TAKING IT TO COURT

July 13, 1999
		Senators continue debate over patients' rights, including whether patients should be able to sue their HMO's. Margaret Warner talks with Chip Kahn of the Health Insurance Association of America and Connie Barron of the Texas Medical Association about a patient's bill of rights and the liability issue. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

A Health Spotlight Report: Patients' Bill of Rights July 13, 1999: A discussion on patients' rights. 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   Health Insurance Association of America Texas Medical Association The Democrats' 'Patients' Bill of Rights Families USA The Business Roundtable	KWAME HOLMAN: Before heading off to Florida this morning, President Clinton hosted a rally on the sun-drenched lawn of the White House, in support of Senate Democrats' version of a patients' bill of rights. But it was Minority Leader Tom Daschle who spoke first. He and Senator Edward Kennedy of Massachusetts are co-sponsors of the Democrats' plan, and Daschle used the opportunity to launch a rapid side-by-side comparison with the Republicans' proposal.
	Differences in the two bills
	SEN. TOM DASCHLE: Our bill is a real plan; theirs is a placebo. Our bill covers every American with private health insurance; their bill leaves out 100 million Americans. Our bill lets doctors make decisions about medical treatment; their bill lets insurance company accountants call all the shots. Our bill guarantees that you see the opportunity for qualified medical specialists whenever you may need them; their bill doesn't. If your HMO refuses to pay for care your doctor says you need, our bill allows you to appeal that decision, to appeal that decision to an independent review board. Their bill contains an appeal process, too, but they let your HMO decide what you can appeal and hand-pick the people who make the decisions. KWAME HOLMAN: President Clinton, whose own health care initiatives were smothered by Republican criticism five years ago, urged Senators from both parties to work toward a bipartisan solution. PRESIDENT CLINTON: This is not complicated, this is not rocket science, and it is very real for the American people out there who feel that they have lost control of their ability to have a secure relationship with their health care providers. And I'm telling you, there is no excuse for not passing it. I hope the Congress will pass this. The Senate has got to lead the way. And I thank those members who are here with us today for fighting for all the American people. This is an American issue, not a partisan issue, and it ought to be that way when the votes are counted. Thank you very much. KWAME HOLMAN: Meanwhile, on the Senate floor, day two of debate on the issue was under way. Tennessee Republican Bill Frist, a noted heart surgeon himself, agreed managed care reform is needed, but said it should be weighed against the potential cost of higher health care premiums. SEN. BILL FRIST: Let me be very brief, because this cost issue is important. And again, I want to come back and say that this patient bill of rights is critical for us to come in and return the balance between physicians and patients and managed care, and I think managed care has gone too far, we need to absolutely make sure that patients are empowered and physicians are empowered so that the very best care is given to that patient. But it means that we have to be very careful in this body not to drive the cost just sky-high through the roof. Why? Because all of the information, all of the data presented to us say that if we make these premiums skyrocket, people are going to lose their insurance. KWAME HOLMAN: Texas Republican Phil Gramm added numbers to Dr. Frist's concern. SEN. PHIL GRAMM: The Congressional Budget Office has concluded that the Kennedy bill would drive up health care cost by 6.1 percent. And what that means is two things: one, 1.8 million Americans would lose their health insurance. Now, let me convert that into something people can understand. That would mean that in breast exams, 188,595 American women would lose breast exams that they would have under current law because Senator Kennedy's bill would drive up health insurance costs so much that 1.8 million people would lose their health insurance. Under the Kennedy bill, there would be 52,973 fewer mammograms. And why? Is Senator Kennedy against mammograms? Of course he's not. But the point is, that his bill, by driving up costs, by hiring all of these bureaucrats and all of these lawyers, where 60 percent of what comes out of these lawsuits goes to lawyers and not to people who have been damaged or hurt or sick-- by imposing those new costs, 52,973 women per year would lose mammograms that they're getting funded today under their health insurance policies.
	Moving through amendments
	KWAME HOLMAN: With the main differences between the partisan positions clearly established, the Senate began moving through the first of a dozen or so expected amendments, each dealing with a specific area of managed care reform. In the first vote this afternoon, Democrats brought up an amendment that would allow an obstetrician-gynecologist to serve as a woman's primary doctor in a managed care plan. It also would allow coverage of longer hospital stays after mastectomies and other breast cancer surgeries. Republicans said they supported the ideas in general, but differed with some of the language. They defeated the amendment, promising to bring their own version to the floor. Democrats also proposed requiring managed care plans to provide full coverage of emergency care for all, including some post-ER services. SEN. BARBARA MIKULSKI, (D) Maryland: When it comes to emergency care, people are afraid of both the symptoms that they face as well as the fear of being denied coverage by their insurance company. ER is not just a TV show. It is a real life situation that thousands and thousands of Americans turn to every day. Yet I hear countless stories from friends and neighbors and constituents, as well as talking to ER docs in my own state, that tell me they're afraid to see their doctor or take their child or parent to the emergency room because they will not be reimbursed and will be saddled with debt. KWAME HOLMAN: Arkansas Republican Tim Hutchinson argued reform language in the Republican bill addresses most of those Democratic concerns, but properly excludes the Democrats' definition of post-emergency room care. SEN. TIM HUTCHINSON, (R) Arkansas: Under this definition, a plan could conceivably be required to pay for services provided by a non-participating provider, which are completely unrelated to the emergency condition that the patient was treated for. To go in for one particular emergency and while you're in that post stabilization period you say, by the way, I also have a problem here and here, can you deal with that? And then require the plan to cover it. That would be a -- I think -- a very serious mistake. KWAME HOLMAN: But Florida Democrat Bob Graham challenged the assertion that patients are likely to abuse a right to follow-up services. SEN. BOB GRAHAM, (D) Florida: What the current law for Medicare requires and what this would require is that the emergency room call the HMO and request the HMO's authorization as to what treatment to provide in a post-stabilization environment. It is only when the HMO is unresponsive, in the case of Medicare within one hour if they have failed to respond, then the emergency room has the right to do what it thinks is medically necessary for the patient. Now, did the committee hear any testimony that there had been major abuses under the Medicare one-hour respond to call standard? SEN. TIM HUTCHINSON: I would say to the Senator from Florida that, in fact, there are abuses. SEN. BOB GRAHAM: I believe it would be responsible if the opponents of this amendment would put into evidence before the full Senate and American people what those abuses have been - SEN. TIM HUTCHINSON: I'd simply say that if there are no abuses, there certainly should be no concern about clarifying language to ensure that, in fact, this post-stabilization treatment is related to the emergency event. KWAME HOLMAN: The Senate is scheduled to debate and vote on amendments to the patients' bill of rights for the next two days.