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New managed care legislation includes right to sue
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8-23-99 Washington. Dissatisfied with the managed care reform bill passed by the Senate in July, a bipartisan coalition in the House has introduced a plan, supported by the Clinton administration, that it claims is more patient-friendly. "This is a tremendously positive step for both patient rights and the democratic process," said Rep. Charlie Norwood, R-Ga., of the Consensus Managed Care Improvement Act he introduced with Rep. John Dingell, D-Mich. "We now have a bill that isn't Republican or Democratic-it belongs entirely to the people." Unlike the Senate bill, the Dingell-Norwood bill would allow patients to sue their managed care plan for denial of benefits. At the same time, it contains provisions intended to prevent frivolous lawsuits. Detractors are not persuaded. "This legislation is built on the erroneous premise ... that trial lawyers are the sole guardians of good medical care," said Karen Ignagni, president and chief executive officer of the Washington-based American Association of Health Plans. "The experience with medical malpractice has demonstrated how false this is." The bill also would no longer allow managed care plans to decide when a treatment is a "medical necessity." Instead, such decisions would be made by an independent external appeals panel made up of physicians with expertise in the specialty under discussion but without any vested interests in either the managed care plan or the potential treatment. Dingell-Norwood would also apply to all employee-sponsored healthcare plans, while the Senate bill applies only to members of fully self-insured ERISA plans. The bill may be brought up for a vote as early as September. John Stone, a spokesperson for Norwood, said the final outcome depends on the support it garners in the House. "If we win big, say with 275 to 300 votes in favor, then the Senate will give in and abandon their bill," he predicted. "If the vote is close, the Republican leadership will demand a straight party-line vote and the Senate version will pass, only to be vetoed by the president."
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