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AMA on patient protection bill
http://www.ama-assn.org/sci-pubs/amnews/pick_99/gvl10802.htm
> [AMNews] [American Medical News]
Government & Medicine
Focus shifts to House on patient protection bill
> Medical necessity and health plan liability remain the
most contentious issues in the House. Medical and
consumer groups want a stronger bill than the Senate's.
> By Geri Aston, AMNews staff. Aug. 2, 1999.
> Washington -- Medical and consumer groups are pinning
>their hopes for strong patient protection legislation on
> the House, following the Senate's passage last month of a
> scaled-back Republican measure they criticize as window
> dressing.
>
> But they face the same powerful foes they squared off
> against in the Senate debate: the insurance and managed
> care lobbies.
>
> The final outcome will have a major impact on physician
> practices.
> The most contentious items, medical necessity and health
> plan liability, are the ones that hit doctors closest to
> home, according to Robert Blendon, ScD, health policy and
> political analysis professor at Harvard University.
>
> "What is fundamentally at stake is the autonomy of
> physician decision-making," he said.
>
> The debate "is the top issue for patients and medicine,"
> said AMA President Thomas R. Reardon, MD.
>
> Disappointed in the Senate vote for approving what it
> views as a "sham" bill, the AMA is lobbying for a tougher
> House measure.
>
> "It's going to take the House of Representatives to
> repair the damage and put patients back into the
> patients' bill of rights," said AMA Chair D. Ted Lewers,
> MD.
>
> The hope is that a stronger House bill would carry the
> day in negotiations between the House and Senate on their
> competing measures when differences in the bills are
> negotiated.
>
> Among the areas in the Senate bill that need fixing,
> according to medical and consumer groups, is the external
> appeals provisions.
>
> The Republican bill would limit reviewers' examinations
> to a determination of whether a plan met its own rules --
> in effect gutting the reason for independent appeals,
> said Judy Waxman, director of government affairs for the
> consumer group Families USA. The bill would preempt
> appeals laws in about 25 states.
>
> Other criticisms of the Senate bill are that it:
>
> * Fails to guarantee that physicians, rather than
> plans, make medical necessity determinations.
> * Doesn't give patients enrolled in employment-based
> insurance the right to sue their plans.
> * Primarily covers only the 48 million people in
> employer-sponsored plans that aren't subject to
> state insurance laws. The external appeals language
> would be an exception to this provision.
>
> On the other side of the debate, the insurance and
> business industries argue that the provisions doctor and
> consumer groups support would drive up costs, increase
> the rolls of uninsured Americans and unnecessarily
> duplicate state HMO reform efforts.
>
> In fact, many of these groups also oppose the GOP
> leadership bills because they believe that the market,
> not the government, should solve the crisis of confidence
> in managed care.
>
> "We're pleased with the Senate's courageous votes on
> liability and medical necessity," said Neil Trautwein,
> health care lobbyist for the National Assn. of
> Manufacturers. "But we're not going to cheer Senate
> passage of a bill that would add costs to the system."
>
> The insurance and business communities' message seemed to
> resonate with GOP senators, who repeatedly said they
> offered a more limited package to avoid encouraging
> costly litigation, increasing insurance prices and
> boosting the number of uninsured.
>
> The Senate GOP leadership decided it was more concerned
> with the worries of business and insurance than those of
> the general electorate as it looks ahead to the 2000
> elections, Dr. Blendon of Harvard said.
>
> Their goal was to appear as if they support reform on
> some of the more emotional issues for the general public,
> such as postmastectomy hospital stay lengths and
> emergency department coverage, and then hope that managed
> care doesn't become a major issue in 2000, he said.
>
> "They've moderately immunized themselves," he said,
> adding that he expects a similar outcome in the House.
>
> House legislative agenda unclear
>
> But things are more complicated there. At AMNews
> deadline, the GOP leadership had said that it would like
> a floor vote before the August recess, but it hadn't
> decided which bill it would offer or which committee it
> would come through.
>
> Several competing measures are in play: The GOP
> leadership bill that passed last year, a package of eight
> bills assembled by a group of Republicans led by Rep.
> John Boehner (Ohio), a compromise package offered by
> several GOP physician-lawmakers and the Democrats'
> measure.
>
> One of the biggest wild cards in the House is the handful
> of GOP doctors and their supporters who are pushing a
> measure closer to the Democrats' bill than the GOP
> leadership is comfortable with. Those lawmakers, led
> primarily by Rep. Charles Norwood, DDS (Ga.), have
> criticized the Senate bill as coming up short on patient
> protection and vowed to fight passage of similar
> legislation in the House.
>
> Dr. Norwood voted for the leadership bill last year but
> seems determined to hold out this year. He views last
> year's House action as "a big mistake," said his
> spokesman John Stone.
>
> The slim Republican margin in the House could mean that
> the leadership has to make a deal with Dr. Norwood or
> face losing on the issue in committee or on the floor,
> Waxman said.
>
> The AMA views Dr. Norwood's package as the "best
> opportunity to get bipartisan support," Dr. Reardon said.
>
> But common ground in the House has proved elusive so far
> this year.
>
> The GOP leadership continues to oppose health plan
> liability, a provision that Norwood supporters consider
> essential.
>
> "We don't want to have some trial lawyer bonanza," said
> Pete Jeffries, spokesman for House Speaker J. Dennis
> Hastert (R, Ill.).
>
> Last year's House vote was dominated by partisanship, and
> that hasn't abated yet. Earlier this year, the Boehner
> package of bills passed on party-line votes out of a
> subcommittee of the Education and the Workforce
> Committee.
>
> And Hastert already has accused Democrats of not wanting
> a bill but an election issue to win back the House next
> year.
>
> "The political situation has just gotten so poisoned that
> it's hard for people to find compromise," Harvard's Dr.
> Blendon said.
>
> If no compromise is found and the Republican leadership
> prevails, President Clinton has promised a veto.
>
> Still, failure to pass legislation would not kill the
> patient protection drive, Dr. Blendon predicted.
>
> The AMA will not give up, Dr. Reardon said. "We've been
> at this five years, and we're not going away. We will not
> stop until we have a strong patients' bill of rights."
>
> The sticking points
>
> As the debate over a federal patient protection bill
> moves from the Senate to the House, these controversial
> issues -- and the arguments for and against them --
> remain.
>
> Liability
> Pro: Supporters believe that patients with
> employer-sponsored coverage should be able to sue their
> health plans when they believe they've been denied a
> necessary covered benefit.
> Con: Detractors argue that any liability provision would
> increase costs, force small businesses to drop insurance
> out of fear of lawsuits, and boost the number of
> uninsured Americans.
>
> Medical necessity
> Pro: Supporters argue that medical necessity should be
> decided by physicians, rather than health plans, based on
> generally accepted principles of professional medical
> practice.
> Con: Detractors say that this would hinder plans' ability
> to control quality and would promote continued wide and
> sometimes dangerous variation in physician practices
> across the country.
>
> Uniform protections
> Pro: Supporters believe that the same protections should
> apply to all Americans, regardless of their health plan
> type.
> Con: Detractors argue that most of the federal
> protections should apply only to people with
> employer-sponsored insurance that is exempt from state
> insurance laws.