June 22, 2001 (Washington) -- Just like the humid Washington summer, the Capitol Hill battle over managed-care reform is hot and sticky.
This week, a bipartisan "patients' bill of rights" began moving through the U.S. Senate, but the White House is taking a hard line against it.
President Bush issued a formal veto threat of the legislation, sponsored by Sens. Edward Kennedy (D-Mass.) and John McCain (R-Ariz.). The bill is endorsed by many physician groups, prominent unions, and consumer advocacy organizations.
Under the Kennedy-McCain bill, patients could sue HMOs and other health plans in state or federal court if they are injured by medical decisions. Under a Bush-endorsed rival plan from Sens. John Breaux (D-La.) and Bill Frist, MD (R-Tenn.) patients could sue only in federal courts.
Bush is maintaining that patients should have the right to sue only as a last resort. He opposes the Kennedy-McCain measure because he says that it allows patients to sue before they have exhausted an independent medical review process.
According to official congressional cost estimates, the Kennedy-McCain bill would increase premiums more than the Breaux-Frist bill. That has led GOP senators, HMO executives, and the White House to assert that millions of Americans could lose coverage. They dismissively call it a "lawyer's bill of rights" or "lawyer's right to bill".
Bush spokesman Ari Fleischer said that the Kennedy-McCain measure "goes way too far and hands too many favors over to trial lawyers, in a manner that would make healthcare premiums go up, in a manner that would deprive people of health insurance because of rising costs, in a manner that would hurt our healthcare system."
But Democrats and their allies also have strong populist arguments. The consumer advocacy group Families USA, for example, just issued a report detailing soaring stock tallies and salaries for the nation's top HMO executives.
"Clearly, the industry has a double standard about costs -- a very generous standard for its executives and a miserly one for America's consumers," said Ron Pollack, executive director of the group.
And earlier this week, in the first vote to amend the Kennedy-McCain bill, Democrats prevailed against a Republican effort to attach an acceleration of tax deductibility for health insurance premiums for the self-employed.
Next week, a vote is expected on an amendment from Sen. Phil Gramm (R-Texas) to exempt employers from lawsuits over services given under health plans.
The Kennedy-McCain bill would permit consumers to file suits against employers if they "directly" participated in a benefit denial that led to injury. That's earned the bill strong opposition from national business interests.
Senate Majority Leader Tom Daschle (D-S.D.) hopes to get a final vote on the HMO bill before the July 4 holiday. If that doesn't happen, he's warned his colleagues that the Senate may stay in session.
Meanwhile, the House debate on patient rights isn't going to occur until July.
However, concerned Republican leaders already have floated legislation that would go further than the Bush-endorsed proposal but not as far as the Kennedy-McCain plan. The House GOP plan would, for example, give patients the right to go to state courts, albeit under narrower circumstances.
Patient rights legislation passed both the House and Senate in 1999, but differences between the two bills never were reconciled.