Contact Your Senators: The Patients' Bill of Rights Could Come to the Senate Floor in June

(June 8, 2001)

The patients' rights legislation could be the first order of business that the Democrats put forward in the "new" Senate, after pending matters such as education and taxes are finished. It could be on the Senate floor by mid-June. Now's the time to generate calls and letters to your Senators.

We support S. 283, the "Bipartisan Patient Protection Act of 2001," also called the McCain-Edwards-Kennedy bill. It is a strong and comprehensive bill, like the Norwood-Dingell bill that passed the House in October 1999. There are 56 votes in support of the bill, but the Republican leadership and the White House are opposed. We don't know how their opposition might sway some of the bill's Republican supporters.

Another factor that may diminish support for strong patients' rights is the recent introduction of a managed care bill by Senators Breaux (D-LA) and Frist (R-TN) that we find unacceptable. It has an extremely scaled down liability provision, as well as a provision that allows states to undercut the federal patients' rights floor by opting out of the federal law if they can say that their state law is "consistent" with the federal law.

Therefore, we need communications to Senators to shore up Democrats and to reach Republicans open to a strong patients' rights bill. Support S. 283, the Bipartisan Patient Protection Act of 2001!

The McCain-Edwards-Kennedy/Ganske-Dingell bill (S. 283/H.R. 526) is the only bill that delivers the strong, comprehensive, and enforceable patient protections that Americans need. This bill is the one that meets every key principle for managed care reform:

• Applies a uniform federal floor of protections to all Americans with private health insurance, allowing states to enact more protective standards. McCain/Ganske establishes a set of uniform federal standards applicable to all private health insurance, including private-sector group plans, individual health plans, and state or local government plans.
  
• Ensures patients recourse to a speedy and genuinely independent external review process when care is denied. McCain/Ganske creates a timely and independent external review that assures individuals a fair and unbiased decision. Neither party can select the external review entity and neither can unilaterally delay the review process by withholding information. Reviewers are free to make an independent determination about whether care is needed and are not bound by plan decisions or policies. And patients have legal recourse if the plan does not comply with the decision of the external review entity.
  
• Allows patients to hold their managed care plan accountable when plan decisions to withhold or limit care result in injury or death. McCain/Ganske allows patients to take their case to a court of law and seek redress for any wrong that causes an injury. The bill preserves existing state liability for medical harm and creates new meaningful federal accountability for administrative decisions, with no caps on damages and a civil penalty of up to $5 million to deter violations.
  
• Provides strong, comprehensive patient protections. McCain/Ganske assures patients the full range of needed patient protections, without loopholes or other provisions that weaken these protections or allow some health plans to opt out.

In comparison, the Frist-Breaux-Jeffords bill (S. 889) falls short of the strong
protections Americans need, failing to meet certain key principles:

• Fails to assure uniform federal floor of protections for all Americans. The Frist-Breaux-Jeffords bill creates a new complex patchwork of federal and state regulation that undermines a uniform standard of protection. Weaker state standards could be substituted for most of the new federal protections and health plans would be permitted to challenge any state protections they argued conflicted with the federal law. State and local government plans that are self-insured are left out altogether.
  
• Undermines independent external review, with a process that helps insurers, not patients. Frist-Breaux-Jeffords undermines the independence of external review and allows plans too much control over the review process, including the right to select the external reviewer and to delay a decision indefinitely by withholding needed information. The review process includes too many barriers designed to keep patients out, including a timeframe for appeal that is too short and a filing fee two times the cost of the fee under the McCain/Ganske bill.
  
• No meaningful accountability for managed care wrongs. Frist-Breaux-Jeffords creates a very narrow federal remedy, which provides little real redress to those harmed by a health plan's decision. Patients would be barred from court based on the decisions of the external reviewer, a nonjudicial body subject to none of the court rules designed to ensure fairness. The bill inappropriately federalizes state issues, forcing medical malpractice cases involving health plans into federal court and rolling back current legal precedent which allows for cases involving medical decisions to be heard in state court. Non-economic damages are capped at $500,000 and no punitive damages are available to deter bad decisions.
  
• Fails to guarantee strong, comprehensive patient protections. Frist-Breaux-Jeffords leaves out several important protections altogether, including protections for patient advocacy by health care professionals, a ban on physician financial incentives, and standards for prompt payment and utilization review of health care claims. Other protections are substantially weakened or include serious loopholes, leaving the bill without a guarantee of strong patient protections.

General Assembly Notes:

The 211th General Assembly (1999) approved health care guidelines for congregations, middle governing bodies and GA entities. Their report directs the Washington Office to advocate for a rational, just health care system available to the entire U.S. population (See Minutes, 1991, Part I, p. 817). Until such a plan is adopted, the Washington Office is directed to advocate on behalf of the uninsured, underinsured, and other vulnerable populations. Also reaffirmed is the need for a health care system that provides physical and mental care that is adequate, affordable and accountable.