[Congressional Record (Bound Edition), Volume 146 (2000), Part 5]
[House]
[Pages 6692-6693]
[From the U.S. Government Publishing Office, www.gpo.gov]



         PATIENTS' BILL OF RIGHTS: IS IT NECESSARY LEGISLATION?

  The SPEAKER pro tempore (Mr. Miller of Florida). Under a previous 
order of the House, the gentleman from Florida (Mr. Stearns) is 
recognized for 5 minutes.
  Mr. STEARNS. Mr. Speaker, I am here this afternoon to talk about the 
Patients' Bill of Rights. Is this legislation necessary? The issue of 
whether or not Americans enrolled in HMOs, health maintenance 
organizations, need passage of the patient protection in order to sue 
their plans is currently in conference here in Congress.
  Today, I would like to call my colleagues' attention to a study by 
John S. Hoff. Mr. Hoff wrote this study for the Heritage Foundation, 
and he outlined some very compelling arguments about why passage of 
this legislation would result in more government control of our health 
care system.
  It is interesting that we are having this debate, because, Mr. 
Speaker, I think the majority of Americans already made clear their 
views on more regulation for health care when the Clinton health care 
bill was overwhelmingly rejected.
  The Heritage Foundation Backgrounder N1350 concludes that increased 
regulation, plus increased litigation will equal rising costs in health 
care and, ultimately, more uninsured Americans. The gentleman from Iowa 
(Mr. Ganske), my good friend and colleague, has been very critical of 
this study and did a Special Order to refute the analysis of this 
health bill. I am not here to comment on his presentation; but my 
purpose is, more importantly, to talk about Mr. Hoff's analysis and why 
Mr. Hoff's analysis, I think, has credible evidence. So I am here to 
merely present the other side of the argument that opposes imposing 
further Federal Government regulations on health care plans and 
delivery of health care.
  So according to Mr. Hoff, let us take each of the major items. He 
believes the Patients' Bill of Rights, in conference as we speak, 
increases regulation. If passed, it would impose detailed regulations 
by the Federal Government on health care plans and the delivery of 
health care. The question is, does anyone in this House think passing 
more government legislation will decrease the Government's involvement? 
In fact, I think most of us, every time we pass legislation that is 
going to increase government involvement, there is going to be more 
regulation. I think the regulation, as Mr. Hoff pointed out, is 
pervasive in this bill.
  For example, private health plans normally evaluate medical services, 
treatments and procedures. Under the Patients' Bill of Rights, however, 
managed care plans and fee-for-service plans are allowed to conduct 
such utilization reviews only, only as specified by the Federal 
Government. The time allotted for a decision and the status of those 
making a decision are two examples of such specifications. Further 
regulation involves an appeals process for denial of coverage. The 
proposed legislation requires an internal appeals process that follows 
precise, regulatory details on each and every procedure.
  It further requires a provision of external appeals of decisions made 
in the internal appeals process. The external appeal requires that the 
plan contract with an entity that is directly or indirectly certified 
by the Department of Health and Human Services, or the Department of 
Labor. So there we have it. We have both of these large agencies 
involved in conducting the reviews. I think this arrangement can lead 
to a situation in which the final determination of what is covered by a 
plan is made by an entity certified, regulated, and answerable only to 
the United States Government.
  Mr. Speaker, the proposed legislation also leads to Federal intrusion 
into the physician-plan relationship. Under the Patients' Bill of 
Rights, provisions of contracts between plans and health care providers 
are void if they restrict or have the effect of restricting the 
provider's ability to advise a patient about their health status or 
medical treatment. The legislation further intrudes by precluding a 
plan from discriminating with respect to participation by providers or 
in payment to them on the basis of license or certification under State 
law.
  Let us take another item. I mentioned earlier increased litigation. 
In addition to the increased burdens of regulation, this Patients' Bill 
of Rights in conference is talking about increased litigation. Each of 
the many regulations contemplated by the legislation will create legal 
rights that could be causes of action.
  In addition to an increasing number of actions that plans may be 
liable, the legislation opens up employers themselves to the 
possibility of being sued for damages resulting from denial of 
coverage. While the bill purports to protect employers if they refrain 
from the exercise of discretionary authority to make a decision on a 
claim for benefits, courts have been willing and creative in finding 
ways around similar provisions.
  Defenders of the legislation point to provisions which limit 
litigation. These provisions,

[[Page 6693]]

however, apply to actions brought under ERISA claims only; they do not 
apply to state tort actions. Tort claims under state law may result in 
``malpractice-type'' lawsuits with large jury awards awarded to 
sympathetic victims of faceless insurance companies.
  Effect of increased regulation and litigation: According to the CBO, 
the House bill would increase health insurance premiums by 4.1 percent. 
This increase may lead to more than 1.2 million Americans losing 
employer-based health coverage. In addition to rising costs, the threat 
of malpractice suits and the exposure of employers to liability could 
lead to millions more Americans joining the ranks of the uninsured.

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