President Proposes Plan to Protect Patients
Oct. 11, 2000 (Washington) -- If Congress can't do it, maybe the president can. Though congressional attempts to pass a "patients' bill of rights" continue to fail, the Clinton administration is jumping on an opportunity: Shortly, the president hopes to issue patient protection rules through its Labor Department. The rules would cover the more than 120 million Americans who are in private-sector employer health plans.
Clinton's rules would guarantee patients faster decisions on coverage questions and appeals of care denials, explains Leslie Kramerich, acting assistant secretary of the Labor Department's Pension and Welfare Benefits Administration. She also tells WebMD that the rules would ensure that patients get more information on why care was denied and would streamline appeals procedures for denials.
The details of the rules are still being worked out, Kramerich notes, and the Benefits Administration may not make its goal of having the rules out by November. But they've been in the works since an initial Benefits Administration proposal in 1998. "This has been a huge priority with us for a long time," she says.
Though the House of Representatives passed patient protections legislation last October -- legislation that Clinton supports -- the Senate has failed to pass similar rights. Rep. John Shadegg (R-Ariz.), who is trying to broker an 11th-hour congressional compromise on patients' rights legislation, gave the Clinton rules a mixed review. "Thank goodness they are doing something for patients," he told reporters Monday. But, he added, "I have to wonder if it isn't a political move ... to take credit before the election."
Meanwhile, the Health Insurance Association of America (HIAA) blasted the Benefits Administration's plans, saying they would subject private health plans to "unrealistic requirements that are far more stringent than those for the government's Medicare program." HIAA claimed that the mandates would raise employer costs enough to cause some to drop health coverage.
The Benefits Administration's rules wouldn't go nearly as far as the various measures that are stalled in Congress, and Kramerich made clear that Clinton would prefer the more sweeping congressional approach.
The House-passed bill, for example, would allow consumers to directly sue health plans. The Senate's patient protection legislation -- which has yet to be approved -- does not allow that right, but goes further than the rules by establishing a mandatory, independent external review system for appealed claims.
Both the House and Senate bills would strengthen patient access to emergency room services, the right to see specialists, and the ability to keep seeing a physician even if an HMO stopped contracting with that clinician.
Formal House and Senate negotiations broke down long ago on final legislation, but on Monday several House GOP lawmakers outlined their efforts for a last-ditch agreement.
Reps. Shadegg and Tom Coburn, MD, (R-Okla.) said that their proposal, backed by House GOP leadership, would empower doctors and patients. Shadegg and Coburn argue that a recent patients' protections proposal from Rep. Charlie Norwood (R-Ga.) -- which is endorsed by the American Medical Association (AMA) -- empowers trial lawyers or HMO bureaucrats.