Agenda progress subtle in 105th Congress

Moving into next year, patient protection legislation remains a priority for APA and the public.

By Lisa Rabasca
Monitor staff

The lesson psychologists might take away from Capitol Hill this year is you win some, you lose some, and sometimes by losing you can further your agenda.

Although Congress failed to approve patient-protection legislation, psychologists for the first time found bipartisan support for a bill that would allow more Americans to sue their managed-care plans for malpractice.

And while that bipartisan support eroded in July because of pre-election posturing, there was still a silver lining: Because no health-care reforms were approved, Congress will find itself under even more pressure next year to enact favorable legislation.

'The good news out of all that is that, in this instance, nothing being passed, is better than something [bad] being passed,' says Russ Newman, PhD, JD, APA?s executive director for practice.'My hope is that the energy level will kick back in, comparable to what it was before partisan politics got involved,' Newman says.

Recent public opinion polls show that consumers want health-care reforms that will guarantee them greater access to quality care, including equal coverage for mental and physical health and patient protections for Medicare enrollees. Pressure from the public will keep Congress focused on patient-protection legislation when lawmakers return in January, Newman says.

Before pre-election politics came into play, Democrats and Republicans supported the Patient Access to Responsible Care Act (PARCA), introduced in April 1997 by U.S. Rep. Charlie Norwood (R?Ga.) and Sen. Alfonse D?Amato (R?N.Y.).

The PARCA measure, which had 239 co-sponsors, would have amended the 1974 Employee Retirement Income Security Act (ERISA) to allow patients in ERISA-regulated plans to sue their managed-care company for inappropriate denial of treatment or inadequate care. Under current law, ERISA allows self-insured companies to avoid state insurance regulations.

In July, PARCA fell victim to pre-election bipartisan politics as lawmakers used health-care reform to clearly define the differences between Republicans and Democrats. PARCA seemed suddenly in jeopardy when the House approved a Republican leadership proposal that denied patients the right to sue managed-care companies for negligent care. The legislation basically died in August when Congress became preoccupied by the investigation into President Clinton?s relationship with former White House intern Monica Lewinsky.

Consumers support reform

Newman credits consumers with forging PARCA?s initial bipartisan support.'The degree to which [APA?s] concern and position about the health-care system resonated with the public?s concern enabled us to work more closely with consumer advocacy groups on reform,' he says.

And although lawmakers were distracted by possible impeachment proceedings, consumers haven?t forgotten health-care reform. Public support for a law allowing patients to sue their health plans for malpractice is growing, according to a Sept. 17 Kaiser/Harvard survey, which found that nearly three out of four consumers support such a measure.

Looking ahead

Norwood is expected to again introduce patient-protection legislation next year and Newman says the Practice Directorate is expecting the lawmaker to include a provision to amend ERISA. Senate Minority Leader Tom Daschle (D?S.D.) and Rep. John D. Dingell (D?Mich.) have pledged to continue supporting the Patients? Bill of Rights, which shares many of PARCA?s basic provisions?including the right to sue a managed-care plan if a company?s decision to deny treatment harms a patient.

In addition to patient protection, several issues remain on psychology?s agenda, including mental health parity legislation, medical-record confidentiality and Medicare graduate medical education funding for psychology internships.

Congress is preparing to renew debate on Medicare reforms next year after the National Bipartisan Commission on the Future of Medicare releases its recommendations for strengthening and improving the program. That report is to be based on changes approved as part of the 1997 Balanced Budget Act, which encouraged Medicare recipients to enroll in HMOs, preferred provider organizations and provider-sponsored organizations. The Practice Directorate actively participated in the Medicare debate, advocating that Medicare beneficiaries who enroll in the new managed-care programs should be protected through standards that provide high-quality care.

Many of the standards enacted for Medicare are similar to the patient protections included in PARCA and the Patients? Bill of Rights. These ban so-called'gag rules' that prohibit providers from telling patients about expensive treatment options; allow patients to challenge a plan?s denial of care; and prohibit plans from discriminating against health-care professionals solely on their licensure or certification.

The Practice Directorate had hoped the Medicare reforms would clear the way for similar changes in the private sector.'We were able to get the Medicare law to incorporate all kinds of patient protections and assumed, I think rightly so, that that would be a springboard for getting the same patient protections in the private sector,' Newman says.'I think the springboard worked to a certain extent. The bottom line is the success in patient-protection issues in Medicare did enable the patient-protection legislation to get a running start in the private sector.'

Next year, the Practice Directorate will be participating in the debate to ensure that Medicare patient protections are not repealed, says Marilyn Richmond, APA?s assistant executive director for government relations. The Practice Directorate will advocate for additional patient safeguards including requiring health-care professionals, not managed-care administrators, to make patient care decisions, and granting patients the option to see providers outside a closed managed-care network at a reasonable cost.

In addition, the Practice Directorate will begin gearing up for the reauthorization of the Mental Health Parity Act, which requires insurance companies to impose the same annual and lifetime benefit dollar limits for physical and mental health services.

The Practice Directorate hopes to broaden parity to include equal co-payments, deductibles, out-of-pocket costs and limits on visits for physical and mental health services. The current law expires on Sept. 30, 2001.

The Practice Directorate also will be keeping a watchful eye on medical record confidentiality.

'We hope to change the basis of the debate,' says Doug Walter, legislative counsel on the APA Practice Directorate government relations staff. The argument has been that insurance and managed-care companies have had access to patient records so why not pass a law to make access easier.

'We are trying to change the debate to make it more patient-friendly so that third parties can only get the records, when it is absolutely necessary and only when authorized by the patient,' Walter says.