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Health Care

How the Bipartisan Bill (H.R. 2723), the Coburn/Shadegg Bill (H.R. 2824), and the Boehner Bill (H.R. 2926) Measure Up on Some Key Patient Protections

Key Patient Protections

House Bipartisan Consensus Bill
(H.R. 2723)

Coburn/Shadegg Bill
(H.R. 2824)

Boehner Bill
(H.R. 2926)

Apply all protections to all people with employment-based insurance (including state and local government workers) and people who buy insurance on their own.

NO. All of the protections (except the point-of-service option) apply to all ERISA plans. State and local government workers are not covered by the review provisions at all, and their plan sponsors may elect to opt out of the remaining protections. No protections apply to people who buy insurance on their own.

Ensure that medical judgments are made by medical experts, not insurance bureaucrats.

NO, because independent medical reviewers are only allowed to determine if the plan followed its own rules, not whether the care was medically necessary or appropriate by any objective measure.

Hold managed care plans accountable when their decisions to withhold or limit care injure patients.

YES, but punitive damages are not available when plan follows recommendation of external reviewer.

NO, because the bill contains numerous loopholes and exemptions that will make it impossible to hold plans accountable.

NO

Ensure that patients in the middle of treatment for an ongoing special condition can continue to see the same health care provider if their provider leaves the plan or their employer changes plans.

NO. Continuity is only ensured when the patient is pregnant, scheduled for surgery, or terminally ill.

Allow patients to see an outside specialist at no additional cost whenever the specialists in their plan cant meet their needs.

NO

Require that HMOs and insurance companies pay for emergency services if a reasonable person would consider the situation an emergency.

YES, but patients could be left with bills for services rendered by emergency room personnel if the plan concludes, after the fact, that those services were rendered by non-participating health care professionals after the patient had been adequately stabilized.

Ensure that doctors and nurses can report quality problems without retaliation from HMOs, insurance companies, hospitals, and others.

NO

NO

Prevent plans from financially rewarding health care professionals for limiting a patients care.

NO

Give consumers access to an independent consumer assistance program to help them choose plans and get the services they need.

NO

NO

NO

Allow doctors to prescribe prescription drugs not on the HMOs predetermined list when needed.

NO

NO

Prevent plans from denying access to clinical trials that may save peoples lives.

NO

NO, except for cancer trials

Allow patients to appeal denials or limitations of care to an external, independent reviewer who makes an independent judgment about the patients medical needs and the appropriateness of any proposed treatment.

 

NO. The bill only authorizes the reviewer to determine if the plan followed its own rules. Thus, the reviewer must follow the plans own definition of what care is "medically necessary or appropriate," no matter how inconsistent with best medical practice that definition may be.

Give women direct access to ob-gyn services from any qualified participating health care professional who provides such care.

NO. The bill does not ensure access to participating health care professionals who are not physicians.

YES, but the bill may limit the ability of these health care professionals to refer patients for other care.

9/28/99 For more information contact: National Partnership for Women & Families (202) 986-2600