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PATIENT PROTECTION LEGISLATIVE UPDATE AUGUST 6, 2001


MEMORANDUM

TO: APA Members
FR: Russ Newman, Ph.D., J.D., Executive Director for Professional Practice
RE: August House Action Completed on Patient Protection Legislation

UPDATE:
Last Thursday evening the House passed a weakened version of the Ganske-Dingell Bipartisan Patient Protection Act (H.R.2563) by a 226 to 203 vote.

Although the House narrowly approved (218 – 213) an amendment weakening some areas of the bill, the House-passed legislation still includes a number of key provisions that are in the Senate version of the bill. These include that:

  • Patients can appeal the denial of care by seeking an independent review.
  • Health plans must provide prompt access to specialists.
  • Patients can get emergency care at the nearest hospital.
  • Health plans must provide access to clinical trials of experimental therapies if no standard treatment is effective.

    The House bill also includes an accountability provision allowing patients to sue health plans for a denial of care. Unfortunately, this provision is significantly different from the stronger provision passed by the Senate June 29 and we will seek to strengthen it during conference.

    The House and Senate bills must be reconciled before anything can be sent to the President for signature, which could prove difficult. The two different legal accountability provisions will have to be reconciled into one provision.

    THE AMENDMENT: The Ganske bill was weakened by an amendment containing a deal struck between President Bush and Congressman Charlie Norwood (R-GA) last Wednesday night. It imposes a low cap on noneconomic damages, something 27 states do not presently have. Because the $1.5 million damages cap is not to be adjusted for inflation, it will erode over time any disincentive for health plans to avoid cutting corners to increase profits. Further, the amendment selectively overturns certain higher state caps while letting any lower state caps stand. In addition, the provision provides a more narrow cause of action to allow injured patients the ability to go to court. This means that some patients with legitimate claims may not be able to access the courts for their injuries. As negotiations between the House and Senate begin in September, we will continue to work for a strong patients' bill of rights, including a legal accountability provision similar to that passed by the Senate.

    THANK YOU!
    This was a very close vote thanks largely to grassroots support for a strong bill. The White House, Republican House Leadership, business and insurance groups all opposed a strong bill and brought considerable pressure to bear. While we did not get everything we wanted, there are still some hard-won patients' rights in this bill that are long overdue. Our job now is to ensure that there is a strong legal accountability provision should managed care plans chose to ignore these fundamental consumer rights.

    Thanks to those of you who contacted your Members of Congress, we are in a very good position to work with this Congress on improving and passing a bill in the Fall that the President will sign. REMEMBER – THE NORWOOD AMENDMENT WOULD HAVE FAILED IF JUST 3 HOUSE MEMBERS CHANGED THEIR VOTE.

    ACTION: Please take a moment to call your Representative's office and express either thanks for opposing the weakening Norwood amendment, or disappointment for supporting the amendment. This kind of follow-up lets Representatives know that their votes are not forgotten right after they occur. Members can still use the APA Practice Organization Legislative Hotline at 1-800-401-9888 to contact congressional offices.

    THE VOTE:
    PLEASE NOTE -- THREE MEMBERS DID NOT VOTE ON THE NORWOOD AMENDMENT – NO PHONE CALLS OR EMAILS SHOULD GO TO THESE MEMBERS AT THIS TIME:
    Illinois- Bill Lipinski (D )
    South Carolina- Floyd Spence (R )
    Texas- Ron Paul (R )

    Please thank the following Republicans and all Democrats (except for those three listed below) for their courageous vote against the Norwood amendment and on behalf of patients:
    Greg Ganske (Iowa)
    Timothy V. Johnson (Ill.)
    Jim Leach (Iowa)
    Constance A. Morella (Md.)
    Marge Roukema (N.J.)
    Christopher H. Smith (N.J.)

    Please express your disappointment to the following Democrats and all Republicans (except those listed above) for their vote in favor of the Norwood amendment:
    Ken R. Lucas (Ky.)
    Collin Peterson (Minn.)
    James A. Traficant Jr. (Ohio)

    Please contact the Practice Organization's Government Relations department at (202) 336-5889 if you have any questions.

    TO FIND YOUR REPRESENTATIVE
    Go to the House website and enter your zip plus four:
    http://www.house.gov/house/MemberWWW.html

    TO VIEW A COPY OF THE COMPLETE VOTE ON THE NORWOOD AMENDMENT:
    http://clerkweb.house.gov/cgi-bin/vote.exe?year=2001&rollnumber=329

    EMAIL
    While phone calls work best when a vote has already taken place, if you prefer you may send an email message.

    BE SURE TO SEND A COPY OF YOUR EMAIL MESSAGE TO:
    pracgovt@apa.org

    To send an email to your member go to the address below:
    http://www.house.gov/house/MemberWWW.html

    When addressing an e-mail to a member of Congress, the body of your message should use the following format:

    SAMPLE LETTER OF DISAPPOINTMENT:
    Your name and degree
    Address
    City ST ZIP

    Dear Representative _________,

    I am writing as a constituent and a psychologist to express my disappointment on your vote in favor of the Norwood amendment. This amendment to Representative Ganske's “Bipartisan Patient Protection Act” (H.R. 2563) favors HMOs over patients in any legal action. Regardless of the merits of the case, or of the degree of harm, the patient could be unfairly restricted in seeking legal redress and in receiving adequate remedy for egregious harm.

    Current law regarding health plan accountability needs to be changed. The law presently allows health plans to make negligent cost-containment decisions, including denials of covered benefits, without adequate accountability to the patient.

    I urge you to reconsider your vote when Congress returns from recess and the Conference Committee convenes. Surely Congress can do better in protecting patients from harm. I look forward to hearing your thoughts on this important issue.

    Sincerely,


    SAMPLE THANK YOU LETTER:

    Dear Representative______________:

    I am writing as a constituent and a psychologist to thank you for you courageous vote against the Norwood amendment and in favor of real patient protections.

    The Norwood amendment to Representative Ganske's “Bipartisan Patient Protection Act” (H.R. 2563) favors HMOs over patients in any legal action. Regardless of the merits of the case, or of the degree of harm, the patient will be unfairly restricted in seeking legal redress and in receiving adequate remedy for egregious harm. I thank you for recognizing this and doing the right thing.

    If there is anything I can do as a health care professional to assist you or your office when this issue comes up for Conference Committee in the Fall, please do not hesitate to contact me.

    Again, my sincere appreciation for your courageous vote.

    Sincerely,




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