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Patients
Bill of Rights moves in Congress;
Do we need more legislation?
By
Raymer M. Sale Jr.
President
Multiple Benefits Corporation
Special to GwinnettForum.com
LAWRENCEVILLE, July 20, 2001 - - Senators John McCain and Ted Kennedy
have proposed and the Senate has pass a "Patient's Bill of
Rights." This bill gives a patient who is covered by an HMO
the right to sue that HMO for denial of benefits and for quality
of care issues.
The action against the HMO can be litigated in State and Federal
courts depending on the type of suit with a $5 million limit on
punitive damages at the Federal level. There is no limit on pain
and suffering or economic loss.
However, the bill goes beyond the right to sue the HMO. It also
guarantees access to non-network emergency rooms, access to specialists,
minimum hospital stays for mastectomy patients, and access to government
run clinical trials. And the bill allows employers to be sued if
they directly helped make a decision against a patient. In the case
of partially or fully self insured and administered plans the employer
can avoid a lawsuit if an outside entity assumes the risk. The estimated
increase in health insurance/HMO cost is 4.2%.
The bill passed by the Senate was modified from the original bill
with regard to employer liability, but that liability still exists
under certain circumstances. This single feature, if ultimately
passed into law, will cause many employers to re think their position
on providing health insurance for their employees and could result
in many employers discontinuing the benefit.
If that should occur these employees will be dumped into the individual
insurance market. Since the individual products are underwritten
differently from the group insurance products, a significant number
of these employees and their families will not be able to buy coverage
due to health conditions.
Another negative effect of this type of legislation is the increase
in costs. Senator Max Cleland's office says the Senate version of
the "Patient's Bill of Rights" will only add an estimated
4.2% to the cost of insurance, and the Republican supported version
will add 2.9%, a difference of only 1.3%. They are correct.
Here is the problem with that line of thinking. If the legislation
only adds 4.2% or 2.9% to the cost of insurance, it will be on top
of another recent increase caused by the Health Insurance Portability
and Accountability Act (HIPAA). We are still reeling from the increase
in insurance costs as a result of HIPAA.
Therefore, costs resulting from the HIPAA legislation and this "Patient's
Bill of Rights" legislation will only exacerbate an already
deteriorating pricing situation.
The increase may actually be much higher than 4.2%. The fact is,
add a few percent here and a few percent there, and pretty soon
the cost of the product---our protection---is out of the reach of
the consumer.
With regard to State mandates, Georgia has a "Patient's Bill
of Rights" and the features of the proposed Federal Law pertaining
to mastectomy patients, emergency room care, and access to specialists
already exist in our state. This is good news because the increased
cost to Georgians should be less than the 4.2% or 2.9% projected
with this law.
The fight is not over, as the House of Representatives will begin
discussion on their version of the "Patient's Bill of Rights"
around July 25. Should the House approve their version, both bills
will then go to a conference committee where the differences will
be debated. The agreed upon final legislation could then be adopted
and the nation could then have a " Patient's Bill of Rights."
It is not too late to contact your Congressman and Senators to
express your opinion. Do we really need more legislation in the
healthcare system?
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