House OKs Patients’ Rights Bill

House Republicans pushed through patients’ rights legislation Thursday that would carve out new protections for millions of Americans in managed health care plans but would place stricter limits on lawsuits than a Democrat-backed bill passed by the Senate.

The 226-203 House vote was a triumph for President Bush and GOP leaders, who just days ago seemed headed for political defeat on legislation that has polarized the parties but enjoys broad public support.

The House bill, like its Senate counterpart, would change the shape of health care for 190 million Americans covered by private health plans, removing barriers to care and bolstering their leverage in coverage disputes.

The measure would guarantee that patients have direct access to certain specialists, meaning a woman would no longer have to get a primary-care physician’s approval to see a gynecologist. And parents would be free to take a child directly to a pediatrician.

Insurers would be barred in most instances from second-guessing patients’ decisions on where and when to seek emergency room care, and they would be required to offer expanded coverage of clinical trials and experimental treatments for members battling breast cancer and other diseases.

The legislation also would create a system of independent medical boards to resolve disputes and greatly expand patients’ ability to sue health plans over denials or delays of treatment.

But the scope of these new legal rights was the subject of a bitter partisan fight, with Republicans closing ranks to pass a critical amendment Thursday erecting hurdles to patient lawsuits and placing strict limits on court-awarded damages.

Bush described House passage of the bill as a win for patients, a compromise that, if it becomes law, would expand their leverage in managed care plans without encouraging frivolous lawsuits that he argues would drive up health insurance premiums.

“Today’s action brings us an important step closer to ensuring that patients get the care they need and that HMOs are held accountable,” Bush said in a statement.

But House Democrats denounced the bill as stacked in favor of insurers.

“The HMO industry should have a smile on their face that would be the equivalent of the grille on a ’52 Buick,” said Rep. Marion Berry (D-Ark.).

Senate Democrats also condemned the House bill and vowed to insist on significant changes when members of the two chambers meet this fall to reconcile their differences. It remains uncertain whether a final measure will emerge that both Democrats and Bush can accept.

Kennedy Calls Vote ‘A Temporary Victory’

The GOP’s win Thursday “will be a temporary victory,” said Sen. Edward M. Kennedy (D-Mass.), a co-sponsor of the Senate bill.

Such remarks underscore how bitterly divided both sides remain over liability provisions that were the key sticking point in the patients’ rights debate.

Still, the House vote marked a turning point in the nation’s ongoing experiment with managed care, a model that has come to dominate the health care landscape largely because of its ability to contain costs by controlling access to treatment.

Health maintenance organizations have become ripe targets for reform in recent years, as their rampant growth was accompanied by rising frustration among their members. Polls show broad public backing for reform, and HMO horror stories have punctuated almost every debate on the issue in Congress for the last six years.

Thursday’s vote represents the first time that both chambers of Congress have moved so aggressively to curb HMOs’ power, even as their competing approaches leave the legislation’s long-term prospects in doubt.

The Democrat-backed bill that cleared the Senate in June would give patients a greatly expanded ability to sue HMOs, allowing unlimited pain-and-suffering damages and punitive damages up to $5 million.

The House bill, by contrast, limits damages in each of those categories to $1.5 million. It also includes other obstacles to patients’ ability to sue. The House bill goes much further, for example, in emphasizing the role of independent review panels that critics say tend to side with the industry.

If a panel rules against a patient, the patient can still sue, but courts would be required to presume that the HMO acted properly unless the patient can present “clear and convincing” evidence to the contrary. That is a stiffer standard than plaintiffs face when filing lawsuits against doctors or hospitals.

“The managed care industry will be quite pleased” with the House bill, said Peter Jacobson, associate professor at the University of Michigan School of Public Health. “This is a piece of legislation that places the kinds of limits on patient lawsuits that will prevent many of them from being filed.”

Unlike its Senate counterpart, the House bill also creates a single federal cause of action that preempts more liberal right-to-sue laws that a handful of states--including California, Texas, New Jersey and Georgia--have passed in recent years.

Experts said the House bill would have a mixed effect in California. The measure’s caps on damages would override unlimited awards currently allowed in state court. But the bill would also extend the right to sue to millions of Californians who are currently prevented from doing so under an obscure 1974 federal statute governing private health plans.

The House bill includes some health insurance tax breaks for self-employed individuals and small businesses. But like its Senate counterpart, the House bill does little overall to aid the 43 million Americans without health insurance.

The House measure also bans class-action suits and bolsters liability protections for employers who fund and administer their own health plans. Suits against such companies--which include Wal-Mart Stores Inc., Caterpillar Inc. and other large corporations--would be confined to federal court, a venue generally considered less favorable to plaintiffs than state courts.

Thursday’s vote capped a tumultuous week in the House, which begins its monthlong recess today after having handed Bush hard-fought victories not only on the patients’ bill but also on the White House energy plan.

The outcome on the patients’ bill was particularly deflating to congressional Democrats, who just days ago appeared to be in command of the issue. They had muscled the bill through the Senate on a decisive 59-36 vote and appeared poised to push their version of the legislation through the House as well.

Norwood’s Defection Stuns Democrats

Bush had repeatedly threatened to veto the Democrats’ bill but faced political peril in doing so because of its broad public support. House Republicans had tried to derail the Democrats’ measure by offering an alternative patients’ bill. But just as the two competing measures were headed for a floor showdown in late July, GOP leaders canceled a vote they acknowledged they would have lost.

The breakdown created an opening for Bush, who entered high-stakes negotiations with Rep. Charlie Norwood (R-Ga.), a former dentist who had made patients’ rights his signature issue in Congress.

Norwood had sided with Democrats on the issue for years and joined six other co-sponsors of the legislation in rejecting the White House overtures. But Norwood stunned his longtime allies Wednesday by cutting a separate deal with Bush on the liability provisions that became the basis of the GOP-backed bill.

The provisions were contained in an amendment that Norwood offered and that passed by the thinnest of margins, 218 to 213.

Norwood’s co-sponsors fumed at the betrayal. During one stretch of House debate Thursday, House members stopped to watch a scene that would have been unthinkable a few days ago: Rep. Greg Ganske, an Iowa Republican who had joined Norwood in backing the Democrat version of the bill, lashing out at Norwood’s amendment. He peppered his onetime ally with a series of pointed questions.

Norwood deflected the attack, saying he had to agree to the deal with Bush to save the legislation from the president’s threatened veto. “I did the best thing I could do. It is time to bring this gridlock to an end.”

But a short time later, Norwood broke down in an emotional speech on the floor, choking back tears as he expressed his admiration for colleagues, including Ganske and Rep. John D. Dingell (D-Mich.), that he had essentially abandoned just 24 hours earlier.

“I appreciate your efforts on behalf of patients,” he told them. “I know you’re trying to do the right thing.”

Norwood’s compromise, offered as an amendment to the bill that carried his name, passed by the thinnest of margins, 218 to 213, with Norwood’s own vote providing the winning margin.

House Republicans erupted in cheers when they reached 218 votes, the margin needed for a majority. Some GOP members began chanting, “Nor-wood, Nor-wood.”

The bill picked up additional votes on final passage, winning the support of five Democrats, 220 Republicans and one independent. Ganske voted for the bill in the end, saying he hoped for changes in negotiations with the Senate.

California’s House members voted along party lines.

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Patients’ Bill of Rights

The House and Senate now have passed their own versions of patients’ bill of rights legislation. In September, lawmakers will start trying to work out differences between the two measures to produce a final compromise.

Main Differences

House bill places $1.5 million limits on pain-and-suffering and punitive damages. Senate bill allows unlimited pain-and-suffering awards and punitive damages, up to $5 million.

House bill would allow lawsuits against health maintenance organizations under a single federal standard. Senate bill allows suits under state laws, which backers say would ensure plaintiffs more options.

House bill grants health plans legal protections when they comply with independent medical review boards.

House bill prohibits class-action suits.

House bill contains health insurance tax breaks for individuals and small businesses.

Key Similarities

Both give patients direct access to pediatricians, gynecologists and other specialists.

Both provide guaranteed coverage of emergency room visits.

Both expand patients’ rights to participate in clinical trials.

Both ban HMO-imposed “gag” rules restricting doctors’ ability to discuss treatment options with patients.

Both create independent medical review panels to resolve disputes.

Both allow patients to sue HMOs in state and federal courts over denials or delays of treatment.