With the House's narrow passage of a patients' bill of rights, House and Senate negotiators will be challenged once again to produce a compromise document that can be sent to President Bush for his signature. The Senate passed its version in June.
This is the second time in two years that patients' rights legislation has been put before a conference committee charged with working out the differences between House and Senate versions of legislation. The conference committee deadlocked in 2000 and ultimately failed to produce a bill.
Whether legislation emerges this time will depend on whether the participating lawmakers want to accomplish policy or political objectives. Congressional leaders are expected to appoint members of both houses to the committee this fall.
"Today's action brings us an important step closer to ensuring that patients get the care they need and that HMOs are held accountable," Bush said of the House vote. "As this bill heads to the conference committee, I remain committed to extending the hand of cooperation to all who share a commitment to achieving real results for better healthcare for every American."
The House passed the legislation by 226-203, voting mostly along party lines. The turning point came earlier, however, when the House voted 218-213 to support a compromise struck by Bush and Rep. Charlie Norwood (R-Ga.), who had defied Republican leadership by backing a more liberal patients' bill of rights.
The House legislation differs most markedly from the Senate bill in its provisions for enrollees to sue HMOs for harm resulting from the denial of covered benefits. For example, a provision known as "rebuttable presumption" in the House bill says a patient must overcome in court a presumption in favor of the insurer if an independent medical reviewer has upheld the insurer's decision. Yet patients do not have the same presumption in their favor if the independent reviewer sided with them.
"There is lots and lots of stuff buried in there like that," one healthcare lobbyist said.
In addition, the House bill would cap awards for pain and suffering and punitive damages at $1.5 million each, regardless of whether the case was pursued in state or federal court. The Senate-passed bill contains a $5 million cap on punitive damages in federal court and does not pre-empt state laws on damages.