Rep. Charlie Norwood (R-Georgia) is trying to revive the debate over patients’ rights by proposing two new bills.
Norwood’s first measure, last year’s Patients’ Bill of Rights Act, has been edited and renamed the Patient Protection Act (PPA). The PPA would require that managed care insurance plans provide their insureds with access to emergency and pediatric care, as well as prescription drugs.
The act would also guarantee patients access to their medical information, protect the doctor-patient relationship, and grant patients the right to an independent review if a physician and insurance company disagree on the physician’s recommended plan of treatment.
The measure has been modified to reflect the Supreme Court’s June 20, 2002 ruling in Rush v. Moran and would allow states to have more stringent independent review provisions than the minimum established by federal law. In Rush v. Moran, the high court upheld state laws allowing consumers to seek an independent review of denials of care by managed care companies.
According to a press release issued by Norwood’s office, the second measure, called the ERISA Clarification Act, also clarifies the Supreme Court’s Rush v. Moran decision, stating the 1974 Employee Retirement Income Security Act does not block actions against health plans for denials of care from proceeding in state courts.
Deja vu
In the 107th Congress, the House and Senate each approved patients’ rights legislation, but negotiations to reconcile the two bills stalled. The Senate measure would have allowed consumers to sue HMOs in state court for unlimited damages, or in federal court with damages limited to $5 million. The House bill, supported by the Bush administration, would have permitted consumers to sue HMOs only in federal court, with a $1.5 million cap on non-economic damages.
Consumers also would have been permitted to receive up to $1.5 million in punitive damages under the House bill, but only if they had won complaints against the HMO before an outside appeals panel and the HMO still refused to cover the cost of care.
Sharply Critical
Rep. John Dingell (D-Michigan), who cosponsored a previous patients’ rights bill with Norwood, said trying to pass a patients’ rights measure without addressing the liability issue is “like trying to move a car forward without an engine.”
Senator John McCain (R-Arizona) agreed, noting “a liability provision has to be part of any patients’ rights package.”
Senator John Edwards (D-North Carolina) also appeared dismissive of Norwood’s proposal, saying “without enforcement, it’s a patients’ bill of suggestions.”
Dingell, McCain, Edwards, and Senator Edward Kennedy (D-Massachusetts) are expected to propose their own versions of a patients’ rights bill.
Donald Young, president of the Health Insurance Association of America (HIAA), said Norwood’s legislation would further drive up health care costs, exacerbating the nation’s uninsured crisis at a time when health care costs already are escalating rapidly. He called Norwood’s bills a “bad idea whose time has passed” and “retread proposals to exorcise yesterday’s ghosts.”
Tough Sell
Norwood’s bills have attracted little support to date, in part because the measures do not include a provision for suing managed care plans for medical decisions resulting in less-than-acceptable patient outcomes.
Norwood defended both his bills in a news release. “I know others will say that with health care costs on the rise, now is not the time for patient protections. But from my perspective, now is precisely the time for patient protections. When insurers and employers are concerned about the cost of health care, the quality of patient care can be jeopardized for the bottom line.
“I am no longer trying to help forge a compromise on liability,” Norwood continued. “I tried that for years and, in the end, all I got was a few hundred beatings and no law.”
Patients’ rights legislation may be a non-starter in this session of Congress. Terrorism and international issues have demanded a substantial amount of lawmakers’ attention; on the domestic front, policymakers are focused more on creating a Medicare prescription drug benefit, addressing rising medical malpractice insurance rates, and reforming the structure of Medicare and Medicaid.
Conrad F. Meier is managing editor of Health Care News.
