The Right Prescription for Patient’s Rights

By Congressman Adam B. Schiff

The House of Representatives is poised, for the second time in two weeks, to vote to give patients a broad set of protections under their health plans. This important issue has been debated for years, and the Senate has already passed this bill. Few legislative reforms will be as vitally important to all Americans as a Patients' Bill of Rights to protect the health of the millions who are enrolled in managed care organizations.

The Patient Protection Act of 2001, introduced by Representatives Ganske, Dingell, Norwood and Berry, reflects the concerns of patients, doctors, employers and insurers alike. The patient's bill of rights is supported by 691 organizations representing doctors, nurses, patients' rights advocates, and consumer groups, including the American Medical Association, the American Psychological Association, the American Cancer Society, and the Child Welfare League of America.

The Patients' Bill of Rights both restores the doctor-patient relationship and guarantees patient access to medically necessary care. I am proud to be a cosponsor of this bipartisan legislation guaranteeing patients a right to choose their own doctor; to access obstetrical-gynecological care for women and pediatric care for children; to seek a second opinion after being diagnosed with cancer; to stay in the hospital for an appropriate length of time after a mastectomy; to participate in clinical trials that are approved and funded by government agencies for diseases like Parkinson's, cancer, Alzheimer's and many other life-threatening illnesses; to go to the closest emergency room without seeking prior-authorization (tough to do when you are unconscious); to seek ambulance services in emergencies without excess out-of-pocket costs or coverage denials; to access timely specialty care; and to obtain medically necessary drugs even when they are not included in the plan's drug formulary.

Not only does this bill take into account the quality of care that patients receive, but it also begins to address the serious problems this nation faces with a growing number of people who are uninsured or underinsured. The bill expands opportunities for individuals to have medical savings accounts, increases the deductibility of insurance premiums for self-employed individuals to 100 percent immediately, provides grants to states for programs that provide health insurance to the uninsured through market innovation, establishes a program to facilitate health benefits information for small employers, and provides tax credits for small employers offering health insurance for the first time.

California has already passed one of the nation’s most comprehensive patients’ bill of rights. When I served in the State Senate, I authored one of the key provisions of California’s Patients' Bill of Rights establishing a patient’s right to appeal to an independent medical review board if their HMO denies treatment recommended by their doctor. In California, once a medical case has gone through the independent review, and if a patient still suffers substantial harm as a result of continuing health plan delays, denials, or modification of medically necessary care, then that patient can sue his or her managed care organization.

Unfortunately, provisions of California's Patients' Bill of Rights and similar protections enacted by other states throughout the country would be preempted if the Ganske-Dingell legislation fails and the industry-supported alternative succeeds. Moreover, California law does not cover all of those enrolled in managed care because even current federal law may exempt insurance plans which operate in more than one state from having to abide by state patient protection laws. Without a federal Patients Bill of Rights, the 190 million Americans in managed care plans are left without these protections. This must change.

The Ganske-Dingell bill is the result of many compromises and negotiations. One such carefully crafted provision allows a patient, after thoroughly exhausting all administrative avenues, to sue their health plan if their health plan fails to exercise the ordinary standard of care in making a decision over coverage, eligibility or cost-sharing, and the mistake results in personal injury or death.

This legislation will not open the floodgates to litigation. It will not expose employers to increased liability. It will not mandate coverage decisions that are not included in a patient's health plan. But it will ensure that the people making medical decisions are patients and doctors, not bureaucrats.

The time has come for Congress to set aside partisan differences and act on behalf of patients rather than any special interest group. California lawmakers owed it to the 29 million Californians who receive health care from managed care, to make sure they had a patients' bill of rights. Now, members of Congress owe it to all Americans to enact a national patients' bill of rights. This is the right thing to do and the time to do it is now.

(Published in the Pasadena Star News, August 2, 2001)

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