It's hair-splitting time on patient-protection legislation in Washington.
The introduction of bipartisan managed-care reform legislation last week-this version blessed by President Bush-shows that as the two sides inch closer to settling the 5-year-old war over federal patient protections, wording differences stand in the way of compromise.
Two competing bills introduced in the Senate differ in the instances in which they allow managed-care enrollees to sue their HMOs in state court and whether damages are limited. Both bills include the word "bipartisan" in their titles.
The latest bill-sponsored by Sens. William Frist (R-Tenn.), a surgeon; James Jeffords (R-Vt.), chairman of the Senate Health, Education, Labor and Pensions Committee; and John Breaux (D-La.)-offers managed-care enrollees the right to sue plans after they exhaust internal and external administrative appeals.
Although sponsors say they're giving enrollees a right to sue in federal court only, a Frist aide said the measure would not block lawsuits in state court that are of the type allowed under past federal court decisions. That would include state-court lawsuits dealing with quality, treatment or delivery of care against large employer-provided plans regulated under the federal Employee Retirement Income Security Act of 1974, the aide said.
It would keep in federal courts lawsuits that challenge plans' decisions over whether they cover certain healthcare services.
In a written statement, Bush said the liability provision of Frist's bill "protects employers and their employees from unnecessary litigation that would increase healthcare premiums and force too many Americans to do without health insurance."
Meanwhile, sponsors of the other bill-Sens. John McCain (R-Ariz.), Edward Kennedy (D-Mass.) and John Edwards (D-N.C.)-say they oppose the Frist legislation because it allows only federal lawsuits.
McCain said his bill "does not deny Americans their right to seek redress through the courts when all other means of resolution are exhausted," asserting that the Frist bill does deny that right.
The American Association of Health Plans, although unhappy about liability provisions in the Frist bill, blasts McCain's bill for letting enrollees bypass administrative appeals when harm occurs after the deadline for an appeal expires or when harm occurs before the plan hears the appeal. It also lets enrollees file suit in state court in some cases involving benefits decisions, the AAHP said.
"The issue is . . . about the trial bar trying to get at benefits disputes," said Karen Ignagni, the AAHP's president and chief executive officer.
A group that has lobbied for years for federal patient protections sees the sides as closer than ever. "Notwithstanding its shortcomings, I think that this effort by (Frist) is a positive step," said Ronald Pollack, executive director of the healthcare consumers group Families USA. "It really casts a sharp spotlight on what the administration is going to do to reach a compromise on two proposals that are closer together than any in previous years in this debate."