The Prognosis for the Patients’ Bill of Rights

Last year, the House of Representatives passed a strong, bipartisan Patients’ Bill of Rights. It was a real victory for the prospect of meaningful managed care reform in this country. Unfortunately, the Senate passed a far weaker bill with many deficiencies in comparison to our House legislation.

I have been appointed to the conference committee assigned to work out the differences between these very different pieces of legislation. I remain hopeful that we will be successful in crafting a bill that remains true to the key components of the House-passed bill. But, the task before us will not be easy.

By the time you receive this newsletter, the conference committee will have been meeting for three months. We are making some progress on agreements relating to particular patient protections such as: access to emergency care, access to specialists, and continuity of care protections. However, there are still very strong differences of opinion about what a Patients’ Bill of Rights law must include.

Those of us who supported the House-passed legislation know that a real Patients’ Bill of Rights must create a federal floor of protections that applies to everyone in private insurance. Whether you live in California, Alabama, or Montana, your health plan should be required to play by a common set of rules that ensure that you are not denied appropriate care. Thus, the scope of the bill must be very broad. The House bill applies to everyone with private health insurance. The Senate bill applies only to a fraction of the people covered by private health insurance.

Additionally, a real Patients’ Bill of Rights must include the right for patients to sue their health plan if the decision-making of that plan causes harm. We are able to hold doctors and hospitals liable for their actions that injure, maim or kill. Why should managed care plans—that increasingly make many medical decisions—continue to be shielded from accountability? The answer is that they shouldn’t. It is really an historical accident that provides such protection to managed care plans. And, correcting this historical accident is long overdue. The House bill holds health plans accountable in state courts—just as doctors and hospitals are treated today. The Senate bill continues to protect health plans from any such liability.

I consider the liability provisions and the scope of the legislation to be fundamental components of real managed care reform. The House-passed bill addresses both of these principles and was supported by a bipartisan majority of the House of Representatives. The Senate bill—which ignores these key provisions—had no such bipartisan support.

Whether these strong differences can be resolved in the next several months remains to be seen, but you can be sure that any bill I support will have broad coverage and will hold health plans accountable for their medical care. Otherwise, a Patients’ Bill of Rights would not deserve that title.