BILL DEALT SETBACK BY SENATE

Capping many months of ANA lobbying for strong patients' rights legislation, ANA President Beverly L. Malone, PhD, RN, FAAN, attended a strategy session with White House staff, on July 13, and later that day joined President Clinton in the White House Rose Garden as he called upon the Senate to pass a strong, comprehensive, and enforceable Patients’ Bill of Rights Act. Also at the podium were Senate Democratic leaders, including Minority Leader Thomas A. Daschle (SD) and Edward M. Kennedy (MA), and representatives of the American Medical Women’s Association, the National Medical Association, and the American College of Emergency Physicians. In his statement, President Clinton cited Malone and the physicians as representing the strong commitment that health professionals across the country have for this legislation’s passage.

In spite of the ANA’s concentrated efforts toward its passage, as well as that of other health care organizations and grassroots supporters, Senate Republicans rejected the comprehensive Patients’ Bill of Rights Act proposed by the Democrats. A weaker, less adequate bill was passed on July 15. Votes cast on amendments and on the final bill were divided along party lines; Republican Senators John Chafee (RI) and Peter Fitzgerald (IL) were the exceptions, opposing the Republican plan.

“In a time when health care decisions are made by profit-focused insurance companies instead of patient-focused health care professionals, the ANA believes that accountability for the delivery of quality, cost-effective health care services must be shared by health plans, health systems, providers, and consumers,” Malone said on the day after the final vote. “However, under this flawed bill, there are no adequate remedies for people harmed by decisions driven by the bottom line.”

During the Senate debate, there were several votes on specific provisions of the Patients’ Bill of Rights Act, accompanied by substantial parliamentary maneuvering on each side. The pressure for a stronger bill led to a few modest changes in the Republican proposal, but the final product has serious shortcomings that preclude its endorsement by the diverse group of organizations, including the ANA, that have advocated comprehensive reform for two years.

The Senate bill covers only about 48 million Americans enrolled in self-funded employer health plans regulated by the Employee Retirement Income Security Act (ERISA). The bill does not protect another 113 million people who have state-regulated insurance plans or who are state or local government employees. The bill does provide a weak appeals process, one that would apply to plans purchased by individuals through employers but excluding 38 million people insured through state and local governments or individual policies. And the ANA and patient advocates support this bill’s amendment prohibiting all insurers from requiring mastectomy as an outpatient procedure, although Republican leaders never fully explained why they departed in this case from their standard position that state regulations sufficiently protect consumers.

The Senate rejected changes that would ensure an independent appeals process, one that would hold health plans accountable for decisions affecting patient care and outcomes. This included eliminating a provision allowing consumers the right to sue health care insurers in state court for damages incurred because of treatment withheld or denied.

The original Republican plan provided no access to clinical trials; however, it was ultimately amended to provide such access—but only for cancer patients. Moreover, access to cancer trials would be limited only to those covered by self-funded plans. Why patients with Alzheimer’s disease, diabetes, or Parkinson’s disease, for example, should not have access to clinical trials was not sufficiently explained.

An important victory for nursing was the addition of language to the Republican bill that would prohibit insurance plans from discriminating against health care professionals solely on the basis of type of licensure. Again, this provision was limited to self-funded plans. But Republicans refused to include whistleblower protections for providers who speak up on behalf of their patients, a measure the ANA has long championed.

It’s still possible for the stronger, more comprehensive, and enforceable measures in the House of Representatives’ version of the Patients’ Bill of Rights Act to pass and then to be incorporated into the final bill during the House-Senate conference. As negotiations continue in the House, the ANA is calling upon nurses to contact their senators and representatives and reiterate the nursing profession’s commitment to an inclusive, commanding Patients’ Bill of Rights.

To reach members of Congress, call the U.S. Capitol Switchboard at (202) 224-3121. For more information on the Patients’ Bill of Rights Act and the ANA’s position, visit our Web site at http://www.nursingworld.org/, or call (202) 651-7088.