would have to go through legal gymnastics to get their case into court.
"It's a huge hole in their bill, that they don't have a truly independent external review process," said Sen. John Edwards (D-N.C.).
As to the president's threat to veto McCain-Kennedy if it got to his desk, Kennedy responded, "I'm convinced that whatever we pass here the president will sign." He claims to have a majority of senators on his bill.
Others on Capitol Hill, like Rep. Charlie Norwood (R-Ga.), who authored a tougher bill of rights measure that passed the House last year, also vowed to fight the new bipartisan measure.
Meanwhile, interest groups like the powerful American Medical Association reacted coolly to the proposal, and the American Association of Health Plans, which represents the major HMOs, expressed "serious concerns" about the new effort, which the HMO lobby said could be a "setback for efforts to improve the quality of health care for consumers."
"When you don't have the AMA and the trial lawyers on, and the health plans on, we're right in the middle, and probably right where we want to be," Frist tells WebMD.