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Last year the Senate passed "The Patients' Bill of
Rights." This legislation represents the most significant
Congressional effort since 1974 to establish new managed care
patient protections. It was based on legislation which I
introduced and which was voted out of my Committee on Health, Education,
Labor, and Pensions.
The House passed its companion bill and a Senate/House conference
committee has been appointed. As the Chairman of the Committee
which has the primary jurisdiction over these issues, I was
appointed as one of the 12 Senate conferees.
On June 29, 2000, I joined with 50 other Senators in passing the
"Patients' Bill of Rights Plus Act" as an amendment to the Labor/HHS
Appropriations bill. The legislation makes significant
advances over the managed care bill passed by the Senate last
summer. The new legislation creates, for the first time, a new
federal cause of action against a health plan or HMO if they fail to
comply with the decision of an independent external medical
reviewer, or if their decision to delay care causes harm to an
individual.
This targeted liability provision ensures that HMOs are held
accountable when they practice medicine but it does not work at
cross purposes with our voluntary, employmentbased system of health
coverage. Governor Howard Dean, M.D., in his 2000
State of the State Address, asked the Legislature not to
enact legislation that would allow additional lawsuits against HMOs
and employers, acknowledging that these would drive the price of
health insurance higher. I believe our new remedy is a lowcost
means of enforcing patient protections without displacing anyone
from being able to get the health care coverage they need.
The new Senate bill also allows Vermont to retain its rightful
regulatory role and avoid the creation of another confusing and
obstructive layer of federal regulation. The broader
Housepassed legislation could potentially override the Vermont
Legislature's decisions and preempt the ability of Vermont insurance
regulators to conduct oversight of health insurance in the most
efficient and effective way.
The "Patients' Bill of Rights Plus Act" adds patient protection
provisions to the Employee Retirement Income Security Act (ERISA)
for the employer sponsored plans that State consumer
protection standards cannot reach. The majority of Americans
already enjoy these protections, since most of the States have
already adopted these standards through their regulation of health
insurance companies.
I believe that it would be inappropriate to set Federal health
insurance standards that not only duplicate the responsibility of
the 50 State insurance departments but also would have to be
enforced by the Federal Health Care Financing Administration (HCFA),
if a State decides not to enact the standard. The principle
that the States should continue to regulate the private health
insurance market guided the design of these provisions of the
Patients' Bill of Rights.
In a June 28, 2000 letter to the Patients' Bill of Rights
conferees, the National Conference of State Legislatures
states: "[T]he National Conference of State Legislatures
(NCSL) supports the Senate approach on scope." They go on to
say "[T]he Senate approach places priority status to the millions of
individuals who are in federallyregulated plans who cannot benefit
from the efforts of state lawmakers to provide important and
valuable patient and provider protections to individuals being
served or providing services in a managed care setting. This
is appropriate." I believe Congress cannot work at cross purposes
with our states which best understand the needs of the local health
care markets. This is not an issue of states' rights – it is
an issue of who is best situated to determine what's right for our
states.
The most important part of the Senate bill is the creation of a
new, independent external appeals process which allows a patient's
health care professional to recommend the best treatment and serve
as the patient's advocate. This will be available to all 131
million Americans in group health plans. The appeals process
guarantees that a health care professional – not an insurance
company accountant – will determine the appropriate treatment option
in accordance with the best scientific evidence and generally
accepted practices of medicine. Under the Senate bill the
medical reviewer's decision will be binding on the health plan.
The "Patients Bill of Rights Plus" is consistent with
the recommendations of the President's Advisory Commission on
Consumer Protections and Quality in the Health Care Industry.
In drafting the bill, we provided patients a prudent layperson
standard for emergency care, a mandatory pointofservice option,
direct access to OB/GYNs and pediatricians, a guarantee of
continuity of care, a prohibition on gag rules, access to
medication, access to specialists, access to approved clinical
trials, and provider nondiscrimination provisions.
The bill also contains a provision designed to prevent health
insurance companies from denying coverage based on "predictive
genetic information" and a new section that provides for
confidentiality protections for information submitted to voluntary
reporting systems designed for quality improvement and patient
safety.
As we prepared this legislation we had three goals in mind.
First, to give families the protections they want and need.
Second, to ensure that medical decisions are made by physicians in
consultation with their patients and are based on the best
scientific evidence. And finally, to keep the cost of this
legislation low, so it does not displace anyone from being able to
get health care coverage.
Our challenge has been to balance improving health care without
driving up the cost to families. At a time when health plans
are pulling out of the state, and Vermonters are already facing
doubledigit premium inflation, we must be very careful not make it
harder for Vermonters to afford health insurance by passing federal
legislation that adds significant new costs, or disrupts efficient
and effective statebased insurance regulation.
During Congressional debate on HMO reform we heard a great deal
of political rhetoric, and I fear that some may simply prefer to
stall patient protection legislation and have this as a campaign
issue. But, in spite of the political hurdles, I believe we
can produce solid legislation that will result in a greatly improved
health care system for Vermonters and all Americans. We have
the opportunity to expand patient protections without significantly
increasing premiums and adding to the number of uninsured. I
am committed to working with the House and the President to move
forward and produce compromise legislation that can be signed
into law.
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