Mr. President, I rise today to speak on a very important piece of legislation–legislation that is vital to the future of health care in this country, the Patients’ Bill of Rights. Democrats have fought long and hard to debate this bill on the floor of the Senate and I am thankful for the opportunity to speak in support of the underlying measure.
Today more than 160 million Americans, over 75 percent of the insured population, obtain health coverage through some form of managed care. Managed care arrangements can and do provide affordable, quality health care to large numbers of people. Yet reports of financial consideration taking precedence over patients health needs deserve our attention. We hear stories and read news articles about people who have paid for health insurance or received employer-sponsored insurance, became ill, only to discover that their insurance does not provide coverage. Recent surveys indicate that Americans are increasingly worried about their health care coverage. 115 million Americans report having a bad experience with a health insurance company or knowing someone who has. This undermining of confidence in our health care system must be addressed. We must act to restore the peace of mind of families in knowing that their health insurance will be there when they need it most. We can accomplish this by establishing real consumer protections, restoring the doctors decision-making authority, and ensuring that patients get the care they need.
Some of the important issues that we are debating include the scope of coverage, definition of who determines “medical necessity,” protecting the doctor/patient relationship, access to care, and accountability.
True managed care reform cannot come from a narrow bill that covers only a certain segment of the population. Today much of the regulation of managed care plans comes from the states. However, federal laws such as the Employee Retirement Income Security Act of 1974 (ERISA) and the Health Insurance Portability and Accountability Act, combined with the various state regulations, form a patchwork of regulation for managed care plans. Some in this chamber believe that the protections we are considering should only apply to ERISA-covered plans and not to the 113 million Americans who have private insurance that is regulated by the states. They argue that these issues should be left to the states to address. Democrats believe that everyone deserves equal protection, regardless of where they may live or work. The Patients’ Bill of Rights would not interfere with patient protection laws passed by the states, it would simply extend these patient protection rights to all Americans.
As managed care has grown, so has the pressure on doctors and other health care providers to control costs. Complaints receiving widespread attention include denials of necessary care, lack of accountability, limited choice of providers, inadequate access to care, and deficient information disclosure for consumers to make informed plan decisions. Mr. President, a strong Patients’ Bill of Rights should address the shortcomings of managed care. S. 6 takes a comprehensive approach in dealing with these issues, which is why I am a cosponsor of the measure.
The dominance of managed care has undermined the doctor-patient relationship. Often tools are used to restrain doctors from communicating freely with patients or providing them with incentives to limit care. We need to ensure that insurers cannot arbitrarily interfere in the medical decision making. The Patients’ Bill of Rights includes a number of provisions to prevent arbitrary interference by insurers. Our bill establishes an independent definition of medical necessity, prohibits gag clauses on physicians and other restrictions on medical communications, and protects providers from retaliation if they advocate for their patients.
The issue of who decides what is medically necessary is probably the most fundamental issue of this debate. We must empower patients so they receive appropriate medical treatment, not necessarily the cheapest treatment, not necessarily the treatment that an insurance company determines is appropriate, but the best treatment. Currently, many doctors are finding insurance plans second-guessing and overriding their medical decisions. Democrats believe that the “medical necessity” of patient care should be determined by physicians, consistent with generally accepted standards of medical practice. Doctors are trained to diagnose and make treatment decisions based on the best professional medical practice. We need to keep the medical decisions in the hands of doctors and not insurance company bureaucrats.
Families in managed care plans often face numerous obstacles when seeking access to doctors and health care services. Some of these barriers include restrictions on access to emergency room services, specialists, needed drugs, and clinical trials. S. 6 would ensure access to the closest emergency room, without requiring prior authorization. It would provide access to qualified specialists, including providers outside of the network if the managed care company’s choices are inadequate, and direct access to obstetricians and gynecologists for women and pediatricians for children. S. 6 would also ensure access to drugs not included in a managed care plan’s covered list when medically indicated and provide access to quality clinical trials.
Finally, Mr. President, the underlying bill allows consumers to hold managed care companies accountable for medical negligence. Currently, insurers make decisions with almost no accountability. Patients deserve the right to a timely internal appeal and an unbiased external review process when they disagree with a decision made by the insurer. Patients also deserve recourse when the misconduct of managed care plans results in serious injury or death. However, under ERISA plans, patients have no right to obtain remedy under state law. These patients are limited to the narrow federal remedy under ERISA, which covers only the cost of the procedure the plan failed to pay for. S. 6 would ensure that managed care companies can be held accountable for their actions. It does not establish a right to sue, but prevents federal law from blocking what the states deem to be appropriate remedies. A strong legal liability provision will discourage insurers from improper treatment denials or delays and result in better health care.
Mr. President, only a comprehensive bill will guarantee patient protection with access to quality, affordable health care. We should not miss this important opportunity to enact meaningful legislation that is federally enforceable and will improve care and restore confidence in our health care system.
