House Passes Bipartisan Bill
To Overhaul Managed Care
By LAURIE MCGINLEY and SHAILAGH MURRAY
Staff Reporters of THE WALL STREET JOURNAL
WASHINGTON -- The House overwhelmingly passed a sweeping
patients-rights bill, soundly rejecting a narrower plan pushed by Republican
leaders, who sustained one of their biggest political defeats of the year.
The action marks the first time either chamber of Congress has voted to
expand the ability of injured patients to sue managed-care plans for
denying needed care. The legislation, which also requires a raft of new
protections for consumers, passed by a vote of 275-151, with 68
Republicans voting with all but two Democrats. The widespread defections
by rank-and-file Republicans underscored the extent to which the
leadership misjudged the issue's political appeal and failed to devise
an
effective way to deal with it.
Expanding the Right to Sue
How the two major House managed-care bills would permit injured
patients to sue their health plans for denied care:
Dingell-Norwood
Coburn-Shadegg
Venue
State court
Federal court
Non-Economic
Damages
No limits
Capped at $500,000
Punitive
Damages
None allowed if health plan
follows recommendations
of independent medical
review panel.
Only in cases when the
plan acts with 'flagrant
indifference' to patient's
safety. Capped at
$250,000 or twice the
economic damages.
The House vote drew cries of outrage from health-maintenance
organizations and employer groups, such as the Business Roundtable and
the National Federation of Independent Business. The two groups spent
tens of millions of dollars over the past two years to derail the various
versions of the legislation, especially the so-called right-to-sue provision.
But President Clinton, who has made the "patients' bill of rights" a priority,
said at an appearance in New York that the vote was a "major victory for
every family."
Still, the bill, sponsored by Democratic Rep. John Dingell of Michigan
and
GOP Rep. Charlie Norwood of Georgia, faces a steep climb to
enactment. It now heads to conference with the Senate, where GOP
leaders are adamantly opposed to the right-to-sue provision, as well as
the
other features of the House bill. Sizing up the likelihood of a House-Senate
compromise, Rep. Bill Thomas, a California Republican, said, "You don't
see many crossbreeds between Chihuahuas and Great Danes walking
around."
'Poison Pill'
In addition, because of the rules the House adopted for the HMO debate,
the managed-care legislation now will be automatically combined with
another bill designed to make health-care insurance more affordable and
available. That bill is considered a "poison pill" by the White House,
which
especially objects to a provision that would expand tax-favored medical
savings accounts. Such a move would help only the wealthy, says Mr.
Clinton, who has vowed to veto the bill.
Administration officials and other supporters of the Dingell-Norwood bill
say they now will try to get the House-Senate conference to adopt the
patient protections from the House, but to drop the controversial
insurance-access provisions. "It's hard, but it's doable," said Ron Pollack,
executive director of Families USA, a health-care advocacy group. He
added, though, that he doesn't expect resolution of the issue this year.
Some supporters say, moreover, that a House-Senate conference should
be skipped altogether, and that the House bill should be taken directly
to
the full Senate in an effort to capitalize on its momentum and win approval.
Whatever the strategy, supporters of the House bill are likely to meet
strong resistance from the Senate GOP leadership. In a statement issued
after the vote, Senate Assistant Majority Leader Don Nickles of
Oklahoma said he planned to try to block any legislation "that would cause
a dramatic increase in health-care costs."
Two-Year Battle
The House passage of the bill, which includes such protections as
increased access to specialists and improved coverage of emergency care,
caps a two-year, highly charged battle over patient protection. The
Dingell-Norwood bill emerged victorious in large part because of the
relentless determination of Rep. Norwood, a Republican dentist who
insists that patients be given the right to sue.
But the bill's prospects also were bolstered by the GOP leadership's
disarray in dealing with the issue. For instance, Republican leaders waited
until the last minute to offer a tepid endorsement of an alternative measure
sponsored by GOP Rep. Tom Coburn of Oklahoma and Rep. John
Shadegg, an Arizona Republican. That measure was defeated by a
238-193 vote.
House Speaker Dennis Hastert's enthusiasm for the Coburn-Shadegg
alternative may have been muted by the fact that it, too, contains a right
to
sue, though a strictly limited one. In any case, the leadership didn't
push the
Coburn-Shadegg alternative as hard as many had expected. Republican
Rep. Peter King of New York said the attitudes of GOP leaders seemed
"almost fatalistic."
The reaction to the House vote was swift and intense. Thomas Reardon,
president of the American Medical Association, which lobbied for the
Dingell-Norwood measure, said he was "ecstatic" about the vote. But the
Health Benefits Coalition, which is made up of insurers and employers,
warned, "If this legislation becomes law, it will guarantee higher health-care
costs for families and add millions more to the growing ranks of the
uninsured."