August 2000 Bulletin

House OKs negotiation bill

Senate allows limited right-to-sue HMOs

Fresh from the victory in seeing the Quality Health Care Coalition Act (H.R. 1304) approved in the U.S. House in the early morning of June 30, chief sponsor Rep.Tom Campbell (R-Calif.), said, "this bill helps doctors help their patients—nothing more, nothing less.

"Medical professionals should be allowed to provide care for their patients as they think best, and today Congress empowered them to do so."

By a vote of 276 to 136, the U.S. House approved the bill that would give independent physicians and other health care professionals the ability to negotiate collectively with insurers on fees and other contract matters without violating federal antitrust laws.

Rep. Campbell hoped the lopsided vote would provide the momentum to get similar legislation approval in the Senate. But the chances of that happening in the Senate this year were quickly doused by Sen. Trent Lott (R-Miss.), the majority leader, who said he was staunchly opposed to the legislation. At that point there was no companion bill in the Senate and time was running out on Congress before the break for the November elections.

Sen. Lott also was fresh from a Republican victory in the Senate. On June 29, the Senate Republican majority approved an amendment to an appropriations bill, allowing limited patient projections, including a restricted right to sue HMOs. Although it differed from a Senate bill approved in 1999 that barred lawsuits, it was a victory for Republicans in that it held off Democrats’ efforts to approve a broader proposal and gave Republicans something to tell voters before the November elections.

The amendment reflects agreements reached among Republican members of the Managed Care Conference Committee. Sen. Don Nickles, (R-Okla.), committee chairman, called it a major concession.

The provision, approved by a vote of 57 to 47, allows patients the right to file a lawsuit in federal court against HMOs that improperly denied care, as determined by an independent reviewer, if the plan fails to abide by the decision. Patients could seek unlimited economic damages and up to $350,000 in compensatory damages. Punitive damages and class action suits would be barred. The provision would exempt employers from liability.

The amendment also includes several guarantees, including access to emergency room care, to out-of-network physicians and to specialists for an estimated 56 million insured individuals. Democrats pushed a proposal requiring that any protection apply to all Americans with insurance, but the proposal was rejected by a vote of 57 to 47.

Meanwhile, efforts to merge House and Senate patient protection bills approved last year, were still in limbo, as the Bulletin was being printed. A sticking point is a right to sue managed care organizations.

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