House to Get ‘Little Time to Recover’ from Campaign Finance Debate Before Taking on Patients’ Rights

Lawmakers in the House will likely face a "searing partisan struggle" over patients' rights legislation "as soon as this week," the Los Angeles Times reports. The issue's future "hinge[s]" on the "readiness" of GOP moderates to "flout the will" of Republican leaders, and on President Bush, who has threatened to veto the patients' rights bill (S 1052) passed in the Senate last month. Bush has "attacked" the Senate bill, sponsored by Sens. Edward Kennedy (D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.), saying that the measure would "trigger an avalanche of lawsuits" against health insurers and "drive up" the cost of premiums (Miller, Los Angeles Times, 7/15). 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). During his weekly radio address Saturday, Bush said, "I hope to sign a [patients' rights] bill that gets people help when they need it, not a bill adding hundreds of dollars to the high premiums they already pay." Still, the Times reports that Bush "may be hard-pressed to follow through" on his veto threat, pointing out that polls "repeatedly show a great deal of public support" for patients' rights legislation.

Rival House Bills
In the House, Reps. Charlie Norwood (R-Ga.), John Dingell (D-Mich.) and Greg Ganske (R-Iowa) have sponsored a bill (HR 526) similar to the Senate bill, but House GOP leaders have drafted rival legislation "designed to crack the coalition supporting the more sweeping [Norwood-Dingell-Ganske] measure" (Los Angeles Times, 7/15). The House leadership bill (HR 2315), sponsored by Rep. Ernie Fletcher (R-Ky.), would allow patients to 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. The bill would prohibit punitive damages (Kaiser Daily Health Policy Report, 7/9). The New Orleans Times-Picayune reports that the "fate" of patients' rights legislation in the House rests on 18 Republicans who, in 1999, "consistently voted" for legislation similar to this year's Norwood-Dingell-Ganske measure. House GOP leaders have lobbied the "renegade members," and Bush has "urged them to return to the fold," staging "high-profile" meetings last week to "build momentum" for the Fletcher bill (Walsh, New Orleans Times-Picayune, 7/16). House leaders said that they "remain confident" that the Fletcher bill will pass (Los Angeles Times, 7/16). But Norwood spokesperson John Stone, referring to the Norwood-Dingell-Ganske bill, said, "We have the votes to pass it, more than enough" (New Orleans Times-Picayune, 7/16).

Report Buoys Fletcher Bill
Rep. John Boehner (R-Ohio) on Thursday unveiled a report that found that liability provisions in the Kennedy-McCain-Edwards bill would increase health care costs by up to $16.3 billion per year and add up to nine million Americans to the ranks of the uninsured. The report, released by the Employment Policy Foundation, predicted that the Fletcher bill would raise costs by $4.2 billion per year and increase the number of uninsured Americans by two million. Supporters of the Norwood-Dingell-Ganske bill said that the report does not "reflect the fact that while health insurance premiums have continuously gone up over the last few years, the number of the uninsured is going down" (Fulton, CongressDaily, 7/13).

FEHBP Insurers Question Amendment
An "unexpected" amendment to the Senate patients' rights bill has "jolted" health plans that serve federal employees and retirees and "tossed" the Federal Employees Health Benefits Program into the "contentious political debate" over the issue, the Washington Post reports. The amendment, sponsored by Sen. Don Nickles (R-Okla.), would give federal employees, as well as Medicare and Medicaid beneficiaries, "more avenues" to sue their health plans in state courts. Large plans in FEHBP oppose the amendment, maintaining that the provision would increase health insurance premiums for the nine million Americans covered by the program. However, supporters say that the liability provision would add "less than a percentage point" to increases in premium rates. The potential for lawsuits in state courts has "unnerved" officials at some of the plans in FEHBP, the Post reports. According to the insurers, the federal Office of Personnel Management, which currently administers an appeals process and provides patients with an outside panel of experts to review medical disputes, already provides "significant oversight." They also say that Congress "intended for federal employees, regardless of where they work and live, to receive uniform benefits" through FEHBP, which would allow the program to "preempt" state law, restricting patient grievances to federal court and permitting enrollees to recover "only the benefit they were denied." In response, Nickles said, "For crying out loud, we should be consistent" with patients' rights legislation, adding, "I would find it troubling if we mandate that on the private sector and say, 'Oops, we forgot to do it for federal employees.'" Ron Pollack, executive director of the consumer advocacy group Families USA, said that Nickles, an opponent of the Kennedy-McCain-Edwards bill, "was clearly trying to ... increase potential opposition for the underlying proposal and create what some people call poison pills" by proposing the amendment (Barr, Washington Post, 7/15).