March 24, 1999

I thank Chairman Bilirakis for holding this hearing on patient protections, our first since October of 1997.

The issue of patient rights has been before the Congress for several years. I began working on the original Patients’ Bill of Rights late in 1996, and introduced it early in 1997. That bill evolved into the measure Dr. Ganske cosponsored in the last Congress, which fell five votes short of passage last summer.

No fewer than four comprehensive patient rights bills are before the Congress today. In addition to my own, three of my Republican colleagues have proposed their own legislation. Dr. Ganske’s legislation closely resembles mine. Dr. Norwood takes a different but no less comprehensive approach, while Mr. Bilirakis reintroduced the leadership bill brought directly to the floor last year.

Today’s hearing will begin to explore some, but not all, of the issues that must be included in any patient rights legislation. We will hear from a number of excellent witnesses, including the President-elect of the American Medical Association,

Dr. Reardon, and also Peter Thomas and Ron Pollack, both of whom served on the President’s Quality Commission. They will describe the hard experience of patients and providers in dealing with their health insurance plans.

While some rogues and scoundrels may be operating in the health insurance industry, we should readily recognize that many health plans are doing all the right things for their patients. Dr. Joseph Blum, from the GW Health Plan, will testify about the measures that some health plans have taken to ensure that patients get timely access to proper care. But with an issue as serious as health care, "some" plans providing "some" protections is just not enough.

Today’s hearing will explore some -- but only some -- of the protections that must be included in any patient rights bill: direct access to pediatricians and obstetricians or gynecologists; emergency room care, information disclosures, an end to gag rules, and a few others. All of these issues are important to patients, but so are many others, among them access to clinical trials, drug formulary protections, continuity of care, point of service, and perhaps the most important, external appeals, medical necessity, and liability.

As a recent Families USA report points out, states have increasingly taken aim at some of these issues. Unfortunately, the record reveals as many hits as misses. Consumers still can’t count on basic protections. Even states with strong consumer protections do not cover a large number of their residents. The 51 million Americans who receive their health insurance from a "self-insured" employer plan under the Employee Retirement Income Security Act are not protected by state laws.

We need comprehensive federal legislation that provides, at a minimum, a uniform floor that all Americans can stand on. In my judgment, that means three things:

One, a binding, independent external appeals process with the authority to resolve disputes between patients and plans in a timely manner;

Two, a strong enforcement mechanism that gives patients the ability to hold their health plan accountable in the event that it caused them injury or death;

And three, a standard for review that ensures that medical treatment decisions are made in accordance with prudent medical practice, based on the patient’s own medical record, the available medical evidence, and the judgment of the treating physician and the health plan.

Without these protections, the other rights may be meaningless.