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Published: Saturday, 6/30/2001

HMO bill glides through Senate

BY RACHEL SMOLKIN
BLADE WASHINGTON BUREAU

WASHINGTON - The Senate yesterday passed broad protections for consumers against managed-care abuses, permitting patients to sue their health plans and fulfilling Democrats' pledge to make patients' rights their top priority since assuming control of the chamber.

Although President Bush has threatened to veto the measure, its passage in the Senate marks a major victory for Democrats, who have been trying for years to enact federal patient protections. To win passage, Democrats made several concessions to Republicans, including changes that would restrict class-action lawsuits and allow patients to use courts only after pursuing nonjudicial appeals.

The 59-36 vote came after senators defeated an alternative favored by most Republicans and Mr. Bush.

“Today's vote brings us a giant step closer to guaranteeing that millions of Americans will no longer be powerless when their HMOs overrule their doctor in denying needed care,'' said Sen. Edward Kennedy (D., Mass.), a leading sponsor along with Sens. John Edwards (D., N.C.),and John McCain (R., Ariz.).

Ohio's Republican senators split their votes, with Mike DeWine supporting it and George Voinovich opposing it. Michigan's Democratic senators, Carl Levin and Debbie Stabenow, voted for the bill.

The bill guarantees 190 million Americans covered by private health insurance the right to see needed specialists and seek emergency care. It permits women to go directly to an obstetrician or gynecologist and allows parents to choose a pediatrician as their child's primary-care provider.

It permits patients to appeal managed-care decisions to an independent panel of medical experts and even sue their health plans in state or federal court. It caps federal court damages designed to punish insurers, known as punitive damages, at $5 million but imposes no limits on awards for wages, pain and suffering, and other losses.

The Senate agreed to a compromise that Sen. Fred Thompson (R., Tenn.) brokered with the bills' sponsors to prevent patients from skirting the appeals process. Patients would need to allow a month for review before they could file suit. The external reviewers' decision would be admissible in court.

The bill's prospects for becoming law are uncertain. Mr. Bush repeatedly has pledged a veto unless significant changes are made. He renewed his veto threat last night, saying in a statement that: "I am pleased that the Patients' Bill of Rights adopted in the Senate today more closely reflects my principles than did the original McCain-Kennedy-Edwards bill. ... The Senate failed, however, to address the danger that excessive, unlimited litigation in state courts would drive up premium costs and cause many American families to lose their health insurance.

“I could not in good conscience sign this bill because it puts the interests of trial lawyers before the interest of patients.''

Mr. Bush has endorsed a more limited House bill that would allow some lawsuits in state and federal court as a last resort.

The House plans to debate patients' rights when it reconvenes from a July 4 recess. If the House passes a bill, lawmakers will try to meld it with the Senate version in a conference committee. Then both chambers must vote on a final version before Mr. Bush can decide whether to sign it into law.

Hours before the final vote, the Senate passed, 98-0, an amendment by Mr. DeWine to restrict class-action lawsuits against health plans. It limits class-action suits to employees in one company against a single health-care plan. Employees at General Motors, for example, could not join with Ford workers to sue a health provider. “One employer – one health-care plan - one class-action suit,'' Mr. DeWine said. “It's that simple ... Abusive class-action lawsuits are not a path to assuring access to quality health care.''

Mr. DeWine also worked last week with Sen. Olympia Snowe (R., Maine) and others to forge a compromise to protect most companies from lawsuits. The measure shields businesses from employees' health-care lawsuits unless companies directly participate in medical decisions.

Mr. Voinovich said, “the real tragedy of Senator Kennedy's patients' bill of rights is that Congress could have celebrated a victory for the American people today by passing a real patient protections bill. Instead, the Kennedy bill hands the victory to the personal-injury lawyers.''



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