Copyright 1999 The Houston Chronicle Publishing Company
The Houston Chronicle
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October 08, 1999, Friday 3 STAR EDITION
SECTION: A; Pg. 1
HEADLINE: House clears HMO reform allowing
BENNETT ROTH, NANCY MATHIS, Houston Chronicle Washington Bureau
WASHINGTON - Overcoming stiff opposition from the insurance industry and the
Republican leadership, the House Thursday approved sweeping managed care
legislation that gives consumers broad rights to sue their health insurance
companies for malpractice.
The 275-151 vote was a clear victory for
President Clinton and congressional Democrats who have lobbied for several years
for patients rights legislation. The measure must now be melded with a much
narrower HMO bill approved by the Senate, which covers far fewer people and does
not include the right to sue.
The House bill, which would apply to all
health plans, would make it easier for consumers to have access to specialists,
and to receive emergency care without getting permission from their health
It would require health plans to set up an internal or external
appeals process so patients could challenge decisions made by their HMOs.
The most controversial provision would amend the 1974 federal Employment
Retirement Income Security Act (ERISA), which covers multistate
employer-sponsored health plans, to allow patients the right to sue for
Clinton, who was in New York City, hailed the passage of
the measure, saying "it shows that America is no longer willing to allow
unfeeling practices of some health plans to add to pain, injury and disease."
Clinton, however, warned congressional leaders not to sabotage the
measure during House-Senate negotiations by loading it up with provisions he
"Let me be clear, we still have a lot of work to do before this
bill becomes the law of the land," Clinton said.
"When the House and
Senate negotiators meet they must be sure the bill is paid for and when they
meet in conference, the Republican leaders must resist the urge to weaken the
patient protections. They must not undo behind closed doors what has been done
in the public."
Some Democrats feel the Republicans will kill the
legislation by burying it in conference committee.
"I'm worried this
bill will go into file 13," said House Minority Leader Rep. Richard Gephardt,
While it is uncertain whether the two chambers can reach
consensus, it is clear that Democrats believe they have an issue that will
resonate with voters in next year's elections.
The potency of the
managed care issue was evident as 68 Republicans broke ranks to support reforms
opposed by their leadership.
Throughout the debate, proponents of HMO
reform recounted horror stories of patients who had been denied care. One of
those victims, 7-year-old James Adams of Atlanta, was invited into the House
chamber by Rep. Greg Ganske, R-Iowa.
Ganske, a doctor, recalled that
when James was a baby and had a fever of 104 degrees his parents were forced by
their HMO to drive 70 miles to an emergency room, even though there were several
James had a heart attack and ended up with gangrene
that forced doctors to sever his hands and feet.
Before the legislation
was passed, 29 GOP members joined Democrats in defeating a compromise measure
endorsed by House Speaker Dennis Hastert, R-Ill, which gave consumers only
limited ability to sue their plans for malpractice.
The House also
soundly defeated a measure pushed by conservatives that contained no right to
Proponents said the bill addressed concerns by doctors and patients
that they have lost their ability to make medical decisions to large impersonal
managed care corporations that are more interested in profits.
Charles Norwood, a Republican dentist from Georgia who co-sponsored the bill
with Rep. John Dingell, D-Mich., sounded a common theme: "It is time to tell
patients that they will actually have decisions made by their doctors, not by
that clerk who may be living in Missouri."
The measure's opponents
warned that the regulations would drive up insurance costs and force companies
to drop employees from health plans. They said that giving people the right to
sue their health care plans would only be a boom for trial lawyers.
believe this bill is poison for our health care system," said Rep. John Boehner,
R-Ohio, who sponsored the measure, backed by business groups, that did not
contain the right to sue.
The managed care industry, which had mounted a
multimillion-dollar campaign against the measure, vowed to continue fighting.
"Instead of enacting reforms that could have allowed patients to settle
disputes quickly and independently the House has moved instead to open the
litigation floodgates and empower trial attorneys," said Karen Ignagni,
president of the American Association of Health Plans, the chief lobbying arm
for managed care plans.
The American Medical Association, the nation's
largest organization of doctors that pushed the bill, praised the House action.
AMA President Dr. Thomas Reardon said "this is a real win for American
Some Republicans, led by Rep. Tom Coburn, a physician from
Oklahoma, sought a middle ground in the debate by proposing legislation that
would allow lawsuits to be filed in federal but not state courts. The Coburn
measure would also have limited the amount of money patients could be awarded.
However, Norwood and others said the Coburn plan would make it too
difficult for most people to take action against their HMOs.
of HMO reform repeatedly cited the example of Texas, where lawmakers in 1997
approved managed care regulations that gave patients the right to sue.
They noted that the liability changes have not caused a rush to the
courthouse or driven up health care costs dramatically in the state.
Gephardt noted that what the House had passed was "a lot like the law in
Texas and that is a conservative state."
House and Senate HMO
Differences between managed care bills approved by the
House Thursday and the Senate in July:
WHO IS COVERED
Covers all Americans with private health insurance.
provisions only apply to 48 million Americans who are in plans that are
regulated only by federal law. This includes greater access to emergency rooms,
specialists, medications and the right to choose a health plan that allows them
to use doctors who are outside a defined network.
RIGHT TO SUE
House: Lifts a federal ban on lawsuits for Americans in health plans
that fall under federal regulation. Injured patients could sue in state or
federal courts for unlimited damages.
Senate: No new rights to sue.
OBSTETRICIANS AND GYNECOLOGISTS
House: Allows women to
see them without prior approval but not to designate them as primary care
Senate: Similar, but only applies to federally regulated plans.
EMERGENCY ROOM CARE
House: Requires payment for
reasonable emergency room services without prior approval.
Similar, but only applies to federally regulated plans.
House: Would have required health plans to pay routine health
care costs associated with clinical trials. Excludes payments for trials funded
by the Food and Drug Administration.
Senate: Includes only cancer
House: No provision.
Senate: Requires health plans to pay for overnight hospital stays if the
doctor and the patient want it.
CONTINUITY OF CARE
House: Allows a patient undergoing a course of treatment to stay with
his or her doctor during a transition period, even if the doctor leaves the
Senate: Similar, but only applies to patients who are pregnant,
terminally ill or institutionalized.
allow those who are self-employed to deduct the cost of health insurance and
create a new deduction for long-term care. Allow more medical savings accounts,
which let people set aside money, tax-free, to pay for routine care if they buy
a high-deductible insurance policy in case of an emergency.
Both require health plans to allow patients to
appeal denials to experts outside the plan.
Both require health insurance companies to disclose details
about what they cover and how they operate.
House and Senate HMO bills compared (text); B.C. Oren / Chronicle, Source:
NOTES: Chronicle Washington Bureau
reporter Nancy Mathis contributed to this story.
LOAD-DATE: May 17, 2000