- U.S. Rep. Charlie Norwood (R-GA), 10/6/99

On October 7, 1999, the U.S. House of Representatives took historic action in support of expanding the legal rights of consumers when it approved by a vote of 275 to 151 the "Bipartisan Consensus Managed Care Improvement Act," H.R. 2723 by Rep. Charlie Norwood (R-GA) and John Dingell (D-MI). This bill would greatly expand patients' rights and allow patients to hold managed care insurers legally accountable for delay or denial of care that results in injury or death.

While not perfect in every detail, Norwood-Dingell would eliminate the ERISA preemption of state causes of action against HMOs.

It requires that insurers provide access to emergency care without pre-approval, the opportunity for patients to select an ob-gyn or pediatric specialist for primary care, and other important patient protections. It also includes an anti-gag provision prohibiting insurers from ordering doctors not to suggest tests or procedures they think necessary.

The Republican leadership supported the alternative measures, including the Boehner substitute, which had no liability provisions, the Goss-Coburn-Shadegg bill, and the Houghton amendment.

The Boehner measure failed by a vote of 285 to 145.

The Goss-Coburn-Shadegg bill, which failed by a vote of 238 to 193, contained a sham liability provision that permits suits only in federal court and only in rare circumstances. It required the exhaustion of three confusing levels of appeals (one internal and two external) before any legal action and establishes an unjustified, rebuttable presumption in favor of the appeal panels' decisions.

Goss-Coburn-Shadegg also contained a radical "loser pays" provision to intimidate plaintiffs, as well as stringent caps on non-economic and punitive damages. It preempted all state law remedies, including medical malpractice claims which might involve different defendants.

The Houghton amendment, which failed by a vote of 270 to 157, would have created a very limited federal cause of action with caps on non-economic damages. It was similar to the more extreme Goss-Coburn-Shadegg measure.

The House, on October 6, approved legislation-that will be combined as a "poison pill" with the bill passed today-that provides tax breaks for various health insurance costs, including deductions for so-called "medical savings accounts." That legislation is opposed by most Democrats.

The House managed care bill will now go to the Senate, which earlier approved a much weaker measure that provides few new patient protections and no liability provisions. A joint House-Senate conference committee would attempt to work out a compromise bill.

NOTE: You can find the text of the Norwood-Dingell bill, the various amendments and substitutes, and a breakdown of all the votes at http://thomas.loc.gov -- just enter the bill number (HR 2723) at the top of the page.