House GOP Leaders May Delay Patients’ Rights Vote
House Republican leaders may delay a vote on patients' rights legislation scheduled for July 26 until next week, hoping to build support for a bill backed by the White House, the Washington Times reports. House Majority Leader Dick Armey (R-Texas) said that House GOP leaders have urged President Bush to "pressure reluctant Republicans" to support a bill (HR 2315) sponsored by Rep. Ernie Fletcher (R-Ky.) (Archibald, Washington Times, 7/25). Under the bill, patients could sue health plans in federal court for quality of care issues and non-quality of care issues, but 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). Republican leaders "apparently still lack a majority" of support for the bill and hope Bush can "twist enough arms to put them over the top" (Rovner et al., CongressDaily/AM, 7/25). CNN.com reports that the Fletcher bill needs "an estimated 10-15 votes" to pass (McCaleb et al, CNN.com, 7/25). Rep. Bill Thomas (R-Calif.), who helped draft the bill, said that holding a vote this week "would be ambitious."
Behind the Scenes
A "vast majority" of House Democrats and about 12 Republicans back a rival bill (HR 2563), sponsored by Reps. Greg Ganske (R-Iowa), John Dingell (D-Mich.) and Charlie Norwood (R-Ga.), similar to legislation passed last month in the Senate, CongressDaily/AM reports (CongressDaily/AM, 7/25). The Ganske-Dingell-Norwood 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, such as those involving violations of their health plan's contract. 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, 7/19). Ganske said that he "had commitments" from "all but a few" Democrats and about 20 Republicans (Washington Times, 7/25). According to "reports," House GOP leaders have offered 10 GOP co-sponsors of Ganske-Dingell-Norwood a "major federal project" in their districts in exchange for support for the Fletcher bill, CongressDaily/AM reports (CongressDaily/AM, 7/25). On Tuesday, Fletcher held a press conference with HHS Secretary Tommy Thompson to announce that after "behind-scenes arm-twisting," Rep. Peter King (R-N.Y.), who voted for a bill similar to Ganske-Dingell-Norwood in 1999, would support the Fletcher measure (Washington Times, 7/25). Bush plans to meet with a group of 10 to 15 House Republicans today and will likely deliver a public address on the Fletcher bill sometime this week. Bush aides have met "quietly" with Norwood, which may "signal that privately, Bush is less rigidly committed" to the Fletcher bill than he has "publicly indicated" and may consider a compromise, CongressDaily/AM reports (CongressDaily/AM, 7/25).
GOP Moderates
The patients' rights debate may hinge on House GOP moderates "torn between loyalty" to President Bush and House leaders and their "socially moderate" districts, the New York Times reports. Vice President Dick Cheney met with GOP moderates this week to build support for the Fletcher bill, but Ganske said that his measure would pass "precisely because moderates pick and choose when they will take a stand." He added, "I'll tell you what -- they are not going to go home and face the voters having voted for an HMO protection bill," referring to the Fletcher measure. However, the Times reports that some GOP moderates "were agonizing" over the decision (Mitchell, New York Times, 7/25).
AMA Backs Democrats ...
In other patients' rights news, Roll Call reports that the debate over patients' rights legislation has "expanded" the "one-time rift" between Republicans and the American Medical Association into a "chasm." This year, the AMA's donations to Democrats have been larger than those to Republicans, a situation that association spokesperson Brenda Craine said "make[s] perfect sense given the support the party has shown" for the Ganske-Dingell-Norwood bill, which the AMA backs. The AMA has traditionally sided with Republicans, but as the managed care industry has grown "larger and more powerful," doctors have done "everything they can" to reverse the trend, Roll Call reports (Crabtree, Roll Call, 7/23).
... But Do AMA Members Agree?
According to a poll released yesterday by the American Association of Health Plans, AMA members "overwhelmingly said their top legislative priority was not the patients' rights bill," adding that the group's leaders "should be pursuing other priorities." The poll of 300 AMA members, conducted in June and July by Ayres, McHenry and Associates, found that 39% of respondents listed malpractice reform as their top priority, 29% selected antitrust reform and 17% chose "making HMOs and health plans subject to new lawsuits." In addition, 91% said that the AMA should "be working vigorously to include medical liability reform" in patients' rights legislation, a plan that AMA leaders have rejected "so as not to jeopardize support" for patients' rights legislation among Democrats. The poll had a 5.77 point margin of error (Rovner, CongressDaily, 7/24).
Cost of Patients' Rights?
Daniel Kessler, an associate professor at Stanford Business School, writes in a Wall Street Journal opinion piece that although patients' rights legislation will make health plans "less willing to say no" to doctors, hospitals and patients, the cost of additional care "ultimately comes out of individuals' pockets" through higher premiums and co-payments (Kessler, Wall Street Journal, 7/25). The Christian Science Monitor reports that while patients' rights opponents warn that the legislation would "prompt a surge" of lawsuits, "experience in ... states [with patients' rights laws] already suggests that patient-insurer disputes are resolved without lawsuits" (Chaddock, Christian Science Monitor, 7/25).
