Federal Patients’ Rights Bill Should Mirror Texas HMO Reform, USA Today Asserts

Patients should be able to sue their HMO when the health plan harms them by denying coverage, as otherwise "patients have no recourse when denied care, and HMOs have little incentive to put patient care ahead of their bottom line," USA Today advocates in a point-counterpoint editorial. Although the HMO industry is "trying to convince the public that such a law would be dangerous" because it would result in a "flood of lawsuits" that would raise insurance premiums and leave more people uninsured, the editorial points out that four years after Texas permitted patients to sue their HMOs, neither scenario has ensued. In fact, because of the complexity of such cases, only about 20 suits have been filed in the state since the patients' rights law passed. The editorial states, "By arming patients with these rights, the law gave HMOs a powerful incentive to improve care. Doing so can save court costs" -- a Texas Medical Association survey found that state doctors "face fewer hassles with HMOs today" than before the law was enacted. However, the HMO industry "seems to have won a receptive audience in the Bush White House" by arguing that federal legislation would surpass what Texas provides and allow patients to sue their plans whenever a coverage dispute occurs. But "Bush would be right to ignore such trumpeted fears. Whenever HMOs are accused of negligence, they routinely claim that they don't decide what medical care a patient receives, just the insurance coverage they'll pay. For most patients, of course, denying insurance coverage is the equivalent of denying care, and HMOs have a wide latitude in deciding what constitutes a covered benefit. Making HMOs legally responsible for those decisions when they harm a patient would be a prudent reform" (USA Today, 2/19).

Counterpoint
Karen Ignagni, president and CEO of the American Association of Health Plans, says in her rebuttal, "If we're really interested in passing legislation that will give patients confidence in being able to resolve disputes quickly and fairly, the [patient-protection legislation proposed by Sens. Edward Kennedy (D-Mass.) and John McCain (R-Ariz.)] widely misses the mark." That the Kennedy-McCain bill is "claimed to be no more extreme than the Texas law" is simply "clever packaging: wrapping a bill in the flags of liberalism and conservatism and presenting it as 'moderate.' But it's false advertising." Ignagni explains that the Kennedy-McCain bill would permit patients to pursue unlimited punitive damages and has a "built-in process allowing lawyers to bypass external review" -- "bait-and-switch legislation." The bait "is the notion that the bill actually advances patients' rights. The switch is that, once enacted, it will be revealed as a full employment program for trial lawyers," according to Ignagni. She adds that the bill "is a clone of the sue-first, ask-questions-later proposals promoted in Congress during the past five years. These bills have had one thing in common: their dogged determination to substitute high-cost litigation for common-sense problem solving" (Ignagni, USA Today, 2/19).