House to begin debate on patients' bill of rights

TOPLINE: The House of Representatives is expected this week to take up a GOP-backed patients' bill of rights -- the one introduced last month as the Senate was passing a Democrat-backed measure President Bush has pledged to veto.

Democrats introduced their own measure back in February -- a bill similar to the one that passed the Senate -- but the Republican leadership and Bush opted to set their own timetable for the debate, keeping the Democrats' bill in committee.

The Democrats got the upper hand in the Senate last month, however, when Vermont Sen. Jim Jeffords left the GOP to become an independent. The new Democratic leadership wasted no time bringing their Senate version of the bill forward.

As in the Senate debate, the House members are likely to spar over allowing patients to sue their HMOs, and for how much.

•  Topline   •  In context   •  In agreement   •  Differences   •  Other differences   •  Key players   •  Key questions   •  Bottom line

IN CONTEXT: The bill sponsored by Kentucky Republican Ernie Fletcher will be on the House floor once it passes the House Rules Committee. Rep. John Dingell, D-Michigan, and Rep. Greg Ganske, R-Iowa, sponsor the Democratic alternative bill. Ironically, it is the same bill that Dingell, Ganske and Republican Charlie Norwood of Georgia pushed successfully in 1999, only to see their efforts thwarted when a conference committee could not reconcile the bill with one passed by the Senate.

IN AGREEMENT: Both bills would allow children to list a pediatrician as primary care physician, provide patients with access to information about their plans, and provide for expansions of medical savings accounts. The bills also run near to each other in other areas -- such as reimbursing emergency room services and allowing women to see OB-GYNs without prior authorization -- but the limitations differ.

DIFFERENCES: The key difference: the right to sue.

The Fletcher bill calls for an outside review panel of doctors -- certified by the secretary of Health and Human Services and paid for by the insurance industry -- to hear appeals from patients denied coverage by their HMOs. If the HMO refuses to abide by the panel's ruling -- and the patient is harmed -- the patient could then sue in state court, where the bill would limit non-economic damages for "pain and suffering" to $500,000; actual damages would remain unlimited except by state law.

If an insurance provider makes a decision during the course of treatment that harms a patient, the Fletcher bill would hold the insurer accountable in federal court. The same procedure of an outside review must be followed, however, and the review panel must overturn the insurer's decision. The same limits on damages would apply.

The Ganske-Dingell bill would allow more time for an appeal, calls for a review panel composed of outside parties independent of the insurance industry and would not limit damages in state court. Federal civil penalties would be capped at $5 million. The Ganske-Dingell bill would allow patients to sue an insurance company over any medical or administrative decision that results in injury or death, and would not require the review panel to overturn the insurer's decision.

The Republican leadership fears that allowing the lawsuits -- coupled with no limits on damages -- will lead to more lawsuits and higher health care costs. The Democrats disagree, and point to Texas where a 1997 patients' bill of rights -- passed when Bush was governor -- has not caused a rush on the courtroom.

Some Republicans want to bar all lawsuits -- and particularly those in state courts. The Fletcher bill, then, would appear to represent a compromise.

OTHER DIFFERENCES: Minor differences litter the landscapes of both bills. The Ganske-Dingell ban on insurance company payments to doctors for limiting the numbers of tests and referrals they recommend, and the Fletcher bill does not apply to state or local government workers. Additionally, the Ganske-Dingell bill allows class action lawsuits, while the Fletcher bill bars them.

KEY PLAYERS:

Ernie Fletcher, R-Kentucky, a physician, co-authored the bill that will reach the House floor, perhaps this week, with the backing of the House leadership and President Bush. Fletcher says his bill represents a compromise.

John Dingell, D-Michigan, has backed the patients' bill of rights since 1999 when he, Ganske and Norwood wrote the one that eventually passed the House, 275-151.

Greg Ganske, R-Iowa, is the lead Republican backing the bill that carries his name and that of Dingell. Nine other Republicans have signed the bill.

At the behest of the White House Charlie Norwood, R-Georgia, dropped his name last winter from the bill he co-wrote to give Bush the option of setting his own timetable for the debate. He remains a signer, and after a meeting with Bush's staff on Sunday, he said he could not support the Fletcher bill. Norwood said he believes a compromise can be found, however.

President Bush and his staff have been talking with GOP House members trying shore up support for the Fletcher measure. He is keenly aware of the popularity of managed care reform, but wants a bill he does not believe will benefit trial lawyers more than patients.

KEY QUESTIONS:

 •  Rep. Charlie Norwood, the Georgia Republican who has been a co-sponsor of a patients' bill of rights for several years, says the Fletcher bill doesn't have the votes to pass. Can the House leadership forge a bill that will get both the backing of the supporters of the Dingell-Ganske bill and the signature of George W. Bush?

 •  If the Fletcher bill passes the House, what will stay and what will go when House and Senate members meet in conference to merge the bills?

 •  Patients' bills of rights passed both houses of Congress in 1999, but the conference committee could not reconcile the two bills. Will this year's joint committee fare any better? And will any bill it carves out be acceptable to both houses?

 •  If the final version of the patients' bill of rights arrives on Bush's desk with most if not all of the Senate provisions he opposes in place, will he carry out his threat to veto?

BOTTOM LINE: Whatever bill passes the House will head for a House-Senate conference committee to reconcile differences between it and the version that passed the Senate last month before it goes to President Bush.

Both Democrats and Republicans are well aware that managed care reform is very popular among the American people. The key issue, as it has been throughout this debate, will come down to the right to sue insurance companies and the amount of damages patients can seek.