The Patients' Bill of Rights

April 21, 1999

ISSUE:

The Senate Health, Education, Labor, and Pensions Committee recently approved a version of the Republican leadership's managed care reform bill; it was 10-8 party line vote. Committee Chair, Sen. James Jeffords' (R-Vt.) used his version of the Senate Patients' Bill of Rights Plus (S. 326) which was basically the same as the Senate Republican leadership bill (S. 300) but without medical saving accounts and other tax provisions. A major weakness of this bill is that with the exception of the external review provision it covers only those in self-insured health plans, so it does not affect more than 100 million Americans. In addition, its provisions are weak and have few enforcement mechanisms.

ACTION:

Contact your Senator and let him/her know how you feel about his/her vote. If your Senator voted for strong protections, call or write to thank them. If your Senator voted against strong protections, let him or her know that you are disappointed and hope that he/she will vote for a managed care bill that has real protections in it when the bill comes to the floor of the Senate.

You can reach your lawmakers by calling the U.S. Capitol switchboard at (202) 224-3121. If you prefer to write, send as soon as possible to:

Honorable___________
U.S. Senate
Washington, DC 20510

BACKGROUND:

Supporters of strong, comprehensive protections introduced the Patients' Bill of Rights Act (S.6), and the Republican leadership countered with (S.300). [For more information on the major bills check with Families USA at www.familiesusa.org/managedcare+u.]

This year, the Republican leadership promised that managed care legislation would go through the committee process rather than straight to the floor as happened last year. On the Senate side, the Finance Committee made a successful bid to share jurisdiction over managed care issues with the Health, Education, Labor, and Pensions Committee, which has marked up S.326. During the markup of the bill, the committee rejected a series of Democratic amendments that would have strengthened the bill. The Committee Republicans did add measures prompted from the President and other Democratic leaders. Language was included to give patients access to specialty care and prescription drugs not normally covered by a plan and to protect patients from extra charges if they go to a non-network hospital for emergency care. The prescription drug amendment by Sen. Collins (R-Maine) was approved unanimously. The only Democratic amendment agreed upon was by Sen. Wellstone (D-Minn.) that would require patients to be allowed to pay for behavioral health services themselves after their coverage runs out. Democrats, however, say the changes are not strong enough to fix the weaknesses they perceive in Jeffords' bill.

Other controversial language in the bill related to external appeals. The committee approved a measure by Sen. Frist (R-Tenn.) to allow external reviewers to decide for themselves whether a service was medically necessary, rather than being bound by the clinical practice guidelines used by the health plan. Republicans assert that this bill will provide external appeals of health plan decisions for 123 million plan subscribers, including 75 million in fully insured group health plans. President Clinton and committee Democrats counter that protections should apply to all 161 million privately insured persons.

Sen. Kennedy (D-Mass.) said the Frist amendment does not go far enough because there is no specific call for "de novo" reviews - a legal term that allows reviewers to take a new look at the entire case, rather than being able to overturn the plan's decision only if it was "arbitrary and capricious." Kennedy said the bill's external appeals procedures remain too weak because they would limit disputes over medical necessity or coverage of experimental treatments. He contends the health plan would be able to choose the review entity and that would allow plans to avoid entities whose reviewers rule against them too often. Kennedy said the language in the Democratic bill (S.6) is based on the appeals system already used by Medicare. His attempt to include an amendment based on that language was rejected by the committee on a party vote.

Senators who voted for strong protections:
Edward Kennedy, D-Mass.
Christopher Dodd, D -Conn.
Tom Harkin, D-Idaho
Barbara Mikulski, D-Md.
Jeff Bingaman, D-N.M.
Patty Murray, D-Wash.
Jack Reed, D- R.I.

Senators who voted against strong protections:
James Jeffords, R-Vt.
Judd Gregg, R-N.H.
Bill Frist, R-Tenn.
Mike DeWine, R-Ohio
Michael Enzi, R-Wyo.
Tim Hutchinson, R-Ark.
Susan Collins, R-Maine
Sam Brownback, R-Kan.
Chuck Hagel, R-Neb.
Jeff Sessions, R-Ala.

GENERAL ASSEMBLY GUIDANCE:

These actions are consistent with the Policy Statement, Life Abundant: Values, Choices, and Health Care, adopted by the 200th General Assembly (1988). "We are called to become vigorous advocates and supporters of public policies and programs that mark a just and healthy common order. We are clearly and unapologetically for a national, regional, and local health policy that insures justice for all." page 58.

These actions are also consistent with the 1991 General Assembly resolution on Christian Responsibility and a National Medical Plan. "The 203rd General Assembly (1991): j. Urges church members and committees and the presbyteries to renew ministries of advocacy so that an equitable, efficient, and universally accessible health plan.....might be adopted by Congress. l. Encourages all members of the presbyterian Church (U.S.A.) To engage in advocacy for universal access to health as a normative part of their devotional life and stewardship commitment." pp. 5-6.