Copyright 1999 The Seattle Times Company
The
Seattle Times
August 06, 1999, Friday Final Edition
SECTION: NEWS; Pg. A2; CLOSE-UP
LENGTH: 753 words
HEADLINE:
HEALTH-CARE REFORM -- HOUSE REACHES DEAL ON MANAGED CARE
BYLINE: SEATTLE TIMES WIRE SERVICES
BODY:
A COMPROMISE BILL crafted by a group of GOP
dissidents and Democrats contains reforms that are far broader than the House
Republican leadership or the Senate supports.
A rebellious
faction of House Republicans has joined forces with Democrats on a bill that
would guarantee new protections to all Americans in managed-care plans. The
compromise, reached on the eve of Congress' monthlong recess, was a setback for
the House Republican leadership on an issue that is of acute concern to American
voters. For weeks, emissaries of House Speaker Dennis Hastert, R-Ill., have
struggled without success to rein in a growing number of party dissidents - led
by a core of lawmakers with medical backgrounds - who favor broader reforms than
the GOP supports.
The consensus bill was drafted by Rep. John Dingell,
D-Mich., and Rep. Charles Norwood, R-Ga., a dentist who has been a leader in the
drive to regulate managed-care plans.
In announcing the bipartisan
agreement, Norwood said Hastert will have no choice but to allow a vote on the
bill, predicting that it will have nearly 100 Republican supporters by the time
Congress returns after Labor Day. The GOP holds a slender five-vote margin in
the House.
"We need a law that will protect patients, not a bill that
will protect politicians at the November ballot box," Norwood said.
Tougher than Senate version
In July, the
Republican-controlled Senate passed managed-care legislation that is
significantly more restrictive than the compromise House bill. It would cover
only some of the nation's insured, for example, and would not permit
managed-care plans to be sued for denying care.
Dingell, Norwood and
others stressed that their measure would cover all those who have insurance.
President Clinton, who has vowed to veto the Senate approach if it
reached his desk, was enthusiastic about the House bill.
"Unlike the
partisan Senate-passed bill, this bipartisan initiative is a patients'
bill of rights' not just in name but in reality," Clinton said.
What the bill would do
The legislation would
guarantee patients access to specialists and coverage when they go to an
emergency room without authorization by their health plan, if the patient
believes he or she is in an emergency situation.
It would give patients
the right to appeal a health plan's denial of coverage to an independent
external review board of health professionals with expertise in the patient's
illness. The independent board's decision would be binding, and if the health
plan failed to comply, it could be fined up to $ 250,000.
Under the
legislation, managed-care plans could not forbid doctors who work for them from
discussing expensive treatments with their patients.
Patients
could sue plans
But the provision that provoked an immediate
onslaught from health plans and the business community was the one that would
give patients the right to sue health plans under existing state negligence laws
for denial of treatment that results in injury or death.
Under current
law, the health plans that cover 125 million Americans generally have not been
liable under state malpractice or negligence laws. The most that a patient can
recover is the cost of the benefit that was denied. For example, if a plan
denies a patient coverage for a mammogram and it later turns out that the
patient has breast cancer, the patient can recover only the cost of the
mammogram.
In deference to concerns that earlier versions of the bill
would have encouraged lawsuits and perhaps allowed employers as well as health
plans to be sued, the bill's authors stipulated that state dollar limits on
damages would apply to lawsuits brought under the bill. Additionally, plans
could not be held liable for punitive damages if they complied with the findings
of the external review. Trying to hold his fractured party together, Hastert
said today he would bring an HMO bill to the floor that includes new rights to
sue managed-care companies. He promised a floor vote in September on an
alternative proposal being developed by Reps. Tom Coburn, R-Okla., and John
Shadegg, R-Ariz. It's the first time a Republican congressional leader has
backed an expanded right to sue - something Democrats have been insisting on
since the managed-care debate began more than a year ago. However, few details
of the alternative provision were available today.
Compiled from
reports by The Washington Post, the Los Angeles Times and The Associated Press.
GRAPHIC: PHOTO; 1) DENNIS HASTERT > 2) CHARLES
NORWOOD > 3) JOHN DINGELL
LOAD-DATE: August 7, 1999
