A House panel last week approved a Republican-sponsored patient-protection package and snuffed Democratic efforts to substitute a more-comprehensive bill that would open the door to enrollee lawsuits against health plans.
The House Education and Workforce employer-employee relations subcommittee passed eight bills that seek to expand the rights of enrollees in federally regulated employer-sponsored health plans. The bills give enrollees the right to appeal coverage denials both within and outside their health plans, to receive emergency and some specialty care, and to get accurate, unrestricted information about coverage, quality and treatment options.
Subcommittee Chairman John Boehner (R-Ohio) intends to consolidate the bills into a single measure, although it is unclear when that will occur. The package will likely go before the full House Education and Workforce Committee as separate bills, probably within two weeks, officials said.
The bills amend the Employee Retirement Income Security Act of 1974, which regulates employer-sponsored health plans. One bill grants the ERISA pre-emption to health-insurance plans offered through professional and trade associations. Health insurers are opposing that measure, which they said will drive up healthcare costs (See story, p. 34).
The subcommittee acted quickly in the first House vote since the full House passed a GOP measure last year. It passed the bills only a week after they were introduced, which surprised much of the Washington healthcare lobbying community.
In fact, the American Medical Association continues to oppose the committee's action because the subcommittee did not give the AMA a chance to comment on the measures before their introduction.
The AMA also said the package provides inadequate guarantees of access to specialty and emergency care, and the package's external review procedure doesn't allow physicians enough say in medical necessity decisions.
Boehner acknowledged those complaints. "While some will insist these measures don't go far enough-and others will insist they go too far-this package is intended to let us move forward with what we agree on while continuing to have a debate about what we do not," he said.
Democrats on the subcommittee said the bills did not go far enough. "The real issue of solving the healthcare crisis, the issue of making health plans accountable for the decisions that they make, is not being addressed, and the issue of making decisions based on medical necessity instead of economic convenience is not being addressed," said Rep. Robert Andrews (D-N.J.), the panel's senior Democrat.
Andrews tried to substitute a Democratic patient-protection bill, but was defeated on a procedural vote.