Patients’ Rights Debate Illustrates Bush’s ‘Troubles in Setting the Agenda,’ Washington Post Reports

In its continuing series on the "new balance of power" on Capitol Hill, the Washington Post today looks at the patients' rights debate, with particular emphasis on President Bush's role. When Bush took office, White House aides "identified the issue as a splendid opportunity" to demonstrate how "Bush would transcend years-old stalemates and make Washington work." Now, six months after Bush's inauguration, managed care reform is "no longer an opportunity but a source of constant frustration," the Post reports. Bush and his team are approaching the issue "almost entirely" on the defensive, a "metaphor for a new president's troubles in setting the agenda," the Post reports. Some aides and allies now say that "there was scant appreciation" of the "formidable task" they faced in "sell[ing]" Bush's message on patients' rights -- that he "supports the idea" of patients' rights legislation, but not certain bills. Bush has said that the Senate-passed bill (S 1052) sponsored by Sens. Edward Kennedy (D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.) does not meet his requirements (Balz/Harris, Washington Post, 7/23). That bill would allow patients to 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. In addition, the measure guarantees patients access to emergency and specialty care, as well as a number of other protections (Kaiser Daily Health Policy Report, 2/7).

The Veto Threat
Bush's policy aides have urged him to "issue sharp veto threats" against patients' rights bills that he does not support, but communication aides have "worried" that those threats could be interpreted as a sign that Bush is opposed to patients' rights altogether. With a "showdown" over patients' rights about to take place in the House, Bush has met with 69 House members to "warn" them that he will veto the bill sponsored by Reps. Charlie Norwood (R-Ga.), John Dingell (D-Mich.) and Greg Ganske (R-Iowa) -- and to urge them to back the bill (HR 2315) sponsored by Rep. Ernie Fletcher (R-Ky.) and favored by Republican House leaders (Washington Post, 7/23). The Ganske-Norwood-Dingell bill is similar to the Senate-approved bill in that it would allow patients to 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, while state courts could award as much in damages as the state allows (American Health Line, 7/20). Fletcher's bill would allow patients to sue health plans in federal court for quality of care issues and non-quality of care issues, but they 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). About 68 House Republicans favor the Ganske-Dingell-Norwood bill, the Post reports. The White House also has resumed negotiations with Norwood, with whom it had been trying to "fashion a compromise." According to an administration official, liability issues are at the "heart" of their disagreement with Norwood's bill. Whether Bush will follow through on his promise to veto a bill that he doesn't like remains to be seen. The Post reports that many Republicans "doubt" Bush's "threat," but Sen. John Breaux (D-La.) said that if Bush does not follow through, "The threat of a veto becomes meaningless in the future" (Washington Post, 7/23).