After intense and somewhat controversial negotiations, the House on August 2 approved, 226-203, a bill (H.R. 2563) that would provide additional protections to individuals in managed health care plans while allowing those individuals to sue their health plans for denial of coverage. The House passed the bill after narrowly adopting, 218-213, an amendment by Rep. Charles Norwood (R-GA) that narrowed the bill’s liability provisions. Three Democrats voted for the amendment and six Republicans voted against it.
The version approved by the House reflects a compromise reached by the President and Rep. Norwood, an original cosponsor of the underlying bill. As introduced, H.R. 2563, sponsored by Reps. Greg Ganske (R-IA) and John Dingell (D-MI), would have granted individuals broader liability protections and is similar to legislation (S. 1052) approved by the Senate on June 29. The President had threatened to veto that measure due to its liability provisions.
During floor debate Democrats expressed their anger over the compromise, while Republicans hailed Rep. Norwood for brokering the deal. “I commend the hard work of so many, but especially the diligent efforts now on a timely basis of people like the gentleman from Georgia and President Bush, who understood compromise is still better for the American people than nothing at all. Laws are better than unresolved issues,” stated Rep. Porter Goss (R-FL).
Rep. Robert Menendez (D-NJ) said, “The patients’ bill of rights went into the White House emergency room with the gentleman from Georgia and it came out as an ‘HMO Bill of Rights,’ an ‘Insurance Bill of Rights,’ a special set of rights no other industry in America has.”
Prior to final passage, the House considered several amendments in addition to the Norwood amendment. The House approved, 236-194, an amendment by Rep. Bill Thomas (R-CA) that added Association Health Plans to the bill and expanded medical savings accounts (MSAs) by removing the cap on the number of accounts and making them available to all individuals. Another amendment by Rep. Thomas that would have reformed medical malpractice laws was defeated, 207-221. A motion to recommit by Rep. Marion Berry (D-AR) was rejected, 208-220.
Several of the access provisions of the bill would benefit women and children and are similar to provisions included in the Senate-passed measure. Rep. Jennifer Dunn (R-WA) discussed the bill from a woman’s perspective. “Woman [sic] usually schedule their children and their family’s health care. What are they looking to be protected from as we look at their health coverage?” she said.
“Women are interested in finding a way to get immediate access to their pediatrician or OB-GYN. We do that in this bill….She is looking for a review process of people like physicians who really care about her best health interests. She wants her family to be safe and well cared for. We provide this kind of recourse in this bill….We are looking for access to affordable health care….This woman wants to control costs and keep premiums affordable for her family,” she continued.
H.R. 2563 would require a health plan to provide access to emergency care without prior authorization, as well as timely access to specialists when specialty care is covered by the plan. Additionally, the bill requires plans to provide direct access to a physician specializing in obstetrics or gynecology. H.R. 2563 also would require plans to allow enrollees to designate a pediatrician as a child’s primary care provider.
In the event that a provider terminates participation in a health plan, H.R. 2563 would require that plan to continue coverage for a transitional period of time if the enrollee is undergoing a course of treatment for a serious and complex condition, is scheduled to undergo non-elective surgery, is pregnant or undergoing treatment for the pregnancy, or is terminally ill.
H.R. 2563 also would require health plans to provide coverage for routine patient costs associated with individuals participating in a federally approved clinical trial. Health plans would be required to provide coverage for inpatient hospital stays resulting from a mastectomy, lumpectomy, or lymph node dissection. Under the bill, coverage would be provided “for a period of time as is determined by the attending physician, in consultation with the patient, to be medically necessary and appropriate.”
Finally, health plans would be prohibited from restricting health care professionals from advising enrollees about medical care or treatment that is not necessarily covered by the plan.
Unlike the Senate-passed bill, H.R. 2563 would extend the authorization for MSAs through 2004. MSAs are set to expire at the end of 2002. Under current law, MSAs are available to businesses with 50 or fewer employees, and the overall number is capped at 750,000. H.R. 2563 would have expanded MSAs to businesses with up to 100 employees and extended the cap to 1 million. However, the Thomas amendment removed the cap and made MSAs available to everyone.
H.R. 2563 also includes a tax credit for small businesses that purchase health insurance for their employees. The tax credit would be available only to those small businesses with 50 or fewer employees that had not previously offered health insurance. A similar provision was not included in the Senate-passed bill.
Additionally, the House-passed bill would provide a 100 percent deduction for self-employed individuals who purchase health insurance. Full deductibility would be effective in 2002. Under current law, full deductibility will be phased-in by 2003.
