MANAGED CARE September 1998. ©1998 Stezzi Communications
When Congress returns this month, the topic of patient rights will be simmering on the front burner. Before adjourning for its summer recess, the House passed the GOP-backed Patient Protection Act on virtually a straight party-line vote, 216–210. President Clinton vowed to veto the Republican measure in its current form. Unable to reach agreement on how many amendments both sides could offer, the Senate delayed consideration of the bill until Congress comes back.
The American College of Emergency Physicians came out against the bill because its guidelines for emergency care coverage — the prudent layperson standard — was "too restrictive." The American Association of Health Plans, which opposes government mandates of any size, shape or color, does not like any of the versions of patient rights legislation floating around Washington.
The key difference between the Senate GOP bill and the Democrats' proposal is health plan liability. The Democrats — with the vocal support of President Clinton — say patients unequivocally should have the right to sue plans. Republicans, on the other hand, would allow patients to appeal denials of coverage to a panel of experts, but not permit them to take HMOs to court.
So what do Beltway insiders think will happen when Congress returns? It's anyone's guess. Consider these comments from Chip Kahn, chief operating officer and president-designate for the Health Insurance Association of America — and oft-described ultimate Washington health care insider: "I can see legislation passing the House and Senate, with Speaker Newt Gingrich and Senate Majority Leader Trent Lott — along with President Clinton — agreeing on a compromise bill, as happened with welfare, immigration and the Balanced Budget Act. I also can see a bill sputtering to a halt in a quagmire in the Senate, like what happened with tobacco."
And, Kahn said, in his opinion, both scenarios are equally likely. The outcome is not much different from what many pundits foresaw at the beginning of the year: a battle royal until Congress adjourns for Election Day.