Perry Cohen asked:
<<what aspects of this bill are most important to PWP and how we
might weigh in on this issue with our representatives during the August
recess?>>
I also haven't done a detailed study but it seems the patient bill of
rights is more than a Parkinson's issue. It could affect anyone insured
by a HMO. The bill pased by the House does contain the rights sought
after by most patient groups. The main arrea of contention regards limits
on patients' right to sue HMO's, which became more limited from the
original bill by an amendment, and the way in which this change was
negotiated between Bush and Rep. Norwood. It could result in a failure to
pass any legislation once again.
Here is a summary comparing the House and the Senate versions from USA
Today . Following is a detailed analysis from kaisernetwork. I don't
understand all the legal issues, but I think the following statement from
Kaisernetwork Daily Health reports tells us something about who would
benefit the most from the House bill:
"Meanwhile, lobbyists for the insurance industry "praised" the
legislation (Washington Post, 8/3). The Wall Street Journal reports that
the insurance industry "wins more than it loses" under the bill
(Bravin/Geyelin, Wall Street Journal, 8/3). American Association of
Health Plans President Karen Ignagni said that the bill "moves away" from
a potential flood of "reckless litigation" against HMOs (Welch, USA
Today, 8/3). However, patient advocacy groups and the American Medical
Association "were furious" over the legislation." (Washington Post, 8/3).
"The AMA "waged an intense" lobbying campaign yesterday to defeat the
measure. "It helps HMOs more than it helps patients," AMA Chair Timothy
Flaherty said (Philadelphia Inquirer, 8/3). The New York Times reports
that House and Senate negotiators will "come under intense pressure" from
consumer groups, doctors, insurers and employers lobbying for or against
provisions in the legislation. "
FROM: USA TODAY
August 3, 2001, Friday, FIRST EDITION
SECTION: NEWS; Pg. 10A
HEADLINE: Key patients' rights provisions
"The Republican-controlled House approved a compromise on patients'
rights
brokered by President Bush on Thursday night that differs in key respects
from a
version passed by the Democratic-controlled Senate in June. Key
provisions of
both bills, and areas of dispute: (Story, 1A)
General rights
* Guaranteed access to emergency care.
* Guaranteed access to specialists, including gynecologists and
pediatricians.
* Guaranteed access to clinical trials.
Administrative reviews
* Insurers are required to submit patients' grievances to independent
review
boards.
* Patients denied care must exhaust outside appeals before going to
court.
Senate bill does not require exhaustion of appeals.
Legal action
* Federal court lawsuits are allowed for contractual disputes.
* State court lawsuits are allowed for denials of medical care;
federal
rules apply. Senate bill does not mandate that federal rules apply.
* Employers who provide their own health insurance cannot be sued in
state
courts.
* Awards for pain and suffering and punitive damages in federal
courts would
be limited to $ 1.5 million. Senate bill has no limits for pain and
suffering; $
5 million limit on punitive damages.
----------------------------------------------------
Date: Sat, 04 Aug 2001 14:06:35 -0400
Subject: Kaiser Daily Report
This story was sent to you by lh from kaisernetwork.org Daily Reports.
CAPITOL HILL WATCH
House Passes Bush-Norwood Patients' Rights Compromise, Setting Up
Conference 'Battle' with Senate
"After a "long, tumultuous debate" on Aug. 2, the House voted 226-203 to
approve a patients' rights bill (HR 2563) sponsored by Reps. Greg Ganske
(R-Iowa), John Dingell (D-Mich.) and Charlie Norwood (R-Ga.) that would
offer Americans a host of protections against health plans, the New York
Times reports (Pear, New York Times, 8/3). House members passed the
legislation after adopting on a 218-213 "near party-line vote" an
amendment to the bill that would limit patients' right to sue HMOs
(Goldstein/Eilperin, Washington Post, 8/3).
Under the amendment, part of an agreement reached Aug. 7 between Norwood
and President Bush, patients could sue health plans in state court --
generally considered more hospitable to plaintiffs -- under a new set of
federal rules that would cap non-economic damage awards at $1.5 million.
Courts could also award patients up to $1.5 million in punitive damages,
but only in cases where patients win complaints against health plans
before an outside appeals panel and an HMO "still persists in refusing
the care they need." In addition, patients could sue health plans after
an outside review panel rejects their complaints, but lawsuits in those
cases would "have a much higher burden of proof to overcome." The
amendment would allow patients to sue large employers that administer
their own health plans over health care disputes in federal court, not
state courts (Kaiser Daily Health Policy Report, 8/2). The amendment
also would restrict class action lawsuits against health plans
(Washington Post, 8/3).
The House also approved an amendment that would expand medical savings
accounts and ease restrictions on association health plans (New York
Times, 8/3). "I think this is a good compromise. And I think it's
something that will be good for patients and good for health care in
America," House speaker Dennis Hastert (R-Ill.) said (Warner, "NewsHour,"
PBS, 8/2). Bush added, "Today's action brings us an important step
closer to ensuring that patients get the care they need and HMOs are held
accountable" (Reinert/Masterson,
Houston Chronicle, 8/3).
Reaction
However, most Democrats and some Republicans "complained bitterly" that
the bill would "leave patients with inadequate leverage" against health
plans and insurance companies (Washington Post, 8/3). They said that the
legislation would overturn many state patients' rights laws that
"provided greater protection" for patients and would "give HMOs an unfair
advantage" in court by establishing a "legal presumption in favor" of
health plans when they win administrative appeals but not offering
patients the "same presumption if they prevailed." House Minority Leader
Dick Gephardt (D-Mo.) said, "This bill is better for HMOs than for
patients. It ought to be called the HMO bill of rights" (New York Times,
8/3). According to Senate Majority Leader Tom Daschle (D-S.D.), "What
we've done now is degrade the opportunity to ensure that there's a
remedy" for patients' right to sue HMOs "when those rights are infringed.
... This is a step backwards" (Lehrer, "NewsHour," PBS, 8/2).
Democrats also "fumed at the betrayal" by Norwood, who reached an
agreement on the bill with Bush without the support of his co-sponsors
(Miller, Los Angeles Times, 8/3). "I'm sorry that Congressman Norwood
sold out for a brief display at the Rose Garden," Rep. Pete Stark
(D-Calif.) said (Archibald, Washington Times, 8/3). Defending the deal,
Norwood said, "Patients are no better off if we just keep passing bills,"
adding that lawmakers "are deluding themselves if they think they can
shove this bill down the president's throat" (Bowman, Scripps-McClatchy
Western Service/Memphis Commercial Appeal, 8/2). Speaking about Bush,
Norwood said, "He's good, he's a pleasure. I don't make any secret of
it, I love the man" (Zuckman, Chicago Tribune, 8/3).
Political Ramifications
Yesterday's vote represented a "dramatic victory" for Bush and
Republican leaders, the Philadelphia Inquirer reports (Koszczuk,
Philadelphia Inquirer, 8/3). The president "wanted to avoid vetoing a
patients' rights bill, which is popular among voters" (Milligan, Boston
Globe, 8/3). Bush had threatened to veto Ganske-Dingell-Norwood before
reaching an agreement with Norwood, maintaining that the bill would drive
up health care costs by funneling lawsuits against HMOs into state
courts, which often award higher damages than federal courts (Kaiser
Daily Health Policy Report, 8/2). Democrats "charged" that the agreement
between Norwood and Bush represented a "cynical attempt to continue the
HMO reform deadlock and to avoid the need for Bush to veto a popular
bill" (Epstein, San Francisco Chronicle, 8/3). However, Republicans said
that, by opposing a bill that Bush supports, Democrats "are trying to
keep alive a political issue they can use against the GOP" in the 2002
elections (Hosler, Baltimore Sun, 8/3). "There are some folks who would
just as soon have the politics and not the policy, and I think those are
the ones who are crying the loudest right now," Hastert said (Snow, CNN,
8/2).
The Los Angeles Times reports that Republicans "had been outmaneuvered"
by Democrats on patients' rights before yesterday's vote, a "particularly
deflating" defeat for congressional Democrats (Los Angeles Times, 8/3).
Congressional Democrats had planned to spend the August recess "blasting"
Bush as "insensitive to HMO horrors" (Orin,
New York Post, 8/3).
More Reaction
Meanwhile, lobbyists for the insurance industry "praised" the
legislation (Washington Post, 8/3). The Wall Street Journal reports that
the insurance industry "wins more than it loses" under the bill
(Bravin/Geyelin, Wall Street Journal, 8/3). American Association of
Health Plans President Karen Ignagni said that the bill "moves away" from
a potential flood of "reckless litigation" against HMOs (Welch,
USA Today, 8/3). However, patient advocacy groups and the American
Medical Association "were furious" over the legislation (Washington Post,
8/3). The AMA "waged an intense" lobbying campaign yesterday to defeat
the measure. "It helps HMOs more than it helps patients," AMA Chair
Timothy Flaherty said (Philadelphia Inquirer, 8/3). The New York Times
reports that House and Senate negotiators will "come under intense
pressure" from consumer groups, doctors, insurers and employers lobbying
for or against provisions in the legislation. The Senate passed
patients' rights legislation (S 1052) sponsored by Sens. Edward Kennedy
(D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.), similar to
Ganske-Dingell-Norwood before yesterday's amendments, in June (New York
Times, 8/3).
Senate Negotiations
The House vote yesterday "set up a fierce contest with the
Democratic-controlled Senate," as negotiators will have to address
differences between the House and Senate patients' rights bills in
conference (Washington Post, 8/3). According to some analysts, lawmakers
may "harden positions" after yesterday's vote, making it "appear unlikely
that reforms will come this year" (Scripps-McClatchy Western
Service/Memphis Commercial Appeal, 8/3). "We are not going to give up
and we're not going to give in," Kennedy said (Boston Globe, 8/3).
Democrats "insisted" that the Senate would "never accept" the House bill,
although they did not "rule out the possibility" of a compromise
(Washington Post, 8/3). In addition, Democrats said that they "can hold
out for concessions" from Republicans, although GOP lawmakers could
"portray them as obstructing progress" on the issue (New York Times,
8/3). Senate Democrats also may attach their version of the bill to a
separate measure and send the legislation back to the House, "defying
members to vote it down" (Boston Globe, 8/3). Meanwhile, Hastert said
that Bush will "remain engaged throughout the process" and urged Senate
Democrats not to "torpedo this thing." Democrats worry, however, that
Republicans hope to "bury the bill in endless negotiations" (Espo,
AP/Bergen Record, 8/3)."
View Entire Floor Debate and Vote
A HealthCast of the entire House debate and vote on the patients' rights
bill -- as well as information such as an analysis from Congressional
Quarterly's Samuel Goldreich and a chronicle of patients' rights
developments to date -- is available at
http://www.kaisernetwork.org/healthcast/house/patientsrights/aug01. The
Senate's June debate on patients' rights legislation is also available at
http://www.kaisernetwork.org/healthcast/senate/pbr/jun01.
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