A PATIENT'S BILL OF RIGHTS A Patient's Bill of Rights was first adopted by the American Hospital Association in 1973. This revision was approved by the AHA Board of Trustees on October 21, 1992.Click here

Senate Democrats Back Opening HMOs to Suits

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By Charles Babington
washingtonpost.com staff writer
Wednesday, June 6, 2001; 12:50 PM


Latest in a series on how the new Senate leadership might affect key legislative issues.

The dramatic growth of health maintenance organizations (HMOs) has prompted calls to give patients a stronger voice in decisions about which medical procedures will be covered by insurance. The Senate's new Democratic leaders plan this month to take up the "patients' bill of rights" issue. Here's a brief primer.

Q. What proposals will the Senate debate?

A. One of two rival bills, SB 872, is sponsored by Sens. John McCain (R-Ariz.), Edward Kennedy (D-Mass.) and John Edwards (D-N.C.). The other, SB 889, is sponsored by Sens. Bill Frist (R-Tenn.), John Breaux (D-La.) and Jim Jeffords (I-Vt.). Bush opposes the first bill and supports the second, but acknowledges that the House would insist on changes.

Q. Are the bills alike in any ways?

A. Yes. Both would guarantee patients access to emergency and specialty care; permit them to appeal the decisions of health maintenance organizations; and prohibit so-called gag clauses, which limit communications between patients and medical providers.

Q. How do the bills differ?

A. The McCain-Edwards-Kennedy bill would allow unlimited economic damages against HMOs in federal courts, and civil judgments up to $5 million for non-economic "pain and suffering." Patients could sue in state or federal courts, and states would set their own liability caps.

The Frist-Breaux-Jeffords bill would allow lawsuits only in federal courts. It would not limit economic damages, but it would cap non-economic awards at $500,000.

Q. How does Democratic control of the Senate affect the debate?

A. The new Senate leadership team backs the McCain-Kennedy-Edwards measure, which should help its chances on the floor. Despite Bush's veto threats, Kennedy recently told the Boston Globe, "I'd bet you lunch he'll sign it" if Democrats can get it to his desk.

Q. Is there a strong likelihood the Senate will amend one of the bills and try to pass it as a compromise?

A. Yes. For example, some senators may try to amend the McCain-Kennedy-Edwards bill to give employers more protection from lawsuits. That might dampen opposition from groups such as the Chamber of Commerce. Industry groups may seek further changes, such as tax credits to help cover workers now uninsured.

Q. Do major employers and insurance groups like either bill?

A. No. These groups say either measure would open the door to dubious lawsuits and possibly huge jury awards, driving up the cost of health coverage. In a May 23 letter to the White House and congressional leaders, 14 business groups, including the U.S. Chamber of Commerce, said both Senate bills would "allow new lawsuits that will increase health care costs and could force more employees into the ranks of America's 43 million uninsured."

Q. Do independent studies support such claims?

A. Not entirely. A recent analysis of the McCain-Kennedy-Edwards bill by the Congressional Budget Office said the measure would increase premiums in employer-sponsored plans by an average of 4.2 percent. The CBO has not analyzed the Frist-Breaux-Jeffords proposal.

Q. What do medical groups say about the bills?

A. The American Medical Association endorses the McCain-Kennedy-Edwards plan. Several smaller, more specialized medical groups have endorsed both measures.

The AMA says the Frist-Breaux-Jeffords bill would override state laws allowing patients to sue their health insurers, and would allow insurers to substitute non-physicians for doctors when a patient needs specialized treatment.

Q. How do supporters of Frist-Breax-Jeffords respond?

A. They say current federal law already makes it difficult to sue HMOs in state courts. Their bill, they say, would let patients see physician specialists when medically necessary. Frist recently said that with the AMA and trial lawyers opposing his bill, "we're right in the middle and probably where we want to be.''

Q. Has President Bush threatened to veto the McCain-Kennedy-Edwards bill?

A. Essentially, yes. On May 31, White House press secretary Ari Fleischer said sending the bill to Bush's desk would be "an exercise that is akin to spinning wheels."

Q. Does that mean the Frist-Breax-Jeffords bill has a better chance of becoming law?

A. Not necessarily. It faces stiff opposition in the House, where a key player Rep. Charlie Norwood (R-Ga.) says he will "personally exhaust every effort" to defeat the measure. He says the bill favors insurance companies at the expense of patients.


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