Last updated on May 13th, 2019 at 02:21 pm
Different patient protection bills in the U.S. House of Representatives and Senate are almost identical in many ways — except for the provision for medical liability for HMOs.
The various bills generally guarantee that patients can go to the nearest emergency room, give women the right to go to their OB-GYN without a referral, provide access to specialists as necessary, and restrict the ability of health plans to give financial incentives to deny care. When insurance companies deny coverage, the bill would let patients appeal to an independent review panel that would make fast, impartial decisions. Finally, and only after exhausting appeals, patients would have the right to sue their HMOs in state court — ending a system that now virtually grants legal immunity to HMOs.
But the bills offer different approaches for offering patients of HMOs legal recourse in the event that they are harmed by a decision to deny coverage. Over time, a progression can be seen in proposals towards offering more concrete protection for employers from liability for the medical decisions of an HMO.
History: Passed by the House in October of 1999, but defeated in the Senate.
Liability: Criticized for leaving employers broadly liable for decisions of HMOs. Allowed suits against HMOS to take place in either federal or state courts. Most states have higher limits for punitive damages than the bill would impose in Federal court.
History: Passed in the Senate June 29, 2001. Threatened by a Bush Veto, bill supporters are working towards a supermajority to over-ride a veto should differences between Kennedy-McCain and a House version be reconciled.
Liability: Amendment added prior to bill passage that would protect employers from liability through identifying a specific decision-maker who is bondable and liable for medical decisions. Critics charge there is other verbage in the bill that may still leave employers — particularly self-insured ones, open to lawsuits.
History: Passed in the House June 26 of 2001 and endorsed by President Bush a day later.
Liability: States in unequivocal terms that employers are not liable for health care decisions made by HMOs.
Aug. 17, 2001 Small Business Times, Milwaukee