In 1997, AFSCME International President Gerald W. McEntee served on President Bill Clinton’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. The Commission looked at the impact of managed care on consumers and health care workers, and discussed ways that quality can be improved. The Commission ended its deliberations in March, 1998 after issuing its final report to the President, Quality First: Better Health Care for All Americans.

In its report to President Clinton, the Commission called on the President to unify the many stakeholders in the health care system by articulating and continuing to emphasize that "(T)he purpose of the health care system must be to continuously reduce the impact and burden of illness, injury, and disability and to improve the health and functioning of the people of the United States." The Commission recommended a set of national aims for improvement, to be achieved through a Patients’ Bill of Rights:

• reducing the underlying causes of illness, injury and disability;
• expanding research on new treatment and evidence of effectiveness;
• ensuring the appropriate use of health care services;
• reducing health care errors;
• increasing patients’ participation in their care; and
• addressing oversupply and undersupply of health care resources.

In early March, 2000 a conference committee of selected senators and representatives attempted to develop a final patients’ rights bill which would have resolved the differences between the versions passed by the U.S. House of Representatives and the U.S. Senate (see below). However, after months of negotiations, it became clear no resolution would be reached during this Congressional session. The standoff is a reflection of the sharp differences in the House and Senate bills and the reluctance among GOP leaders to accept a bill that covers all families and holds the insurance industry accountable. After the 2000 Presidential elections we expect the issue of patient protections to be taken up again, with similar bills being proposed.

The House-approved bill (H.R. 2723) was a bipartisan compromise sponsored by Reps. Charles Norwood (R-GA) and John Dingell (D-MI). The bill contained the following key provisions:

• Applied all protections to all people covered by managed care plans, including state and local government employees.

• Included whistleblower protections that prohibit employers from retaliating against doctors, nurses, and other certified or licensed health care professionals who report quality problems to their employers, accrediting entities or public regulatory agencies.

• Allowed patients to appeal denials or limitations of care to an external reviewer who makes an independent judgment about the patient’s medical needs and the appropriateness of the proposed treatment.

• Expanded liability so that all plans can be held legally accountable when they harm patients by wrongly denying or limiting care.

• Ensured that patients have access to emergency services and specialists.

• Prevented plans from financially rewarding health care professionals for limiting a patient’s care.

The Senate-approved bill (S. 1344) had many serious deficiencies; it provided weak patient protections to only about one-third of families who are in managed care plans. The bill excluded state and local government employees, many workers in small- and medium-sized firms, and those who do not receive coverage through employment but instead purchase individual insurance policies. In addition, S. 1344 had no whistleblower protections for health care workers, and it failed to hold all plans legally accountable when patients are injured because of plan decisions to delay or deny care. The external appeals process in the Senate bill was rigged to favor health plans.