Managed-care reform advocates got a big boost last week when President Bush endorsed giving HMO enrollees a right to sue their plans, and three Senate Republicans joined Democrats in announcing a patients' bill of rights that also expanded plans' legal accountability.
In a set of proposals sent to Senate Minority Leader Tom Daschle (D-S.D.) and House Minority Leader Richard Gephardt (D-Mo.), Bush came out in support of allowing lawsuits in federal courts to recover damages that resulted when plans denied covered benefits. Under Bush's proposals, enrollees could sue only after they had exhausted their internal and external appeals.
Liability has remained the thorniest issue in the managed-care battle. Senate Republicans in 1999 defeated House-passed legislation that would have allowed lawsuits, and replaced it with language that permitted binding appeals only. But with the defection of three members to a pro-lawsuit bill and Bush's support of federal suits, Senate GOP opponents of the plan may have a hard time this year.
Bush also said he wanted to ensure that the appeals process is speedy and that legislation doesn't discourage employers from offering healthcare coverage.
Sen. James Jeffords (R-Vt.), chairman of the Senate Health, Education, Labor and Pensions Committee, which has jurisdiction over managed-care practices, said he supported Bush's ideas. But employers and health insurers said it would increase litigation, driving up healthcare costs and the number of uninsured workers.
Meanwhile, the bipartisan legislation was unveiled by a group of U.S. senators and representatives led by Sens. John McCain (R-Ariz.) and Edward Kennedy (D-Mass.). They defended their plan, saying it would prevent frivolous lawsuits and protect employers.
The legislation allows managed-care enrollees to sue their health plans for damages related to the denial of covered benefits. It requires them to first exhaust internal and external appeals processes before going to court, except in cases in which death or irreparable harm occurs before the appeals process is completed.