|Patients' Rights Bill: This May Sting|
In an atmosphere politically-charged by the recent shift in control to the Democratic party, the U.S. Senate today begins work a Democratic-backed patients' rights -- HMO reform bill. With so many political wounds still fresh, debate on this major health care issue promises to be anything but "healing."
While only one bill is officially before the Senate, two are really in play. The Democratic-backed bill officially being debated, S. 1052, is sponsored by Senators Edward Kennedy (D-Mass.) and John McCain (R-Arizona). President Bush is opposed to the Kennedy-McCain bill and has stated he will veto it. President Bush favors the Republican alternative bill, S. 889, sponsored by Senators Bill Frist (R-Tenn.) and John Breaux (D-Louisiana). [See: Bush on Patients' Rights]
Over the course of the debate on the Kennedy-McCain bill, opponents will attempt to amend it with major provisions from the Frist-Breaux bill. "There will be combat on the floor," Sen. Frist told reporters earlier this week. Frist, however, still holds out hope for a peaceful bi-partisan agreement "The mood is different this year. Everybody wants a bill," he said.
Question is, what parts of which bill does everybody want? Here are some comparison of major provisions of the bills:
Right to Sue HMOs and Insurers
Both bills afford patients the right to sue health plan providers for treatment or misconduct resulting in injury or death.
Kennedy-McCain: Patients who could clearly "demonstrate" harm would be allowed to bypass all independent medical review and mediation process and file suit directly in either state or federal court. Awards for pain-and-suffering would have no limit in federal courts, but awards for "willful and wanton" misconduct could not exceed $5 million.
Frist-Breaux: Patients could sue only in federal courts and only after exhausting available avenues of independent medical review and mediation. Awards for pain-and-suffering and other non-economic damages would be limited to $500,000.
Who is Covered?
Kennedy-McCain:All persons with group health insurance coverage and individual health insurance are covered by most provisions. Applies to state and local government sponsored plans and church plans. About 190 million people would be covered under the bill.
Frist-Breaux: All persons with group health insurance coverage and individual health insurance are covered by most provisions. Does not cover persons in self-insured state and local government health plans. Covers about 170 million people.
Both bills require coverage for an inpatient hospital stay for a period of time determined medically necessary by the providing doctor for a patient following a mastectomy, lumpectomy or lymph node dissection for the treatment of breast cancer.
Kennedy-McCain: Plans must allow patients who have been diagnosed with cancer to visit and appropriately qualified physician for a second opinion.
Frist-Breaux: Contains no such provision.
Patients' Medical Information
Both bills Require plans to provide information to participants regarding plan benefits, cost-sharing, access to physicians, preauthorization procedures, service, emergency care, clinical trials, grievance and appeals process and provider compensation methods. Upon request plans must provide qualifications of providers and facilities; external appeals and the drug formulary.
Kennedy-McCain: For significant changes in the plan, beneficiaries must be notified in advance of the effective date of the change. Plans are given the flexibility to disclose information electronically, when appropriate
Frist-Breaux: Requires Secretary of HHS to conduct a study with the Institute of Medicine (IOM) regarding health care professionals available to patients and barriers to sharing information among professionals and recommendations for the disclosure on health care professionals.
Here are links to both bills as published on the Library of Congress' Thomas Legislative Information System: