Update on Patients' Rights and Medicare

Patient's Rights

The staff of the legislators on the conference committee between the House and Senate is privately (and regularly) working to resolve the differences between the bills passed by each house. The House passed a strong, bipartisan bill last fall affecting all consumers (the "Norwood-Dingell bill"); the Senate had earlier passed a sham bill that gave very few protections to very few people (virtually along party lines).

The conference has made some progress on smaller issues, such as emergency room care, access to pediatricians, and non-discrimination among providers. However, the issue of "scope" (who's covered by the protections) and the right to sue are still unresolved. The conferees also have to deal with the so-called "access" provisions in the House and Senate bills that are controversial and which we believe are cause for President Clinton to veto. For a description of those provisions, see our fact sheets. 

Sen. Don Nickles (R-OK), the chair of the conference, has set the end of this week as the deadline for action, but everyone agrees the deadline won't be met. Sen. Nickles wants all the smaller issues resolved before they tackle the most controversial ones (like right to sue). The challenge for the Republican leadership is coming out with a bill that can both get passed again by the House and Senate, and that can also get President Clinton's signature..

One new development: The American Association of Health Plans (AAHP), the HMO trade association, is budgeting $200,000 for two-weeks of TV ads starting tomorrow, according to USA Today. AAHP says that its goal is to build public support for legislation requiring doctors and hospitals to report all serious medical mistakes to a federal agency. However, it looks more like they are trying to sidetrack attention from the problems in the insurance industry to doctors and other health professionals and, more importantly, undercut support for the Patients' Bill of Rights. The AMA spokesman is quoted as saying that the ad campaign is "clearly a subterfuge to direct attention away from holding them accountable when they deny needed care."

What can you do to promote patients' rights? The best thing is to help keep the issue alive in the public's mind through letters-to-the-editor and op-eds. This may help to keep some pressure on the Republican leadership to move the legislation to protect vulnerable Republican senators who are up for reelection.

Medicare

The drug issue continues to heat up. There have been a slew of hearings and much jockeying for position. Out of respect to the power of the issue, Republicans in the relevant committees in both Houses are designing their own prescription drug benefit bills. They are all likely to rely private insurance products as the way to deliver benefits, and focus mostly on providing assistance to lower-income Medicare consumers, without any mechanism to contain costs. Their bills are also likely to include other changes in Medicare, more akin to the Breaux-Frist (formerly Breaux-Thomas) approach.

Democrats continue to talk about a universal benefit as part of Medicare. The Democratic leadership in the Senate will soon announce a new drug benefit bill that will build upon the President's approach. In addition, most of us support a bill by Rep. Tom Allen (D-ME) (HR 664 and S. 731). This bill seek to end price discrimination against Medicare consumers by making sure that they get the same price as the drug companies' favored customers (such as the big HMOs). The bills do not incorporate a Medicare drug benefit.

In addition, the health insurance and the pharmaceutical industries continue to be at odds over the structuring of any drug benefit. The drug companies are doing all they can to avoid a new Medicare benefit, fearing the ability of the federal government to try to negotiate prices (just as it does with hospital and doctor fees now). They want any drug benefit to be through private insurance. However, the Health Insurance Association of America (HIAA) says that the drug industry's "[p]roposed private drug-only insurance policies for seniors are an empty promise that ignores the realities of the insurance market by promoting coverage that cannot succeed in the real world." HIAA would like to see a low-income benefit, tax credits, or increased payments to Medicare HMOs to allow them to provide drug coverage.

As you know, this issue is among the hottest out there. Our community needs to keep advocating for a universal, voluntary prescription drug benefit as part of Medicare, including the ability of the Medicare program to make sure the benefit is affordable (both to the long-term financing of the program as well as to individual consumers).

What to do? Continue to raise the issue in every forum you can, including candidate events and with the media, and generate events to get public (and media) attention. Push the candidates to support a universal, affordable drug benefit as part of Medicare. You should also encourage your legislator to co-sponsor the price anti-discrimination bill by Cong. Allen and its Senate version. 

The House and Senate co-sponsors can be seen on THOMAS, the government's legislative tracking site. Do a search for the bill entitled, "Prescription Drug Fairness for Seniors," then go to "Bill Summary/Status" then scroll down to "Co-Sponsors."

Further information on the prescription drug issue is posted on the web site of the Kaiser Family Foundation.