PI Action alerts & updates ... 2000
Congress to Make Final Decision on Patients Bill of Rights
Your action is needed to ensure strongest managed care protections
possible!!
Congress has recently reconvened after its winter recess. At the
end of February, a joint House/Senate conference committee will
meet to work out differences between two Patient Bill of Rights
bills, intended to provide protections for managed care consumers.
In July of 1999, the Senate passed its version. The Patient Bill
of Rights Act of 1999 (S. 1344). This legislation, sponsored by
Senator Trent Lott (R-MS), does not provide adequate protections
and only covers about one-third of Americans (see background information
below). In October 1999, the House passed its version, the Bipartisan
Managed Care Improvement Act of 1999 (H.R. 2723). This bill, co-sponsored
by Representatives John Dingell (D-MI) and Charles Norwood (R-GA),
is supported by most HIV/AIDS and other healthcare consumer advocates
and provides many real protections for people living with HIV/AIDS.
The Senate bill received only Republican support, with all Democrats
and two Republican Senators voting against it. However, the House
version was approved by a bipartisan majority, with 68 Republicans
breaking from the leadership and voting for the legislation. President
Clinton has indicated his support for the House version.
The joint House/Senate conference committee made up of 12 Senators
and 21 Representatives will soon meet to work out differences between
the two bills. The final product from the committee will then be
sent to the full House and Senate for a vote before going to the
President for his signature or veto. Congressional leadership has
indicated that it wants to finish work on managed care legislation
before Easter. Your letters and phone calls are needed immediately
to influence the work of the committee and ensure that it supports
the strongest protections!
Background on H.R. 2723 and S. 1344
Congress has been working on a “Patients Bill of Rights”
for over two years. In 1998, neither the House nor the Senate was
able to pass legislation. Last year, the House passed H.R. 2723
and the Senate approved S. 1344. However, the joint House/Senate
conference committee was not convened in time for legislation to
be sent to the President before Congress adjourned for the year.
While both pieces of legislation are touted as providing meaningful
protections for managed care consumers, there are significant differences
between them.
The Senate bill would apply to even fewer individuals. This legislation
only covers those whose employers act as the insurer for their employees
and are called “self insured”. In other words, the employer
designs the insurance plan, pays the claims, and assumes financial
risks involved. These employers are generally only very large companies.
You may want to ask your employer if you fall in this category.
The House bill would cover employees regardless of whether their
employer is self-insured or simply pays for the insurance for their
employees.
However, those who receive health coverage through Medicare or
Medicaid, who do not receive coverage through their employer but
buy their own insurance, or who receive coverage through a public
employer (such as the federal, state, or local government) would
not be affected by either legislation.
The main differences between the two bills lie in the protections
offered by each proposal. Advocates are supporting the House provision
because it offers significant consumer protections, not included
in the Senate version.
H.R. 2723 Contains Important Protections Not Found in S. 1344:
Allows specialists to be a primary care provider for people living
with a chronic or life-threatening illness.
This is critical for people living with HIV/AIDS who need access
to an HIV specialist in order to get adequate care and appropriate
coordination of care and referrals.
Standing referrals to specialists.
This provision allows individuals to get approval to see a specialist
on an ongoing basis, without having to get a referral for every
visit.
Allows access to out-of-network providers and care.
This allows individuals to access care or providers not included
in the plan.
Access to clinical trials.
This would prevent insurance companies from refusing to cover routine
health care expenses for individuals who join a clinical trial.
The Senate version only covers those participating in clinical trials
for cancer.
Allows for an external review.
Under the House plan, an individual can appeal—or get an outside
opinion about—a health plan’s denial of benefits if
it is based on the decision that the service is not medically necessary
or appropriate, or that the service is “experimental”.
Under the Senate plan, an external appeal is only allowed if the
claim poses a significant risk of putting the individual’s
life or health in jeopardy, or if the service is considered “experimental”.
Additionally, an extremely important difference in the review process
is that in the Senate plan the health plan chooses the reviewer
and this person would only decide whether the plan followed its
own procedures, not whether or not the patient needs the care.
Provides the right to sue for damages.
The House plan allows individuals to hold managed care plans accountable
for their decisions. However, health plans that comply with an external
reviewer’s decision may not be held liable for damages. The
Senate plan does not allow the right to sue.
Both Bills Contain Important Managed Care Protections:
Access to emergency rooms.
Both versions would allow an individual to go to the nearest emergency
room without calling their health plan first.
Access to all prescription drugs.
This is particularly important for people with HIV/AIDS. Both bills
would allow doctors to prescribe treatments that are not on the
health plan’s list of approved drugs, but are medically necessary.
However, it’s important to remember that the Senate version
only covers a small number of insured people, so many would not
receive these protections.
Conclusion
While even the House version of the Patient’s Bill of Rights
may not be everything advocates had hoped for, it is a strong, comprehensive
piece of legislation that goes a long way toward ensuring protections
for many managed care consumers. In particular, it offers many meaningful
protections for people living with HIV/AIDS and other life-threatening
diseases.
In addition, there are political reasons to advocate for the strongest
bill possible. There is currently bipartisan support in Congress
and the public—as well as the Clinton Administration—for
managed care reform legislation. This could change after the November
election. It is important to join this battle for appropriate protections
for managed care even though this bill won’t affect the millions
of uninsured Americans. As we advocate for more access to care for
those who have no insurance coverage, we also have to fight for
the quality of the health care that does exist. We must ensure that
people have access to quality care with appropriate protections
for themselves and their loved ones. Finally, if Congress passes
a weak bill, and it is signed into law, many policy-makers and representatives
of the health care industry will consider their work done and we
might not see stronger protections for a long time.
Action Needed for This Alert
Write or call your U.S. Representative and two U.S. Senators this
week.
Urge them to support the strong protections included in H.R. 2723
and to reject the inadequate protections and coverage in S. 1344.
Ask them to convey their support to members of the conference committee.
If your Representative or Senator is on the conference committee
(see enclosed list), it is extremely important that you contact
him or her as soon as possible.
You can use the sample phone message and letter below to help craft
your message.
Sample Phone Message
“I am calling regarding the Patients Bill
of Rights, which is currently in conference committee. I support
the provisions included in H.R. 2723, and urge Representative/Senator
_______________to urge members of the conference committee to support
the protections included in that bill.”
Sample Letter for H.R. 2723 and S. 1344
The Honorable ___________
U.S. Senate or U.S. House of Representatives
Washington, DC 20510 (Senators) or 20515 (Representatives)
Dear Senator/Representative ________________:
I am writing regarding the Patients Bill of Rights,
which is currently being reviewed in conference committee. In particular,
I support the strong consumer protections offered in H.R. 2723.
I urge you to support those protections, and to convey your support
to members of the conference committee.
Insert personal story here. If you or someone you
care about would be affected by this legislation, discuss that here.
You might want to talk about any difficulties you or others may
have had with managed care plans that demonstrate the need for such
legislation. This would also be a good place to discuss why these
protections are particularly important for people living with HIV/AIDS.
The Senate version, S. 1344, does not provide adequate
protections, nor does it cover enough people who are insured through
managed care plans. I urge you to reject this bill and support meaningful
managed care reform. Again, please support the provisions included
in H.R. 2723.
Thank you for your consideration.
Sincerely,
Your name
ACTION TIP
Where to contact your elected officials?
District or DC office?
When communicating with your elected officials, it is usually fine
to call their district office. Messages are collected and given
to the legislator. However, when you are calling about a bill or
issue that will be voted on quickly—such as the one in this
Alert, we recommend you call the Washington, DC office directly
so that your opinion is documented immediately.
You can reach your U.S. Senators and Representative through the
Capitol Switchboard at 202-224-3121.
Managed Care Reform Conference Committee
The following Members of Congress make up the conference committee
that will create the final Patients Bill of Rights. If your Representative
or Senator is on this list, it is particularly important that you
provide your input on this issue!
Senate
James Jeffords (R-VT)
Judd Gregg (R-NH)
Bill Frist (R-TN)
Tim Hutchinson (R-AR)
Don Nickles (R-OK)
Phil Gramm (R-TX)
Michael Enzi (R-WY)
Edward Kennedy (D-MA)
Christopher Dodd (D-CT)
Tom Harkin (D-IA)
Barbara Mikulski (D-MD)
John Rockefeller (D-WV)
House
Thomas Blilely (R-VA)
Michael Bilirakis (R-FL)
John Shadegg (R-AZ)
Bill Archer (R-TX)
William Thomas (R-CA)
Nancy Johnson (R-CT)
Jim McCrery (R-LA)
John Boehner (R-OH)
Jim Talent (R-MO)
Ernest Lee Fletcher (R-KY)
Porter Goss (R-FL)
Dan Burton (R-IN)
Joe Scarborough (R-FL)
John Dingell (D-MI)
Frank Pallone (D-NJ)
Charles Rangel (D-NY)
Pete Stark (D-CA)
William Clay (D-MO)
Robert Andrews (D-NJ)
Henry Waxman (D-CA)
Marion Berry (D-AR)
