GOVERNMENT & MEDICINE

New bill fails to advance patient protections

A Senate-passed measure includes a new liability provision but is labeled a "sham" by the AMA.

By Susan J. Landers, AMNews staff. July 24, 2000.

Washington -- One word makes all the difference when comparing a patients' rights bill passed by the House with another passed by the Senate, remarked President Clinton in a July 6 speech at the University of Missouri.

"So, when you hear people say, I support a patients' bill of rights, the operative word in that sentence is 'a' as opposed to 'the,' " said the president, who strongly favors House-passed legislation known as the Norwood-Dingell bill.

Clinton criticized a Senate measure passed on June 29 by a 51-47 vote, mainly along party lines, for its failure to provide adequate protections to all citizens with health insurance.

The president's speech also served to draw attention to a Missouri patient protection bill supported by the state's Democratic Gov. Mel Carnahan, who is running against Sen. John Ashcroft (R, Mo.) in a tightly contested race.

The AMA is campaigning in Missouri for the Norwood-Dingell bill with print ads attacking Ashcroft and others who voted against the bill when it was brought to the Senate floor by Sen. Edward Kennedy (D, Mass.) in mid-June.

The AMA decried the most recent Senate GOP bill. Board Chair D. Ted Lewers, MD, called it a "sham" and "a ploy to feed big insurance's deep desire to kill effective reform."

Dr. Lewers stressed the AMA would not relent in efforts to pass a bill with the Norwood-Dingell provisions.

While the Senate bill does include a new provision that allows patients to sue health plans in federal courts, it still covers only the 56 million Americans in "self-insured," employer-sponsored group health plans. By contrast, the House bill, passed last fall, generally covers those enrolled in all group health plans -- approximately 161 million people. It allows lawsuits to be filed in state courts to pursue personal injury or wrongful death damages.

The new Senate bill also includes provisions allowing physicians to provide continuing care to certain patients even after the physician leaves the health plan. It would establish a center for patient safety that would conduct research on medical errors.

Those provisions represent a good-faith effort at compromise, said the bill's sponsor, Sen. Don Nickles (R, Okla.), who for several months has led House and Senate negotiators in an attempt to craft compromise legislation. The conference now appears to be at a standstill.

Additional concessions by Senate Republicans are doubtful, said a Nickles staff member. "We are walking a fine line in trying to find ways to bridge the differences so we can produce a conference report that can be supported" in both chambers.

But negotiations could be restarted if House Republicans determine they can pass something other than the Norwood-Dingell bill, she said.

Rep. Charles Norwood, DDS (R, Ga.), said the House would support only a bill that covers all Americans who have health insurance, allows patients to choose their own physicians and permits lawsuits against managed care plans.

Although Senate passage of the new bill means that its supporters can tell people in their districts that they passed a patient protection measure, that message may be a bit murky, said Larry Levitt, a director at the Henry J. Kaiser Family Foundation. "The details of this debate have gotten so complicated that there is no question they are beyond the ability of most voters to comprehend," he said.

In addition, voters surveyed by Kaiser in December 1999 said they preferred Democrats' performance on patients' rights over Republicans' by a 2-to-1 ratio, Levitt said.

"So voters come to this issue trusting Democrats more," Levitt said. "The challenge for Democrats is to try to distinguish their proposals from the Republican proposals, while the challenge for Republicans is to demonstrate that they are for a patients' bill of rights."

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