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Copyright 2000 The National Journal, Inc.  
The National Journal

January 22, 2000

SECTION: HEALTH; Pg. 242; Vol. 32, No. 4

LENGTH: 932 words

HEADLINE: Dems Ready to Pounce Over Patients' Rights

BYLINE: Spencer Rich


Congressional health care policy debates have a certain
predictable rhythm. Democrats see a problem and come up with a
proposed solution requiring government regulation or new
programs. Republicans object that the solution is worse than the
problem and would increase bureaucracy, federal controls, and

     That well-established pattern will continue this year in
the ferocious dispute over so-called patient protection
legislation, which is designed to curb health insurers' abuses,
including denials of medical services. On one issue, however, the
usual positions are reversed: House Republicans, backed by anti-
abortion groups, are advancing a bill to nullify an Oregon law
allowing assisted suicide, despite pleas from Democrats that
states' rights should be respected in this case.      The election-year maneuvering over patient protection
legislation, currently in House-Senate conference committee, is
expected to take an especially high profile. The House, after a
long fight last October, passed a strong patients' rights bill,
275-151. The measure, sponsored by Reps. John D. Dingell, D-
Mich., Charlie Norwood, R-Ga., and Greg Ganske, R-Iowa, would
curb alleged abuses and denials of service by HMOs and other
private health plans. Despite the opposition of the managed care
industry, employer groups, and the House GOP leadership, 68
Republicans joined the Democrats in supporting the bill.

     The Senate approved narrower legislation in July. Critics
say it is full of loopholes and lacks the House bill's provision
to allow lawsuits in state courts against health plans whose
denial of services causes injury or death. The Senate bill's
protections also apply to fewer patients.

     Some Capitol Hill insiders contend the nation supports
the House reforms and Republicans will pay a steep political
price if no reasonably strong bill emerges from conference
committee. "If there's a bill, we get credit," said a Democratic
aide. "If there's no bill, the Republicans take the blame." He
predicted that if conferees produced a weak bill, Senate
Democrats would filibuster to block it or the President would
veto it.

     Others, such as Gail Wilensky, the former Medicare
administrator, believe that public support for a patients' rights
bill is fairly broad, but not very deep. So the outcome depends
on how the GOP reads the voters' mood.

     The House patients' rights provisions are attached to
another bill that would expand tax breaks for patients' medical
savings accounts and create "association health plans" that let
small businesses band together to buy health insurance with less
state regulation. This measure also includes tax incentives to
increase availability of health insurance for the self-employed.
Some of the bill's provisions are unacceptable to the President.

     Other health issues may also crop up on the legislative
agenda. These include:

     Organ Transplants: Health and Human Services Secretary
Donna Shalala last year proposed revising procedures for the
nation's organ transplant system so that more of the available
organs go to the sickest people and fewer are reserved for
patients in the local area where the organs were "harvested."
Critics said the shift would benefit a handful of national organ
transplant centers that perform a high number of transplants and
would lead to a loss of patients by smaller medical centers. Some
questioned whether Shalala was usurping powers that should be
left to the private organ transplant network. Congressional
Republicans have temporarily blocked the HHS regulation. But a
bill permanently limiting the Secretary's power in this area may
not advance very far.

     Medical Record Privacy: Congress was unable to reach
agreement last year on legislation to protect the privacy of
patients' medical records. This failure triggered an earlier
law's requirement that Shalala promulgate regulations in the
absence of legislative action. She proposed a privacy regulation
covering electronic transmission of records, but Congress may
again try to act.

     Medical Errors: A recent report by the National Academy
of Science's Institute of Medicine said medical mistakes claim
the lives of up to 98,000 people a year. Legislative proposals
are expected, but disputes over the institute's recommendation
for mandatory reporting of serious errors could stall action.

     Health Coverage: President Clinton is expected to propose
a tax credit to help some of the 44 million uninsured Americans
obtain coverage.

     Tobacco: A Supreme Court decision on the Food and Drug
Administration's powers to regulate tobacco could trigger
legislative proposals.
At a Glance: Patients' Bill of Rights

     The Issue: Democrats, and some Republicans, will keep up
the election-year pressure for a House-Senate conference
committee to produce a sweeping patients' bill of rights.
Key Players:

     Senate Majority Whip Don Nickles, R-Okla., sponsor of the
Senate bill
Rep. John D. Dingell, D-Mich., ranking Democrat on the House
Commerce Committee and sponsor of the House bill
Recent Action: Last fall, House GOP leaders named conferees on
the bill but excluded key Republicans who support strong patient
What to Watch: To reach a compromise, Democrats would have to
limit lawsuit provisions and Senate Republicans would need to
cover more patients.

LOAD-DATE: January 25, 2000

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