Feeling the pressure of election-year politics, the U.S. Senate narrowly approved a Republican-sponsored patients’ rights bill in late June that gives HMO members a limited right to sue their insurer. A more inclusive Democrat-backed bill went down to defeat on a largely partisan vote.

One leading opponent of the Senate legislation was Georgia Representative Charles Norwood, a Republican and coauthor of the House’s related bill, which extends broader protections and rights to HMO patients and includes more insured individuals. Norwood labeled the Senate bill, which received no Democratic votes, a "monstrosity" and predicted it would garner no support in the House.

APA backed Norwood’s patients’ rights legislation over several competing bills, concluding that it offered patients, particularly those with mental illnesses, the most comprehensive protections and liability provisions among the competing alternatives. Staff of APA’s Division of Government Relations met with key lawmakers to urge them to support Norwood’s bill, which was coauthored by Rep. John Dingell (D-Mich.).

The Senate proposal was attached as an amendment to an appropriations bill for the departments of Labor and Health and Human Services.

A key difference between the House and Senate versions is that the House bill would give patients the right to sue their HMOs for unlimited damages for the consequences of delayed or denied care in either state or federal court. The Senate bill, because it extends this right only to beneficiaries whose plans are covered by the federal ERISA law, would only allow patients to sue their insurer in federal court. The Senate bill allows even those suits to proceed only after the patient has gone through an independent review process.

In addition, the House bill, which is strongly supported by Senate Democrats, would apply its provisions to all insured Americans, while the Senate Republicans’ bill would cover only those in self-insured health plans, about one-third the number who would gain protections under Norwood’s bill.

The Senate passed another patients’ rights bill last year, and a joint conference committee was appointed to resolve the differences between the versions passed by the two chambers. Republicans on the conference committee have shown little if any inclination to compromise and accept some of the House bill’s provisions, and frustrated Democrats, seeing no chance to make the bill more comprehensive and consumer oriented, have boycotted recent meetings of the conference committee. As a result, Sen. Don Nickles (R-Okla.), author of the Senate bill, bypassed the conference committee and negotiated directly with his Republican colleagues to arrange for them to vote in favor of his bill, which they did on June 29.

In the week after the Senate passed its patients’ rights bill, prospects for finding common ground before the end of the current congressional session appeared doubtful.

In a speech at the University of Missouri on July 6 President Bill Clinton added his voice to the chorus condemning the Senate bill and calling on Congress to enact the Norwood-Dingell version. He described the Senate Republicans’ bill as "worse" than having no bill and said that the bipartisan House version was a "real" patients’ rights bill.

In a much more decisive vote, the House reversed nearly a century of labor law that barred independent physicians from organizing to bargain collectively. By a 276-136 vote on June 30, the House endorsed a bill heavily lobbied by the AMA and introduced by Rep. Tom Campbell (R-Calif.) to permit physicians to engage in collective bargaining with HMOs and other managed care organizations. APA is a strong supporter of this change in the nation’s antitrust laws and asked its members to contact their congressional representatives to urge them to support the bill and reject amendments designed to weaken the antitrust exemption.

The bill would give self-employed physicians the right to negotiate with managed care companies over fees and other terms of participation on provider panels, but not allow them to go on strike if they are unhappy with the results. The law would sunset after three years.

Despite the House’s enthusiastic backing of the collective-bargaining proposal, its fate in the Senate is in doubt since Senate Majority Leader Trent Lott (R-Miss.) is strongly opposed to it. After the House passed the bill, Lott commented, "I won’t be trying to pass it . . . I don’t think we need more. . . labor unions in America."

The insurance industry, which lobbied heavily against the House bill, is also likely to invest its resources to ensure that the bill goes no further.

Proponents of the collective bargaining bill, which covers physicians in private practices, contend that it would restore to physicians some of the control they lost to the insurance industry over how they are allowed to care for their patients.

While AMA Trustee Donald Palmisano, M.D., hailed the House vote on the bill as "a milestone victory for America’s physicians and their patients," managed care industry spokesperson Karen Ignani condemned it as "one of the most anticonsumer proposals ever approved by Congress" and suggested that it would lead to higher health insurance premiums.