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Copyright 1999 The Houston Chronicle Publishing Company  
The Houston Chronicle

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October 08, 1999, Friday 3 STAR EDITION


LENGTH: 1352 words

HEADLINE: House clears HMO reform allowing suits


BYLINE: 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 plans.

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 malpractice.

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 opposes.

"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, D-Mo.

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 hospitals closer.

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 sue.

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.

Rep. 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.

"I 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 patients."

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.

Proponents 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 bills compared

Differences between managed care bills approved by the House Thursday and the Senate in July:


House: Covers all Americans with private health insurance.

Senate: Many 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.


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.


House: Allows women to see them without prior approval but not to designate them as primary care doctors.

Senate: Similar, but only applies to federally regulated plans.


House: Requires payment for reasonable emergency room services without prior approval.

Senate: 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 patients.


House: No provision.

Senate: Requires health plans to pay for overnight hospital stays if the doctor and the patient want it.


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 network.

Senate: Similar, but only applies to patients who are pregnant, terminally ill or institutionalized.


Both 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.

Source: Associated Press

GRAPHIC: Graph: House and Senate HMO bills compared (text); B.C. Oren / Chronicle, Source: Associated Press

NOTES: Chronicle Washington Bureau reporter Nancy Mathis contributed to this story.

LOAD-DATE: May 17, 2000

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