Patiently waiting
Competing 'bill of rights' proposals at loggerheads
By Andy Walton
CNN Interactive
The call for a "patients' bill of rights" has been a campaign issue for both parties. But the parties differ on what the phrase means, and while a compromise has been slow in coming, rhetoric has been abundant.
The House of Representatives passed the Norwood-Dingell bill, which the Clinton administration supports, last year. The Senate passed its Republican proposal, and attempts to hammer out a compromise stalled for months. In late June, the Senate passed a Republican compromise bill -- dubbed the Nickles amendment, after its sponsor, Oklahoma Republican Don Nickles -- that would allow lawsuits against HMOs, but the House and Senate have still been unable to reconcile their conflicting bills.
Key differences between the House and Senate bills:
- The Senate bill covers only the 58 million Americans whose employers are "self-insured," and whose programs are not subject to state regulation. Senators supporting the bill say the states should be allowed to regulate health insurance where they can. The House bill would apply to everyone with private insurance, a number the Democrats estimate at 161 million.
- The Senate proposal would allow patients to appeal decisions denying coverage through an appeals process established by the HMOs. The House version specifies an outside reviewer.
- Both bills include a "prudent layperson" standard -- HMOs and other insurers would be required to cover emergency room care if a prudent layperson would consider the case urgent. The House plan would go farther in requiring coverage of post-stabilization care.
- The Senate plan includes Medical Savings Accounts (MSAs), which bypass insurance companies; Republicans believe that spending their own money directly will lead consumers to make more cost-effective decisions, and that competition will drive costs down. Democrats worry that MSAs will lead the "young, healthy and wealthy" to leave the insurance pool, driving up rates for everyone else.
While a compromise has remained elusive, the rhetoric has become heated as each side has tried to use the issue to its advantage in an election year while accusing the other of using the issue to its advantage in an election year.
Republicans attack the Democratic proposal, saying that it will enrich trial lawyers and, by increasing costs, cause millions of people to lose coverage. Democrats attack the Republican plan as watered down and ineffective, and accuse the GOP of bowing to the insurance industry.
Most observers agree that any legislation is unlikely this year; both parties are distracted by campaigning and neither side wants to give the other a potentially winning issue in November.
While federal legislation has been slow in coming, state governments have developed their own versions of a patients' bill of rights. The laws vary widely, but some of the most common features are shown in the interactive map below. Use the lect and right arrows too navigate through the topics.
