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Democrats issue grassroots call for patient rights bill

As talks to hammer out differences between the House and Senate patient protection bills loom, Senate Democrats press for the AMA-backed bipartisan House version.

By Susan J. Landers, AMNews staff. Jan. 24, 2000. - Additional information.

Washington -- Senate Democrats took advantage of Congress' winter recess to hold hearings in December and January throughout the country to gather grassroots support for passage of a strong patient protection bill.

Their aim is to build momentum in the Senate for the House-passed bill, which is widely viewed by physician and consumer groups as stronger than the Senate legislation. The bipartisan House measure passed in October 1999, and the Republican Senate bill passed in July.

"Patients shouldn't have to fight cancer or other life-threatening illness and have to fight their HMO at the same time," Sen. Byron Dorgan (D, N.D.), chair of the Democratic Policy Committee, told a group of patients, physicians and patient advocates gathered for a recent hearing at Inova Fairfax Hospital in the Washington suburb of Falls Church, Va.

"We're working to develop grassroots support that will help us convince a handful of senators to change their minds and support a real Patients' Bill of Rights that will empower patients," Dorgan said.

Hearings also were held in Valhalla, N.Y.; Dickinson, N.D.; and Chicago. Others are in planning stages, said Dorgan, who was joined at the Virginia hearing by Sens. Charles Robb (D, Va.) and Jeff Bingaman (D, N.M.).

Dorgan likened the Senate legislation to a "fig leaf" because, he said, it gives only skimpy protection to patients enrolled in managed care plans.

The House bill, sponsored by Reps. Charles Norwood, DDS (R, Ga.), and John Dingell (D, Mich.), is the better bill by far, Robb said. But he noted that its chances of passage are "iffy" without the strong public support the hearing was designed to stimulate.

The House and Senate bills differ in several key aspects. The largest gulf between the two is in the area of liability. The House bill would allow people with employer-based health coverage to sue their health plan for malpractice if they think the plan has denied them a medically necessary benefit. The Senate bill contains no liability provision.

Ironing out differences

Differences must now be resolved by lawmakers in a conference committee that looms as a major hurdle in the forward progress of the House bill. Dorgan predicted that conferees are not likely to begin negotiations for several months. He advised those attending the Virginia hearing to contact Senate Majority Leader Trent Lott (R, Miss.) and House Speaker J. Dennis Hastert (R, Ill.), who oppose plan liability, and ask them to "change course" and allow the House bill to move forward.

The House measure is strongly supported by the AMA and was praised as "a big win for American patients" by AMA President Thomas R. Reardon, MD.

Applauding the Senate hearings, Dr. Reardon noted, "There is real public interest in the passage of patient protection legislation, and I think it's important for Congress to understand that."

Standing fast against the expansion of health plan liability is the American Assn. of Health Plans, which represents many of the largest managed care companies in the nation. The health plans contend that patients would not be afforded greater protection simply by allowing more lawsuits to be brought against managed care plans.

AAHP President Karen Ignagni called the Senate Democrats' field hearings a "political" move and said many in Congress are now rethinking the entire issue of patients' rights in light of a recent Institute of Medicine study on the nation's high rate of medical errors.

The new report illustrates that the focus on managed care reform as the main route to increased patient protections is too narrow, Ignagni said. Among the report's recommendations were those calling for establishment of a national patient safety center and for mandatory reporting of serious errors.

Dr. Reardon called Ignagni's reference to the IOM report a "diversionary tactic" designed to take the focus off the "real issue, which is holding health plans accountable for making medical decisions which harm patients."

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Debate explores health plan liability

Washington -- A future that includes expanded liability for managed care companies would be a dangerous place as viewed by Richard A. Epstein, a professor at the University of Chicago Law School. On the contrary, countered AMA Trustee Donald J. Palmisano, MD, it would be a much safer place for patients.

The two debated the pros and cons of expanded liability for health plans as called for under a patient protection bill passed last fall by the House and strongly supported by the AMA. The debate took place at the American Enterprise Institute, a Washington, D.C., think tank, Jan. 7.

Epstein said the expansion of liability for health plans likely would mean higher premiums, decreased access to health care plans and more uninsured people.

Dr. Palmisano emphasized the need to hold managed care plans accountable for decisions that harm patients. He noted that a 2-year-old Texas law expanding managed care plans' liability has resulted in only five lawsuits. The Texas law also boosted premiums by only pennies per month per health plan member.

While Epstein said he would place his faith in market forces to hold managed care companies in check, Dr. Palmisano said most patients are not able to scout the marketplace for health plans but must accept the plan offered by their employers.

Dr. Palmisano also said doctors' refusal to sign contracts with managed care plans would be tantamount to abandoning patients.

Dr. Palmisano argued for the reform of the Employee Retirement Income Security Act of 1974, or ERISA, which shields many managed care plans from lawsuits.

"Because of ERISA, managed care organizations can act in an arbitrary manner, with no responsibility," he said.

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