[Public Papers of the Presidents of the United States: William J. Clinton (1998, Book II)]
[September 1, 1998]
[Pages 1493-1494]
[From the U.S. Government Publishing Office www.gpo.gov]

[[Page 1493]]

Letter to the Majority Leader of the Senate on the Patients' Bill of 
September 1, 1998

Dear Senator Lott:
    Thank you for your letter regarding the patients' bill of rights. I 
am pleased to reiterate my commitment to working with you--and all 
Republicans and Democrats in the Congress--to pass long overdue 
legislation this year.
    Since last November, I have called on the Congress to pass a strong, 
enforceable, and bipartisan patients' bill of rights. During this time, 
I signed an Executive Memorandum to ensure that the 85 million Americans 
in federal health plans receive the patient protections they need, and I 
have indicated my support for bipartisan legislation that would extend 
these protections to all Americans. With precious few weeks remaining 
before the Congress adjourns, we must work together to respond to the 
nation's call for us to improve the quality of health care Americans are 
    As I mentioned in my radio address this past Saturday, ensuring 
basic patient protections is not and should not be a political issue. I 
was therefore disappointed by the partisan manner in which the Senate 
Republican Leadership bill was developed. The lack of consultation with 
the White House or any Democrats during the drafting of your legislation 
contributed to its serious shortcomings and the fact it has failed to 
receive the support of either patients or doctors. The bill leaves 
millions of Americans without critical patient protections, contains 
provisions that are more rhetorical than substantive, completely omits 
patient protections that virtually every expert in the field believes 
are basic and essential, and includes ``poison pill'' provisions that 
have nothing to do with a patients' bill of rights. More specifically, 
the bill:
    Does not cover all health plans and leaves more than 100 million 
Americans completely unprotected. The provisions in the Senate 
Republican Leadership bill apply only to self-insured plans. As a 
consequence, the bill leaves out more than 100 million Americans, 
including millions of workers in small businesses. This approach 
contrasts with the bipartisan Kassebaum-Kennedy insurance reform law, 
which provided a set of basic protections for all Americans.
    Lets HMOs, not health professionals, define medical necessity. The 
external appeals process provision in the Senate Republican Leadership 
bill makes the appeals process meaningless by allowing the HMOs 
themselves, rather than informed health professionals, to define what 
services are medically necessary. This loophole will make it very 
difficult for patients to prevail on appeals to get the treatment 
doctors believe they need.
    Fails to guarantee direct access to specialists. The Senate 
Republican Leadership proposal fails to ensure that patients with 
serious health problems have direct access to the specialists they need. 
We believe that patients with conditions like cancer or heart disease 
should not be denied access to the doctors they need to treat their 
    Fails to protect patients from abrupt changes in care in the middle 
of treatment. The Senate Republican Leadership bill fails to assure 
continuity-of-care protections when an employer changes health plans. 
This deficiency means that, for example, pregnant women or individuals 
undergoing care for a chronic illness may have their care suddenly 
altered mid course, potentially causing serious health consequences.
    Reverses course on emergency room protections. The Senate Republican 
Leadership bill backs away from the emergency room protections that 
Congress implemented in a bipartisan manner for Medicare and Medicaid 
beneficiaries in the Balanced Budget Act of 1997. The bill includes a 
watered-down provision that does not require health plans to cover 
patients who go to an emergency room outside their network and does not 
ensure coverage for any treatment beyond an initial screening. These 
provisions put patients at risk for the huge costs associated with 
critical emergency treatment.
    Allows financial incentives to threaten critical patient care. The 
Senate Republican Leadership bill fails to prohibit secret financial 
incentives to providers. This would leave patients vulnerable to 
financial incentives that limit patient care.
    Fails to hold health plans accountable when their actions cause 
patients serious harm. The proposed per-day penalties in the Senate 
Republican Leadership bill fail to hold health plans accountable when 
patients suffer serious harm

[[Page 1494]]

or even death because of a plan's wrongful action. For example, if a 
health plan improperly denies a lifesaving cancer treatment to a child, 
it will incur a penalty only for the number of days it takes to reverse 
its decision; it will not have to pay the family for all the damages the 
family will suffer as the result of having a child with a now 
untreatable disease. And because the plan will not have to pay for all 
the harm it causes, it will have insufficient incentive to change its 
health care practices in the future.
    Includes ``poison pill'' provisions that have nothing to do with a 
patients' bill of rights. For example, expanding Medical Savings 
Accounts (MSAs) before studying the current demonstration is premature, 
at best, and could undermine an already unstable insurance market. As I 
have said before, I would veto a bill that does not address these 
serious flaws. I could not sanction presenting a bill to the American 
people that is nothing more than an empty promise. At the same time, as 
I have repeatedly made clear, I remain fully committed to working with 
you, as well as the Democratic Leadership, to pass a meaningful 
patients' bill of rights before the Congress adjourns. We can make 
progress in this area if, and only if, we work together to provide 
needed health care protections to ensure Americans have much needed 
confidence in their health care system.
    Producing a patients' bill of rights that can attract bipartisan 
support and receive my signature will require a full and open debate on 
the Senate floor. There must be adequate time and a sufficient number of 
amendments to ensure that the bill gives patients the basic protections 
they need and deserve. I am confident that you and Senator Daschle can 
work out a process that accommodates the scheduling needs of the Senate 
and allows you to address fully the health care needs of the American 
    Last year, we worked together in a bipartisan manner to pass a 
balanced budget including historic Medicare reforms and the largest 
investment in children's health care since the enactment of Medicaid. 
This year, we have another opportunity to work together to improve 
health care for millions of Americans.
    I urge you to make the patients' bill of rights the first order of 
business for the Senate. Further delay threatens the ability of the 
Congress to pass a bill that I can sign into law this year. I stand 
ready to work with you and Senator Daschle to ensure that patients--not 
politics--are our first priority.

                                                      William J. Clinton

Note: The letter referred to the President's memorandum of February 20 
on Federal agency compliance with the Patient Bill of Rights (Public 
Papers of the Presidents: William J. Clinton, 1998 Book I (Washington: 
U.S. Government Printing Office, 1999), p. 260). An original was not 
available for verification of the content of this letter.