Congressman Bill Pascrell

Representing the 9th District of NEW JERSEY

Making Patients the Top Priority

Jul 26, 2001
Op-Ed

Victoria Leone could hardly believe the improvement her husband Robert was making in his battle with cancer.  Thanks to regular physical therapy sessions following his radiation treatments, he was back to going up and down stairs on his own, and feeling much better.  Then Victoria's HMO informed her that their insurance would no longer pay for his therapy treatments.  They said they had become "preventative," and when Victoria complained extolling the virtues of the care he was getting, they told her to sign her husband up at a local health club.

What happened to Victoria and Robert could happen to any of us. And sadly, it is happening far too frequently to families all across America.   Patients are being confronted each and every day with insurance companies that prioritize profits over people, and put bottom lines ahead of basic fairness.  That is why we must end these abuses and ones like them, and reform the way that manage care operates in this country.

Congress is currently debating such sweeping reform.  In fact, the Senate has already passed a strong Patients' Bill of Rights authored by Republican John McCain and Democrat Edward Kennedy.  The House of Representatives was scheduled to take up this important measure this week, but, shamefully, its Republican leadership decided to put off the vote.  I am proud to be an original sponsor of H.R. 526, the Ganske-Norwood-Dingell version of the Patients' Bill of Rights, which also enjoys strong bipartisan support.  It is past time to pass this bill and send it to the President for his signature.

HMO reform is not about politics.  It is not about which party is right or wrong, or which party is privy to virtue when it comes to providing quality health care.  HMO reform is about moms and dads, brothers and sisters, grandmothers and grandfathers.  It is about accountability, and demanding that patients and doctors make health care decisions, not insurance company bureaucrats.  

The Patients' Bill of Rights does this in several important ways.  It applies its important protections to all patients with employment-based insurance as well as those that buy their own coverage.  It requires insurance companies to cover emergency services at the nearest emergency room, and allows patients to see an outside specialist at no additional cost whenever their health plan doesn't meet their specific medical needs.  The bill also guarantees the continuity of care, and protects the sacred doctor-patient relationship by ensuring that health care professionals are free to provide information about the range of treatment options.

Because it is so critical that disagreements between an HMO and a patient regarding treatment be resolved quickly and fairly, the Patients' Bill of Rights includes specific criteria and timeframes for reviewing - both internally and externally - a denial of a claim for benefits.  Lastly, the bill will finally allow patients to hold insurance companies accountable for their decisions, just as they can with doctors, nurses, and hospitals.

Those who oppose reform have made unsubstantiated assertions about the dangers of this bill.  They argue that the bill will ignite a litigation explosion, and subject small business owners to liability if they provide health insurance for their employees.  They say premiums will skyrocket, and that businesses will simply stop providing a health care benefit.   These assertions have been proven to be myths.

In Texas, where then-Governor George W. Bush didn't support, but allowed to become law, an HMO accountability bill, approximately seventeen lawsuits have been brought against managed care insurers since 1997.  That is an "explosion" of around four cases a year.

There has also not been a drop in insurance coverage.  To the contrary, during the law's first two years, the population in Texas grew by 700,000, and the number of people without insurance actually dropped by one percent.  The year after Texas passed its liability protections, premiums actually decreased, and last year the number of people with insurance increased by over 200,000.  In its annual report, the Census Bureau attributed a large portion of the increase in the number of insured Americans to the increase in employer sponsored coverage.

The most egregious fabrications may be related to the issue of employer liability.  The Patients' Bill of Rights specifically exempts employers from liability in state or federal court for every conceivable type of activity they could be engaged in, except those where the employer directly participates in a decision to delay or deny health benefits.  An employer can select or terminate a plan, even design the plan's benefits including co-payments, without being liable.   It is right in the bill, in clear language for anyone interested in facts.

This is an important debate, and the Patients' Bill of Rights is an important bill.  As this debate unfolds, I intend to remind my colleagues in Congress what this is really all about.  It is not about lawyers, and it is not even about insurance companies.  It is about Victoria Leone and people like her all across America.  We can do better, and we must.

Rep. Bill Pascrell Jr., D-Paterson, represents the 8th Congressional District.

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