Aug. 3, 2001 (Washington) -- After gaining a key defector, the Republican-controlled U.S. House of Representatives approved managed care patient protection legislation that has the endorsement of President Bush.
The bill contains limited lawsuit rights for consumers against HMOs and other health plans, and its passage was a key last-minute victory on patient rights for Bush and the GOP. House Democrats said, however, that the bill would weaken consumer protections.
The 226-203 vote for the managed care bill followed party lines closely. No Republicans voted against it, and just five Democrats gave their support.
Before any legislation is to become law under Bush's signature, a showdown looms between the House and the Democrat-controlled Senate and its bill with broader lawsuit provisions as they haggle in committee to come up with a bill to present to the president.
Until late Wednesday, Rep. Charlie Norwood (R, Ga.) had stood with Democrats and renegade Republicans for a broader right to sue. In 1999, Norwood bucked GOP leaders and led a tough HMO bill successfully through the House.
Even earlier this week, a GOP triumph seemed unlikely in the House, but Norwood and Bush announced a surprise compromise Wednesday, paving the way for last night's victory.
In making the deal with Bush, Norwood abandoned his traditional allies on the issue, including Reps. John Dingell (D, Mich.) and Greg Ganske (R, Iowa), MD. But Norwood cast his compromise as crucial to getting a bill signed into law. Bush had threatened to veto the Senate bill, as well as earlier Norwood legislation. "It is time to bring this gridlock to an end," Norwood said. "The president has moved our way."
Norwood's limited lawsuit provisions won a narrow 218-213 victory yesterday in the House. Just three Democrats voted for the amendment, while seven Republicans voted against it.
As recently as a week ago, House Republican leaders had postponed an initial debate on patient rights, conceding that they lacked the votes for a proposal they had developed. But Norwood is widely known as a "founding father" of the movement to tighten controls on HMOs, and his compromise with Bush was crucial for yesterday's vote.
Many angry Democrats accused Norwood of selling out. Dingell said that the Bush deal was a "sham" for patients.
In order to sue a health plan under the Norwood legislation, a consumer would first have to complete an external appeals review with independent doctors. If those doctors sided with the plan, the consumer could still sue, although under tougher standards.
For disputes over administrative and contract issues, patients would go to federal court. For medical care delivery disputes, patients would go to state court -- but under new federal rules.
The Norwood measure puts a $1.5 million cap on "pain and suffering" awards, and a $1.5 million cap on punitive damages. Punitive damages would only apply if an external panel ruled that a health plan should provide care, but the plan then refused to provide it.
The American Medical Association, which had sided with Norwood on earlier legislation, said that it opposed his lawsuit compromise. The doctors group claimed that the measure would give health plans an easier standard in state courts than that allowed doctors in cases of negligent medicine.
The House-passed bill would also bar consumer lawsuits against employers who offer health coverage, unless employers were directly involved in medical decision making.
As with the Senate's bill, the House legislation applies to every American with private health insurance. It moves to ensure a national standard of access to emergency care, specialty care, and clinical trials. It would offer the guarantee of direct access to pediatricians and ob-gyns, would allow patients with ongoing health needs to keep the same doctor, and would increase requirements on plans to provide consumers with information about their policies. It also forbids HMO "gag rules" that limit doctor-patient discussions about treatment options.
The American Association of Health Plans said after the vote that it had "serious concerns" with the House bill. Nevertheless, the group said it was pleased that the House "moves away from the reckless litigation binge that the Senate-approved bill would encourage."
The House also approved the permanent expansion of a national test program on medical savings accounts (MSAs), a tax-sheltered health insurance alternative. The Senate bill does not include an MSA provision.