House GOP Leaders Face ‘Stiff Test’ in Patients’ Rights Debate

As Congress returns from the July 4 recess, House Republicans leaders face "stiff tests of their ability to modify or derail" a patients' rights bill ( S 1052) passed in the Senate last month, the Los Angeles Times reports. The House will likely address the bill, sponsored in the Senate by Sens. Edwards Kennedy (D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.) next week. Support among Democrats and some Republicans for the House version (HR 526) of the Kennedy-McCain-Edwards legislation, sponsored by Reps. Charlie Norwood (R-Ga.), John Dingell (D-Mich.) and Greg Ganske (R-Iowa), appears "solid" (Hook, Los Angeles Times, 7/9). Under the bill, patients could sue HMOs in state court for denial of benefits or quality of care issues and in federal court for non-quality of care issues. The legislation would cap damages awarded in federal court at $5 million, but state courts could award as much in damages as the state allows (Kaiser Daily Health Policy Report, 2/7). However, House GOP leaders have begun "leaning hard on their rank and file" to back a rival bill (HR 2315), sponsored by Rep. Ernie Fletcher (R-Ky.) (Los Angeles Times, 7/9). Under the bill, patients could sue health plans in federal court for quality of care issues and non-quality of care issues, such as those involving violations of their health plan's contract. Patients could only sue in state court in cases where health plans refused to abide by decisions made by outside appeals panels. The bill would cap non-economic damages in federal court at $500,000, but state courts could award as much money in damages as the state allows. However, the bill would prohibit punitive damages (Associated Press, 6/28).

1999 vs. 2001
In 1999, the House passed a bill sponsored by Norwood and Dingell, similar to this year's Norwood-Dingell-Ganske measure, with support from 68 Republicans. However, the Times reports that many of those Republicans "signaled their willingness to compromise by also voting for more limited versions of the legislation." According to an analysis by Congressional Quarterly, 21 Republicans voted only for the 1999 Norwood-Dingell bill and not for "weaker" versions of the legislation, and only 17 members of that group remain in Congress. While GOP leadership sources said "it will be tough to pry support away from the broader bill," House Majority Leader Dick Armey (R-Texas) said on "Fox News Sunday" that Republicans would "benefit this year from something they lacked in 1999" -- a "good alternative to the Democratic bill."

Bush
House Republican leaders also hope to "spare" President Bush, who has threatened to veto the Kennedy-McCain-Edwards bill, from "politically perilous decisions." According to the Times, Bush "has much to lose if the GOP leaders do not prevail." The president "would rather not veto politically popular legislation" but "neither does he want to sign bills that alienate Republican conservatives," the Times reports (Los Angeles Times, 7/9). White House officials said that Bush will "focus on persuading" moderate Republicans to oppose the Norwood-Dingell-Ganske bill in favor of the Fletcher measure (Eilperin, Washington Post, 7/8). Still, the Providence Journal reports that whether Bush will "make good" on his threat to veto the Kennedy-McCain-Edwards bill remains "up in the air." Observers predict that Bush "might best demonstrate political nimbleness by following the middle ground" -- negotiating "enough of a concession from the Democrats to let him embrace the bill, sign an eventual compromise with the Senate and claim the victory as his own" (Mulligan, Providence Journal, 7/9). This week, Bush will launch a campaign to "claim" the patients' rights issue "as his own," holding a series of events to "highlight" support for the Fletcher bill. White House aides said that Bush hopes to "convince the public that he is sensitive to patients' concerns" and "convey the logic behind his opposition" to the Kennedy-McCain-Edwards bill, which he has said would "drive up" health insurance premiums and could prompt employers to drop coverage for employees (Kornblut, Boston Globe, 7/9).

Motorola Concerns
Meanwhile, Motorola Inc., a self-insured company that provides health coverage for 230,000 employees, retirees and dependents around the nation, has become "acutely concerned" about patients' rights legislation, and officials "think it could force them to change many aspects of what they do." The New York Times reports that because Motorola "rules on individual claims for health benefits like an insurance company, "it could be sued by its workers" under the Kennedy-McCain-Edwards bill (Pear, New York Times, 7/8). Under the legislation, employees could not sue employers who contract with insurers and health plans to provide them with health coverage. Employers also could name an outside designated decision maker to make medical decisions that affect employees, shielding them from liability. However, the bill would leave 6% of the nation's employers -- mostly large companies that administer their own health plans for employees -- vulnerable to lawsuits (Kaiser Daily Health Policy Report, 6/28).