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
BODY:
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
costs.
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
protections.
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