[Congressional Record Volume 145, Number 8 (Tuesday, January 19, 1999)]
[Extensions of Remarks]
[Page E65]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

[[Page E65]]



              INTRODUCTION OF THE PATIENTS' BILL OF RIGHTS

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Tuesday, January 19, 1999

  Mr. STARK. Mr. Speaker, I am pleased to join with my Democratic 
colleagues from both the House and Senate today to re-introduce the 
Patients' Bill of Rights. This legislation came within five votes of 
passage in the last Congress. We are anxious to work with our 
colleagues to pass this important legislation this year.
  Patient protection should not be a partisan issue. This is the health 
care issue that continues to top this list of my constituents' 
concerns--and I represent California which has the longest history of 
managed care in our country.
  The Patients' Bill of Rights is a bill whose time has come. It builds 
on bills that have previously been introduced, on recommendations from 
the President's Advisory Commission on Quality in the Health Care 
Industry that met last year, on legislative efforts of various states, 
and on consensus agreements among consumer groups, many providers, and 
certain health plans.
  As more and more of our population joins managed care plans, the need 
for federal oversight of plan quality grows greater. Patients deserve 
to know that their health plans are held accountable to a basic set of 
consumer protection standards. That is what the Patients' Bill of 
Rights will do.
  Though many states have enacted consumer protection bills, they 
cannot regulate many of the health plans within their borders due to 
our convoluted health care system. Federal action is required.
  The Patients' Bill of Rights creates a set of federal standards that 
assures patient access to covered benefits and that holds health plans 
accountable for their actions.
  The most important components of the bill are as follows:

       Health Plan Accountability: The Patients' Bill of Rights 
     holds health plan administrators to the same level of 
     accountability for making medical decisions as doctors.
       Under current law, if an individual receives health care 
     benefits through his/her employer, and a health plan makes a 
     medical decision to withhold treatment that harms a patient, 
     that health plan's only responsibility is for the provision 
     of benefits that had been denied. The estimates are that some 
     125 million Americans are in these types of health plans.
       So, if a health plan denies a woman a mammography and she 
     later is found to have advanced breast cancer--which would 
     have been detected much earlier with the screening exam--that 
     plan's only liability is the cost of the mammogram that was 
     not provided.
       The remedy for this is straightforward: if health care 
     plans are going to be making medical decisions, they must be 
     held accountable to the same standards for legal liability as 
     health care providers.
       In the last Congress, I introduced a free-standing bill (HR 
     1749) to correct this glaring inequity. The Patients' Bill of 
     Rights corrects it as well. Our legislation would allow 
     states to determine whether or not a consumer can bring a 
     state cause of action against health plan administrators 
     whose medical decisions result in harm.
       There has been much ado about this provision and its 
     potential impact on business. The fact of the matter is that 
     few employers are making medical decisions regarding their 
     employees' health care. And, the bill goes so far as to 
     explicitly protect employers from any liability as long as 
     they are not involved in any medical decision-making.
       There has also been much talk that the courts will soon 
     resolve the issue of ERISA preemption. Unfortunately, we are 
     years away from a point when such resolution will be found. 
     Courts across the country are developing very different 
     interpretations of ERISA preemption and, consequently, there 
     is no clear direction from their decisions. This is too 
     important an issue to wait any longer. A legislative solution 
     is warranted.
       External Appeals: Guaranteeing consumers access to a 
     strong, independent external appeals process is also one of 
     the best ways to assure the provision of quality care.
       Unless there is an outside, independent decision-making 
     body for which consumers can ultimately take their appeals, 
     we will not obtain real consumer protection. Health plans 
     that hold a financial interest in denying care simply cannot 
     be the final arbitrators about whether care will be provided.
       The Patients' Bill of Rights calls for health plans to 
     contract with independent external appeals entities certified 
     by the State or the Department of Labor to provide timely 
     analysis of the plan's actions with the help of neutral 
     health care professionals. There are defined timelines in the 
     legislation to ensure that consumers facing serious, time-
     sensitive health consequences will be able to have their 
     appeals resolved and the appropriate care provided. For 
     example, in the case of urgently needed care, the external 
     appeal entity could take no more than 72 hours to issue a 
     decision.
       Disclosure of Consumer Information: Today, consumers have 
     no way of comparing health plans based on easily understood 
     quality criteria. The collection of standardized data and the 
     provision of standardized comparative information is a key 
     component of the Democratic legislation.
       As an example of this lack of ability to compare plans, 
     PacifiCare, the largest Medicare HMO contractor and an 
     insurer in the Federal Employees Health Benefits Program, 
     refused to release its NCQA data last year. NCQA data may not 
     be perfect, but it is the only measure out there today by 
     which consumers can compare health plans. PacifiCare should 
     not have been allowed to get away with holding that data 
     confidential.
       One of my principal concerns has always been that managed 
     care plans are quick to sign people up and collect monthly 
     premiums, but slow to see a large number of their patients. I 
     think that every health plan should be required, upon 
     enrollment, to conduct an examination of each new enrollee 
     before the health plan can receive any premium dollars.
       The strongest argument in support of managed care is that 
     when it is done well--and is truly coordinating the care of 
     patients--it can produce superior health outcomes. The 
     idea of a care coordinator helping a patient through the 
     typical health care maze is a good one. But, how can a 
     managed care plan fulfill that role if the patient is 
     never seen, let alone evaluated?
       The Patients' Bill of Rights does not go so far as to 
     require that a plan examine a patient before premiums can be 
     collected. However, it does require that data by presented to 
     consumers on the plan's preventive health care services. In 
     this way, consumers and employers will be able to compare 
     health plans as to how fare the plan really goes toward 
     managing patient's health. This data is available for 
     prospective as well as current plan enrollees.
       These are several of the key consumer protection and 
     quality provisions in The Patients' Bill of Rights. I chose 
     to highlight these points because I think they are 
     fundamental components of meaningful managed care reform. But 
     the bill contains many additional important protections.
       The Patients' Bill of Rights is the most consumer-oriented 
     managed care reform bill that has been introduced. Instead of 
     protecting providers, it aims to help consumers. It calls 
     for: direct access to OB-GYNs; direct access to specialists 
     for patients with chronic medical conditions; coverage of 
     routine patient costs for approved clinical trials; 
     participation by plan physicians and pharmacists in the 
     development of drug formularies; access to an out-of-plan 
     specialist if no appropriate in-plan specialist is 
     available--at no extra cost to the patient; and the creation 
     of a consumer ombudsman in each state to help consumers make 
     health care choices that meet their needs.
       Again, I am pleased to join with my colleagues today to 
     introduce this vitally important legislation. I look forward 
     to working with members in both bodies and on both sides of 
     the aisle--and with the President--to pass federally-
     enforced, consumer-oriented managed care legislation this 
     year.

     

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