Patient-rights measure wins House approval; Bipartisan bill provides protections to clients of HMOs; Right to sue in state courts; Far-reaching terms stand little chance in hostile Senate


WASHINGTON -- Responding to rising frustration with managed health care, the House voted overwhelmingly yesterday to grant patients sweeping new protections against denial of treatment -- including a right to sue.

The 275-151 vote, in favor of a bipartisan proposal sponsored by Reps. Charlie Norwood, a Georgia Republican, and John D. Dingell, a Michigan Democrat, was also a sharp slap at the Republican leadership.

The leaders had backed a weaker bill but preferred none at all, and they set up procedural hurdles in hopes that no managed care bill would pass.

Instead, the House, with 68 members of the Republican majority joining 206 Democrats and one independent, put its stamp on the broadest effort so far to impose federal regulations on managed care health plans.

In recent years, these plans have assumed an increasingly dominant role in health insurance.

It is far from clear, however, that the measure approved yesterday will become law. The House bill would impose much tighter regulations on insurers than would a Senate measure passed in July, and the two versions would have to be reconciled into one bill.

"What we're doing today, we're doing for America," Norwood said, choking back tears as he likened the effort to the nearly dozen assaults on Hamburger Hill by U.S. soldiers during the Vietnam War, in which Norwood served as an Army dentist.

"It's all been said, and it's all been done. What we need to do is mount the top of Hamburger Hill."

Opponents warned that the legislation was so sweeping as to be dangerous. They argued that it would expose insurance companies and employers to the kinds of malpractice lawsuits that have driven up costs for doctors.

The result, these opponents contended, would be sharply higher insurance premiums that would leave more Americans without health care coverage.

"Do we really want to take a chance that millions of Americans are going to lose their insurance?" asked Rep. John A. Boehner, an Ohio Republican.

Arguing that a new right to sue HMOs would mostly clog the courts and enrich trial lawyers, House Speaker Dennis Hastert added: "We're trying to get people into hospital rooms and doctors' offices, and not necessarily into law offices and courtrooms before they can get that treatment."

The House bill would guarantee HMO patients greater access to specialists and to emergency care and restore to doctors more control over treatment decisions.

To enforce those guarantees, the bill sets up a process for an outside review of disputed decisions by insurance companies.

The most striking change would allow aggrieved patients to sue in state courts for damages if they believe they have been harmed by a denial of care and are unsatisfied by the review process.

At present, employees who receive health insurance through companies that operate in more than one state have no guaranteed protections against denial of treatment, even by measures adopted at the state level.

This group includes about 2.5 million Marylanders who would gain new rights under the legislation approved by the House.

All four Maryland Democrats and two of the four Maryland Republicans voted in favor of the bill.

The two who voted against it were Reps. Robert L. Ehrlich Jr. of Baltimore County and Roscoe G. Bartlett of Western Maryland, both of whom supported less far-reaching alternatives.

President Clinton congratulated members of both parties who had joined in the bipartisan coalition -- led in part by House members who are doctors -- to push the legislation through.

"This is a major victory for every family," Clinton said. "It shows that America is no longer willing to allow unfeeling practices of health plans to add to the pain and misery of disease."

Given the hostility of the Republican leadership toward the bill, the legislation faces a rough path to enactment.

The next step is the appointment of a conference committee to iron out differences between the House version and the much more narrow version approved by the Senate.

Most notably, the Senate version does not grant a new right to sue HMOs.

Senate Majority Leader Trent Lott said last night that he was disappointed by the House vote. He also noted that Congress might not have time to work out the differences and approve a final bill before it adjourns for the year.

The Republican target for adjournment is Oct. 29.

Meanwhile, House Majority Whip Tom DeLay suggested that the Republican-dominated House conferees would not fight vigorously for the House-approved measure in the conference committee.

"Remember who controls the conference: the speaker of the House," DeLay said.

Hastert has long been involved in health care issues. But he failed to assume a major role in the managed care debate until near the end -- only to see his approach defeated.

The speaker was forced to schedule a vote on the legislation after a coalition of Democrats and mostly moderate Republicans invoked an unusual parliamentary maneuver.

With Republicans sharply divided, Hastert first endorsed a bill similar to the Senate's, with no right to sue.

Once it became clear that that measure would fail, the speaker said he would support an alternative that would let managed care patients sue HMOs, but only in federal court, where the size of damage awards could be limited by Congress.

"We all agree that there needs to be changes," said Rep. Tom Coburn, an Oklahoma Republican. Coburn, an obstetrician, wrote much of the Norwood-Dingell bill but offered a weaker measure as a safer alternative. "What we don't agree on is, what are the risks of going too far?"

The Coburn proposal failed, 238-193. At that point, many Republicans, including Coburn, defied pressure from their leaders and voted for the more far-reaching legislation.

"They've been rolled," Sen. Edward M. Kennedy, a Massachusetts Democrat, said of the House Republican leadership. "It's the most dramatic reversal we've seen in recent times."

Kennedy said he thought the success of the House vote was the result of a groundswell in support of the measure that has built in the months since the Senate acted. Special interests on both sides of the issue have spent millions of dollars on advertising and lobbying campaigns.

Republican leaders did succeed with another tactic that could be a serious impediment to final enactment of the measure. They attached to the patient protection bill a package of tax breaks for the purchase of health insurance -- tax breaks that Clinton and most Democrats opposed because no budgetary provision was made to compensate for the lost revenue.

Clinton warned the Republican leaders to "resist the urge to weaken the patient protections" during the House-Senate negotiations and not to "undo behind closed doors what has been done in public."

Pub Date: 10/08/99

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