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Copyright 1999 The Hartford Courant Company  

October 6, 1999 Wednesday, STATEWIDE


LENGTH: 934 words


BYLINE: JOHN A. MacDONALD Courant Staff Writer


Showdown votes in the House of Representatives starting today will resolve a critical question for consumers and insurers: Will Congress keep alive the possibility of legislation allowing patients to sue their health plans in coverage disputes? Or will lawmakers kill the proposal for this year and probably until after the 2000 elections?

While House members will be voting on a number of other proposals to give consumers more clout in dealing with health insurers, none will be more controversial than the lawsuit issue.

The right to sue, supporters say, is the key to holding insurers accountable if they deny patients needed care. President Clinton last weekend cited as an example a 12- year-old cancer patient who lost his leg because an insurer delayed treatment.

Insurers counter that opening courtroom doors to such lawsuits will drive up prices, causing more employers to drop coverage, just as the Census Bureau reports the number of uninsured Americans rose last year to 44 million.

On the eve of what promises to be a hectic two-day debate, there was the usual round of closed-door meetings and arm-twisting, but little else to indicate a storm was about to hit. Analysts said the most probable outcome is House passage of some right-to-sue provision, but the lingering question was how strong it will be.

Speaker Dennis Hastert, R-Ill., attended a $1,000-per-person fund-raising breakfast Tuesday with insurance lobbyists. Later, Republican leaders said they were joining the speaker in supporting a narrow right-to-sue provision.

The House debate, like the one in the Senate in July, is expected to break mostly along party lines, with one notable exception. Several of the most visible champions of the right to sue are Republicans -- doctors who have broken ranks with their leadership. The only physician in the Senate, Bill Frist, R- Tenn., opposed expanding insurers' liability.

Tired of restrictions imposed on doctors by insurers, the American Medical Association is one of the most outspoken advocates of the right to sue. Insurers and the business community have allied to oppose the proposal.

"This bill will not result in a flood of lawsuits . . . as opponents claim," said AMA President Thomas Reardon, citing an association legal analysis to back up his statement.

Karen Ignagni, president of the American Association of Health Plans, an HMO trade group, foresees the opposite result. "You're not lining up behind the working men and women of this country in voting for this legislation," said Ignagni, who once represented the AFL-CIO in Capitol Hill battles. The union supports the right to sue.

The Senate voted against including a liability provision in its version of what is widely known as the Patients' Bill of Rights. Prospects are considered to be better in the House because of the persistence of Republican Rep. Charlie Norwood, a 58-year-old Georgia dentist who looks and talks like a Southern county sheriff.

Last year, with Newt Gingrich, R- Ga., in the speaker's seat, Norwood bowed to the leadership's wishes and voted for patients' rights legislation that omitted the right to sue. This year, with the less domineering J. Dennis Hastert, R-Ill., in filling Gingrich's place, Norwood has formed an alliance with Rep. John D. Dingell, D-Mich., and brought along about two dozen Republicans who support including the liability provision.

If Democrats remain united, and Dingell said they will, and if Norwood can hold his Republican supporters in line, the House will send the Norwood-Dingell right-to-sue provision to a conference with the Senate. If the House rejects the lawsuit provision, Democrats have given every indication they will use it as a 2000 campaign issue.

Trying to persuade lawmakers they will not suffer adverse reactions from a "no" vote, Ignagni released a poll showing that Social Security, taxes and education, not health care reform, will be the issues most on voters' minds next year.

Still, a recent Washington Post- ABC News Poll showed that 65 percent said protecting patients' rights will be "very important" in how they vote in 2000. And Norwood has repeatedly warned fellow Republicans they will make a mistake if they do not address the issue before the elections.

The only impartial analysis of the cost of the Norwood-Dingell legislation -- a key point of contention -- shows it would would boost premiums 4.8 percent per year when all of its provisions are fully phased in. This would be on top of inflationary increases that, in Connecticut, are expected to range from 7 percent to 16 percent next year.

In addition to the lawsuit provision, the Norwood-Dingell measure would provide easier access to emergency rooms and specialists, require health plans to set up an internal and external appeals process when care is denied, and allow patients to remain under the care of a doctor for a specified time even if a health plan drops the physician.

Rival Republican legislation also would allow patient lawsuits, but under severely limited conditions and only after patients had exhausted their internal and external appeals rights.

Hastert has sought to shift attention to several measures to expand access to health care to the uninsured. These include tax credits to buy insurance, a proposal to allow small employers to band together to purchase health insurance and an expansion of medical savings accounts, tax-exempt accounts that can be used for medical expenses.

"The most important group to me is the 44 million Americans who must go without health insurance," Hastert said.

LOAD-DATE: October 6, 1999

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