Bush Vows to Push for Patients’ Bill of Rights, But Says He Would Veto Kennedy-McCain-Edwards Bill

President Bush said on March 21 that while he hopes to sign a patients' bill of rights by the end of year, he would veto any proposal in Congress with right-to-sue provisions that would be too expansive and would "drive up" health care costs, the Philadelphia Inquirer reports. Speaking before the annual convention of the American College of Cardiology in Orlando, Fla., Bush said, "I want to sign a patients' bill of rights this year, but I will not sign a bad one, and I cannot sign any one that is now before Congress" (Hutcheson, Philadelphia Inquirer, 3/22). This veto threat was directed at legislation proposed by Sens. John McCain (R-Ariz.), Edward Kennedy (D-Mass.) and John Edwards (D-N.C.) that would allow patients to sue their health plans in state court and seek up to $5 million in non-economic damages in federal court (Chen/Rubin, Los Angeles Times, 3/22). In his speech, Bush said that a patients' rights bill must have "reasonable caps on damage awards" and that the $5 million figure was "too high, and [would] drive up the costs of health care in America." The President outlined five principles that he thinks should govern any patients' rights legislation:

• The measure "must cover everyone, all patients in all private health plans."
• It should "guarantee all patients important rights," including the right to "get emergency treatment at the nearest emergency room" and the right to see a specialist.
• In cases of denied medical care, patients "should have the right to a fair and immediate review" through a "strong, binding independent review process" that includes an "impartial review panel of medical doctors."
• The measure "should offer patients who have been harmed a meaningful remedy, without inviting frivolous lawsuits." This includes a "recourse in court" after the independent review process, which would prevent "most disagreements" between a patient and a health plan from "wind[ing] up in court."
• Finally, a patients' bill of rights should "ensure that Americans will have access to affordable health care coverage" --therefore, it should not encourage "excess and frivolous litigation" that could "drive up insurance premiums for everyone" (Bush speech text, 3/21).

'Disappointment' in Congress
While Bush's proposal and the Kennedy-McCain-Edwards bill both offer guaranteed coverage and access, they are far apart on the extent to which patients should be able to sue their health plan. In addition to the $5 million cap, the senators' proposal would allow patients to sue in state courts, which often award higher damages than federal courts (Lytle, Orlando Sentinel, 3/22). Bush favors limiting lawsuits to federal courts -- "I will not support a federal law that subjects employers to new multiple lawsuits in 50 different states," he said (Sobieraj, AP/Nando Times, 3/21). The cap under Texas' law, which Bush yesterday cited as a "good model" for federal legislation, is $750,000 (Sanger, New York Times, 3/22). Sponsors of the Kennedy-McCain-Edwards bill "expressed disappointment" at Bush's veto threat. Rep. Greg Ganske (R-Iowa), one of the bill's House sponsors, said that bill supporters "have a lot of things in common with the president," adding that the measure is "modeled" after a patients' bill of rights that became law in Texas while Bush was governor. Kennedy said that the bipartisan coalition behind the proposal would try to get the bill to the Senate floor by the end of May. Edwards added, "At some point the president is going to have to make a decision -- does he stand with the HMOs, or with patients and doctors, because all the patients' and doctors' groups support our bill" (Koffler/Rovner, CongressDaily, 3/21).

An Alternative Plan
While the prospects of the Kennedy-McCain-Edwards bill becoming law appear diminished, a "senior administration official" said that Bush aides were working with Sens. Bill Frist (R-Tenn.), John Breaux (D-La.) and James Jeffords (R-Vt.) to craft a patients' bill of rights in line with the president's guidelines (Goldstein, Washington Post, 3/22). Under the draft of this proposal, patients would have to "exhaust an independent medical review process" before being allowed to sue only in federal court, where non-economic damages would be capped at $500,000 (Welch/Sternberg, USA Today, 3/22). The Washington Post reports that Frist, Breaux and Jeffords are crafting a proposal in which "responsibility for patient protections" would be divided between state and federal governments. Under this plan, states would initially be subject to the federal law, but could seek an exemption -- possibly through HHS -- if they offered similar protections through state laws. Such a plan could possibly assuage, on one hand, the Democrats and "many House Republicans" who believe that "any new federal" patients' rights should be universal, and, on the other, the Republican senators who believe that state rules should govern about two-thirds of Americans with health insurance (Washington Post, 3/22). Speaking of the proposal, Jeffords said, "It's finished. All we have to do is pick up a couple of Democrats" (Rovner, CongressDaily/A.M., 3/22).