DOCTORS IN THE HOUSE

October 6, 1999
		Congress begins a contentious debate over how far to go with HMO reform. After this report on the debate by NewsHour health correspondent Susan Dentzer, two U.S. Representatives and two advocates discuss the right to sue HMO's and greater access to specialists, among other issues. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

A Health Spotlight Report: Patients' Bill of Rights Oct. 6, 1999: A discussion of HMO reform legislation. Sept. 30, 1999: Patients vs. HMO's July 16, 1999: A Republican bill passes July 15, 1999: Senate votes against HMO suits. July 14, 1999: A partisan debate. July 13, 1999: Should patient's be able to sue HMO's? July 8, 1999: An Alzheimer's vaccine? Remaking Medicare June 24, 1999: Should doctors unionize? June 7, 1999: Mental Health Conference July 20, 1998: Three patients' rights bills. July 1998: Forum: Should the government manage care? July 9, 1998: Debating managed care The NewsHour's Health Spotlight. Browse the NewsHour's coverage of Health   Rep. John Dingell, (D-MI) Rep. John Shadegg, (R-AZ) National Federation of Independent Business American Medical Association	SUSAN DENTZER: For the past two years, Washington has battled over new federal protections for roughly 160 million Americans in managed care health plans. Among the controversies has been whether to guarantee patients the right of access to medical specialists -- and whether to expand patients' ability to sue their health plans for damages if they are denied needed care. SEN. TRENT LOTT, Senate Majority Leader: Work with us. You want to get something done? Let's make it happen. SUSAN DENTZER: Senate Republicans passed their version of a so-called "Patient's Bill of Rights" last July, but President Clinton called it inadequate. Today he urged the House of Representatives to do better. PRESIDENT CLINTON: Insist on a up or down vote on a bill that is comprehensive, enforceable and paid for. SUSAN DENTZER: In the House, there are four competing managed care reform plans all claiming to address the concerns of both patients and doctors fed up with many aspects of managed care. They would create a number of new federally-mandated protections for patients. For example, patients with serious medical conditions would have the right to be seen by specialists. Women would have the right to see a gynecologist for primary health care without having to get a referral from their health plan. And costly emergency care would be covered in any hospital if the treatment was for a condition that a reasonable person might consider an emergency. REP. CHARLES NORWOOD, R-GA: What we've done in this country over the last 30 years is turn over the health care industry of this country to this insurance industries, and they are in total charge.
	Four competing bills
	SUSAN DENTZER: The most popular bipartisan effort is led by Georgia Republican Charlie Norwood, a dentist, and Michigan Democrat John Dingell. What distinguishes their bill from the others is a provision that deals with a patient's right to sue a health plan and recover damages if denied access to needed care. In most instances, a quirk in existing current federal law prevents that from happening. But under the Norwood-Dingell bill, people injured as a result of a plan's denial of care would have the explicit right to sue the plan in state court and could go on to collect an unlimited amount in compensatory and punitive damages. The Norwood-Dingell bill has been endorsed by the President but denounced by both health insurers and key business groups in a costly lobbying blitz. ANNOUNCER: Congress is about to change your health insurance. And you'll pay the price. SPOKESMAN: I have got to pay more for new government regulations? I can barely afford insurance now. SUSAN DENTZER: Competing with Norwood's bill for Republican support is an alternative sponsored by Jon Shadegg of Arizona, and Tom Coburn of Oklahoma, a practicing physician. Their bill would allow patients to sue only in federal court after they had appealed the denial of care through an external review process. The Shadegg-Coburn bill would also cap the amounts that could be awarded patients for punitive damages against the health plan and for pain and suffering. REP. TOM COBURN, R-OK: We're going to find out on these votes if you really want to have a compromise piece of legislation that solves the problem of accountability, that restores choice and doesn't bankrupt the payroll of the American people who are supplying health care in this country. SUSAN DENTZER: A third bill sponsored by Lindsey Graham of South Carolina and Amo Houghton of New York would allow suits in federal court but would ban punitive damages, the issue that some members of Congress find most worrisome. And a fourth bill sponsored by Rep. John Boehner of Ohio has many of the patient protections of the others, but no provision expanding patients' rights to sue. Today the House began its work on yet another Republican bill aimed not at managed care reform, but rather at extending health coverage to some of the estimated 44 million Americans who are uninsured at any given time. REP. JAMES TALENT, (R) Missouri: These people are out there suffering; they're paying for it; we're paying for it and the illnesses that they have. We can't afford not to pass this bill. SUSAN DENTZER: Sponsored by Jim Talent of Missouri and John Shadegg, the bill would allow self-employed workers to deduct all health insurance premiums from federal taxes. It would also allow small businesses and trade associations to set up new insurance pools to obtain cheaper health coverage. REP. JOHN SHADEGG, (R) Arizona: Our legislation, the legislation that Jim Talent and I wrote, gives those people access to care. SUSAN DENTZER: But Democrats complained low-wage earners wouldn't benefit from the bill's tax breaks for health coverage. REP. XAVIER BECERRA, (D-CA): Most of these tax breaks go for those who pay income tax in large portion, so who's left out? Most of those 44 million Americans who are working poor, and therefore don't pay the substantial number of income taxes to get all of those tax breaks. SUSAN DENTZER: Nonetheless, the vote on the Republican measure aimed at broadening coverage was approved along party lines. The House immediately moved to debate managed care reform with votes scheduled for tomorrow.