The House Commerce Committee may vote as soon as next month on a managed-care reform bill drafted by three Republicans.
Reps. Charlie Norwood (R-Ga.), a dentist; Tom Coburn (R-Okla.), a physician; and John Shadegg (R-Ariz.) have submitted the Consensus Managed Care Improvement Act to Commerce Committee Chairman Tom Bliley (R-Va.) and Rep. Michael Bilirakis (R-Fla.), chairman of the committee's health and environment subcommittee.
Bliley and Bilirakis will decide before Memorial Day whether to formally introduce the legislation or send it back to the three authors for revisions. If Bliley and Bilirakis give their OK, the committee may be able to hear testimony on and approve the legislation by mid-June.
Although the GOP has resisted opening the door to lawsuits against health plans, the legislation would allow enrollees or their families to sue health plans for injuries or deaths that result from plans' refusals to cover healthcare services.
The legislation, however, would require any enrollee to prove that there was an injury before a suit could be filed. It also would exempt from punitive damages any health plan that followed the decision of an external appeals panel.
The bill seeks to exempt employers from such lawsuits, unless the employer makes healthcare coverage decisions.
The legislation would require plans to allow enrollees to appeal plan decisions both internally and externally. Enrollees would also have direct access to emergency, specialty, pediatric, and OB/GYN care, and those in closed-network HMOs could see physicians outside the networks.
Although the new legislation tried to address the objections of big employers and health plans about the potential costs of lawsuits, the Health Benefits Coalition, which is made up of employers, insurers and the Premier hospital alliance, said the bill still would drive up premiums and make health insurance unaffordable.
"Rather than offer a true alternative, the Norwood-Coburn-Shadegg bill punishes and burdens employers who voluntarily provide health coverage and the millions of Americans who receive it," Dan Danner, the coalition's chairman, said in a written statement.
Meanwhile, a related bill is scheduled for consideration this week in a Senate committee. The Health, Education, Labor and Pensions Committee is preparing to work on legislation setting federal protections for patient-records privacy.
The bill bars states from passing stronger privacy standards, but it does not pre-empt existing state restrictions. Provider groups have been arguing for pre-emption of all state laws to relieve them of the burden of complying with differing standards.