Editorial: Health care reform may wither again

Friday, March 26, 1999 | 11:53 a.m.

Much of Congress' work in 1998 was wracked by fractious partisanship that doomed important legislation, including health care reform. After President Clinton's acquittal in his Senate impeachment trial, though, there was some hope that the comity that developed in the upper house in dealing with that potentially divisive issue could be transferred to other critical issues confronting the nation in 1999.

But optimism that once existed for the passage of a patient's bill of rights is dissipating. There have been recent signs that congressional efforts to reform HMOs in 1999 could be a dismal repeat of 1998, when the Republican-dominated leadership in both houses killed meaningful health care reform.

Last week the Senate Committee on Health, Education, Labor and Pensions did vote to give HMO patients more rights, but the legislation clearly isn't as comprehensive as it should be. The legislation would guarantee that more than 120 million Americans in employer-sponsored health care plans could have the option of appealing decisions if they're denied coverage of particular services. But other major protections in the bill -- ensuring that reasonable emergency room visits would be covered, giving women direct access to gynecologists and guaranteeing that terminally ill patients and pregnant women could keep their doctors for three months if their doctors get dropped from their plans -- are severely curtailed.

These provisions only apply to the 48 million Americans covered under self-funded plans set up by their employers. These self-funded plans usually are run by larger companies that have the financial ability to assume the risk of insuring their employees. Since self-funded plans are federally regulated and the states oversee the remainder of the plans, Republicans argue there isn't a need for Congress to establish protections for all patients.

The Republican Senate plan is incredibly short-sighted. Patient protections for a family shouldn't hinge on whether the breadwinner works for a company large enough to set up a self-funded health plan. A patchwork of regulations establishes a disparity that is unfair, especially for residents who live in states without managed care oversight. Congress should set a floor, an absolute minimum, so that all Americans can benefit equally from patient protections.

Also rejected by Senate Republicans on the Committee on Health, Education, Labor and Pensions was a Democratic plan that would allow patients to sue HMOs and other health plans if their treatment is denied or delayed. When the Senate takes up the bill sometime this spring, it should amend the legislation so that HMOs are responsible for their actions, allowing Americans to file lawsuits and recover damages if an HMO harms a patient. There is no reason why this industry -- unlike any other -- can't be held accountable for its actions.

Meanwhile in the House, movement has been slow on health care reform, with the New York Times reporting that new House Speaker Dennis Hastert, R-Ill., isn't interested in comprehensive legislation. Instead Hastert would prefer that a series of limited bills, which target specific plans, get passed. "The problem is, we'll run out of time before we get to the hard parts," laments Rep. Charlie Norwood, R-Ga., who has introduced legislation similar to that offered by House Democrats. "And if we don't get to any of the hard parts, you're not going to get any congratulations on the easy parts."

Norwood has identified the salient issue. Republicans are mistaken if they believe that passing a limited patient's bill of rights will earn them enough political cover so they won't suffer any damage with their constituents. If Congress passes legislation that gives patient rights to less than half of the potentially eligible Americans, those without the protections will understandably be upset when they discover that some of their neighbors have them but they don't.

Sen. Chris Dodd, D-Conn., probably summed it up best when he said of the developments last week: "This is pretty depressing. It's greed prevailing over need." A Band-Aid approach to health care reform won't work. Congress instead should pass legislation that is uniform, setting minimum standards so that all Americans are guaranteed the same patient protections.