The President strongly supports the enactment of H.R. 2723, the Bipartisan
Consensus Managed Care Improvement Act of 1999. This bipartisan
legislation would provide new patient protections to all Americans in all
health plans, and hold health plans accountable when their actions cause
harm to patients.
Since 1997, when he received the report of his Quality Commission, the
President has been calling on the Congress to pass a strong, enforceable,
and bipartisan Patients' Bill of Rights. In the absence of congressional
action, the President directed the Federal health plans, covering over 85
million Americans, to implement the patient protections recommended by the
Commission. Many States have also passed legislation providing important
protections to their residents, including requiring new protections for
patients in emergency situations, establishing access to independent
external appeals processes, and ensuring access to specialists.
While these actions are important, the limits on State jurisdiction and
Federal regulatory authority make it impossible to ensure that all
Americans in all health plans have the protections they need. States do
not have the authority to regulate self-insured plans, leaving almost 50
million people unprotected nationwide. Moreover, current enforcement
limitations under Federal law frequently preempt State law even for those
plans regulated by the States.
Adoption of any substitute amendment other than Norwood-Dingell will
demonstrate that this Congress is not serious about responding to the
public's need for protection in the Nation's ever-changing health care
delivery system. The President is strongly committed to working with
Members of both parties to pass a meaningful Patients' Bill of Rights this
year; he is equally committed, however, to vetoing any legislation that is
a Patients' Bill of Rights in name only.
On August 5, 1999, the President commended Representatives Norwood,
Dingell, and Ganske for their leadership in introducing a strong,
enforceable Patients' Bill of Rights. He endorsed H.R. 2723 because it
provides meaningful patient protections, such as the right to emergency
care wherever and whenever a medical emergency arises; the right to access
the health care specialists that a patient needs; the right to ensure care
is not disrupted during treatment; the right to an unbiased internal
appeals process and an independent external appeals process that allows
patients to get the care they were promised; and the right to hold health
plans accountable for actions that harm patients.
The Administration strongly opposes the amendments in the nature of a
substitute to H.R. 2723. These amendments that were made in order by the
Rules Committee would weaken key provisions of the bill and are designed
solely to undermine the enforcement provisions contained in H.R. 2723. If
these substitute amendments are adopted and presented to the President, his
senior advisors would recommend that he veto the bill.
The Boehner amendment scheduled to be offered today provides clearly
inadequate protections and does not even extend those protections to all
Americans in all plans. Since the limited protections only apply to
employer sponsored plans, at least 15 million Americans would not be
covered under this legislation. Moreover, the patient protections fall
short in numerous areas, including: no requirement to assure access to
specialists when a plan's provider network is inadequate; allows plans to
provide excessive financial incentives to providers to limit medically
necessary care; and requires parents of newborns to receive prior approval
before receiving emergency care. Finally, there are absolutely no
individual remedies that can be accessed through the courts to hold plans
accountable for actions that have harmed patients.
While the Coburn/Shadegg amendment offers some additional protections, such
provisions are far too weak. The legislation is unacceptably flawed in
numerous areas, including:
Newborns would not be provided the same access to emergency care
protections as provided to adults. Parents would need to receive
prior approval to be sure they can be reimbursed for emergency care
services for their children.
No protections against plans limiting access to necessary
medications. This bill allows plans to deny coverage of prescription
drugs that are not part of the plan's drug formulary even when prescribed
by health care providers and determined to be to medically necessary.
An external review process that is biased against low-income
patients. All patients, even if they are unable to afford it, must
pay a $25 filing fee to have their case considered by an external review
entity. If the patient cannot pay the filing fee, the appeals entity will
not hear their case.
Meaningless information disclosure requirements that leave patients in
the dark about their rights. Plans are not required to inform
enrollees of their limited new rights. Moreover, plans may meet their
information disclosure requirements by providing patients with technical
billing and diagnostic codes, which are intended for use by health care
professionals, not patients.
A flawed enforcement provision that severely limits patients ability to
hold plans accountable. Under the Coburn/Shadegg amendment, the
roadblocks to accessing court based remedies include:
- Imposing a health care cost cap that must be exceeded to sue or
even appeal a harmful plan decision. Under this provision, a woman
who was denied a mammography and subsequently had her cancer spread
would not be able to sue the plan let alone appeal the original denial
- Requiring patients who have already been harmed to exhaust all
levels of appeals before seeking redress. Under this provision, a
patient who by any definition has been injured as a result of a plan
decision must go through an unnecessarily time consuming appeals process
even though the outcome is clear.
- Requiring time consuming and burdensome certification in order
for a patient injured by a plan decision to file a case. This
requirement may be without precedent, and it certainly implements an
extraordinary hurdle for enrollees seeking redress.
Enacting meaningful Patients' Bill of Rights legislation is long overdue.
The President strongly urges the House to pass a "clean" H.R. 2723, which
enjoys broad bipartisan support, and give all Americans the health care
protections they need and deserve.
As the President has already indicated in a letter, the Administration
remains very concerned about the Rule that was approved for H.R. 2723
because it prohibited the consideration of revenue measures in support of
H.R. 2723, many of which were passed by the House in other legislation.