House Takes Up Patients' Rights Legislation
As is being widely reported in the press, this U.S. House of Representatives is expected this week to once again consider legislation to establish a federal Patients' Bill of Rights. This action follows Senate passage of similar legislation (S 1052) on June 29. However, unlike the process in the Senate, the House is expected to begin with consideration of patients' rights legislation that President Bush is supporting. This bill (HR 2315), introduced by Representatives Ernest Fletcher (R-KY) and Colin Peterson (D-MN), is favored by House Republican leaders. An alternative bill (HR 2563), sponsored by Representatives Greg Ganske (R-IA), John Dingell (D-MI) and Charlie Norwood (R-GA), is very similar to the Senate-passed bill and like the Senate bill is unacceptable to the White House.
Congress has been debating a Patients' Bill of Rights for nearly four years, but progress has been stymied by partisan stalemate, particularly over the contentious issue of allowing individuals to sue their health plans in state court for monetary damages. In recent weeks, the White House threatened to veto both the Senate-passed bill and the Ganske-Dingell-Norwood bill because of objections over health plan liability - most prominently the right to sue health plans in state court for damages related to denied coverage for needed treatment. By contrast, President Bush is supporting the Fletcher-Peterson bill that severely restricts suits against heath plans in state court. Currently, sponsors of both bills are locked in a tight struggle for votes among House members of both parties.
For the past four years, NAMI has pushed hard for enactment of patients' rights legislation that includes enforceable standards for all health plans to ensure access to mental illness treatment services. NAMI will continue to support all proposals before Congress that contain the following key provisions:
1) Limits on the use of restrictive prescription drug formularies that operate as barriers toward access to the newest and most effective medications,
2) enactment of mandatory third-party, independent, clinical review with prompt timelines for binding decisions and,
3) coverage of routine treatment associated with participation in clinical trials for new treatments for serious brain disorders.
The Ganske-Dingell-Norwood bill (HR 2563) contains all of these key components. The Fletcher-Peterson bill (HR 2315) contains many of these protections as well, but in a more limited form. For example, both bills contain strong protections allowing doctors and patients to overrule a health plan's restrictive formulary when clinically appropriate. However, HR 2315 does not contain a protection in HR 2563 that would protect against higher cost sharing for prescriptions that are not on the plan's formulary. Further, HR 2315 grants external review panels more limited authority in reviewing health plan decisions to deny care than the powers granted to the same review boards created in HR 2563 (including the right to review medical necessity criteria). Likewise, the requirement for health plans to pay for routine treatment associated with participation in a clinical trial is restricted in HR 2315 to cancer treatment, and does not include clinical trials related to mental illness. Finally, the Ganske-Dingell-Norwood (HR 2563) contains stronger protections barring HMOs from creating financial incentives for physicians who deny care and penalizing physicians that advocate on behalf of patients.
For more information on NAMI's position on a patients' bill of rights, please go to NAMI Where We Stand Paper at http://www.nami.org/update/unitedbill.html
All NAMI members and advocates are encouraged to contact their House members and urge them to support a strong, enforceable Patients' Bill of Rights that ensures access to needed treatments and services for persons with severe mental illnesses and their family members. All House members can be reached by calling the Capitol Switchboard at 202-224-3121. Fax numbers, email and mail addresses can be obtained by clicking on "Write to Congress" on the Public Policy home page of the NAMI Web site, http://www.nami.org/policy.htm
The Fletcher-Peterson bill (HR 2315) contains an amendment that would vastly expand multi-employer health plans that are exempt from state consumer protections under the federal ERISA law. This Association Health Plan (AHP) proposal would allow multi-employer plans to evade the 32 state mental illness parity laws that NAMI advocates have worked hard over the past decade to pass. Supporters of AHPs view them as a means of expanding coverage to the 43 million Americans that are currently uninsured. Unfortunately, a study from the congressional Joint Economic Committee indicates that AHPs would cost the federal Treasury as much as $48.6 billion over 10 years, while benefiting only 1% of those who are now uninsured. Thus, while NAMI strongly supports the goal of expanding coverage for the uninsured, NAMI opposes the AHP proposal in HR 2315 because of its potential to severely undermine the effectiveness of state parity laws.
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