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Congress Debates BandAids as Profits Grow

from September, 1999 Newsletter

The good news is that the continuing degradation of our health care system-even for those with insurance-is on the agenda; politicians in Washington know they must at least talk about health care reform. The bad news is they're debating about the size of the BandAid.In August, the Senate passed a Republican-backed patient protection bill that will cover the 48 million people in plans that are self-insured by their employer (only about five million of whom are in HMOs). The House is expected to debate a version of patient protection this fall. President Clinton says he would veto the Republican bill if it reaches his desk.

Among other provisions, the Senate bill would :

- Require coverage for emergency care at an out-of-network hospital
- Require coverage of routine care for patients enrolled in clinical trials concerning cancer treatment
- Require "timely access" to specialists (no specific time limits are established by the bill)
- Force plans to have a process for appealing claim denials, including review by someone outside the insurance company. (The insurer may, however, choose who does the reviewing.)

Democrats demanded that all 161 million people covered by private insurance be covered by patient protection legislation. They said patients should be able to sue plans for damages caused by wrongly-denied care, and that the Republicans' external review provisions were much too weak.They did not, as a party, use the health care debate to call for a single payer plan, which would remove the need for piece-meal reform legislation.

Health Care Legislation in the 106th Congress

In the current session of Congress, both parties have already proposed legislation with "Patients' Bill of Rights" in the title. The Democrats were first with S. 6/H. R. 358. In the Senate, the "Patients' Bill of Rights Act of 1999" was sponsored by Sen. Tom Dashcle, with 31 additional co-sponsors. The Republicans followed with S. 300 and H. R. 448. Sen. Trent Lott and 49 others sponsored the "Patients' Bill of Rights Plus Act." The "Plus" apparently refers to the promotion of "Medical Savings Accounts" tacked onto such rights as the Republican leadership has seen fit to bestow. Here's a few rights; plus, bend over.

It should be no surprise that the Democrats propose more and better rights than do the Republicans. The Families USA web site has a detailed chart comparing this legislation on these points. However, both sides here are dealing with rights that could be exercised only by individuals who have health insurance, and then only within limits set by the terms of that coverage.

Neither the Republican nor the Democratic leadership has seen fit to address health care for the uninsured or the underinsured - that would be anywhere from a minimum of 17 percent of the American population to more than 25 percent, depending on where the line is drawn between "decently insured" and "underinsured." With all the rights proposed, there is no right to health insurance coverage and no requirement that the coverage meet any minimal standard.

However, there is one surprisingly decent proposal now before the Congress. On March 19, 1999, the American Health Security Act of 1999 (H.R. 1200) was introduced. The principal sponsor is Rep. Jim McDermott (D, Washington). There are 17 co-sponsors to date, including Rep. John Conyers from Michigan.

We have a summary of the provisions of the bill on our web site. It does provide for universal coverage, and would be financed by a reasonable combination of payroll and income taxes. Long-term care, dental services, mental health services and prescription drugs are covered.

The bill is very similar to the old H.R. 1200 from the last session of Congress, a session in which all attempts at health care reform died. Perhaps, with no all-consuming debate on impeachment to provide an excuse for ignoring it, the subject of health care reform will be seriously addressed this time around.

There are other bills proposing a variety of minor reforms. S. 117 would permit individuals to continue existing health plan coverage while participating in clinical trials. H. R. 76 would change hospital security procedures to make infant abductions less likely. H. R. 293 would prohibit health plans from discriminating against individuals on the basis of genetic information. H. R. 567 would require a non-emergency doctor to be available at all times for hospitalized patients. These minor bills, taken together, may do as much to improve health care as the Patients' Rights plans. That is, perhaps a little improvement, but not much, and certainly nothing to get enthusiastic about.

Congressman John Dingell of Michigan, with no co-sponsors, has introduced H. R. 16 "to provide a program of national health insurance, and for other purposes." His plan falls somewhat short of universal health coverage and depends on the creation of a national Value Added Tax for its financing. Even with all its shortcomings, H. R. 16 was the best bill in Congress before the (re) introduction of H. R. 1200, . Perhaps Congressman Dingell will see fit to withdraw his bill and support universal coverage.

Managed care providers, who blocked HMO regulation proposed in Congress in the fall of 1998, are already planning to shape the health care debate for the elections in 2000. The American Association of Health Plans will soon launch a $1 million media offensive in early Presidential contest states Iowa and New Hampshire. Its message: A government-knows-best approach will cost workers and small business owners dearly.

"We want to change the anti-managed care climate," says AAHP chief Karen M. Ignagni.

(from Business Week, November 9, 1998)

An Associated Press article written in November of 1998 details the expenditure of $60 million lobbying the 105th Congress to defeat any type of reform. (This article is located in our "Archive" section. Use your "BACK" button to return to here.)

HMOs and similar providers of corporate medicine would like to continue blocking any and all reforms. The mainstream party organizations would prefer to limit debate to whether someone with insurance coverage should or should not have the right to sue the insurance provider. The American Health Security Act of 1999 goes far beyond this boundary, and actually addresses the real problems with American health care today.

We have the opportunity to force a much wider debate about overthrowing corporate medicine entirely. At this moment, the chances of H. R. 1200 becoming law are roughly zero, even though many ordinary people would support it - if they knew about it. Our job is to focus the attention of newspaper editors and readers, TV reporters, elected representatives, doctors, nurses, union activists, etc. on the issues of universal health care. Talking and writing about this bill is one way to do that.

Thomas - U. S. Congress on the Internet has the full text and current status of bills under consideration in Congress. It will help to know the numbers of the bills you are looking for. (see above) This web site is run by the Library of Congress.