U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

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89–011 2001

107th Congress, 1st Session – – – – – – – – – – – – – House Document 107–42

PRINCIPLES FOR A BIPARTISAN PATIENTS’

BILL OF RIGHTS

COMMUNICATION

FROM

THE PRESIDENT OF THE UNITED STATES

TRANSMITTING

PRINCIPLES FOR A BIPARTISAN PATIENTS’ BILL OF RIGHTS TO

PROVIDE ALL AMERICANS WITH PROTECTIONS IN MANAGED

CARE

FEBRUARY 7, 2001.—Referred jointly to the Committees on Energy and

Commerce, Ways and Means, and Education and the Workforce and

ordered to be printed

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THE WHITE HOUSE,

Washington, February 7, 2001.

Hon. J. DENNIS HASTERT, Speaker of the House of Representatives,

Washington, DC.

DEAR MR. SPEAKER: I was grateful for the opportunity to meet

with you last month at the White House to discuss our shared goal

of passing a strong Patient’s Bill of Rights. Over the last two weeks

my staff and I have met with Members of Congress from both parties, and I believe that we have an opportunity to work together

to enact legislation this year to address this important issue. I am

writing to ask for your support, and for the support of all Members

of Congress, for a bipartisan Patients’ Bill of Rights to provide all

Americans with protections in managed care.

As Governor of Texas, I worked with Democrats and Republicans

to enact some of the strongest patient protection laws in this country. My goal now in seeking Federal legislation is simple: I want

to ensure that all patients receive needed medical care and that

doctors are allowed to make medical decisions.

To achieve these goals, patients should have the right to an independent medical review of a health plan’s decision to deny care.

This review should be conducted by medical experts outside the

health plan and must be binding on the health plan. I also believe

that, following an independent medical review of a health plan’s

decision to deny care, patients who have been wrongly denied medical care should be allowed to hold their health plans liable in Federal court.

I cannot support a plan, however, that encourages unnecessary

or frivolous litigation. Expensive litigation, and the resulting rise

in health care costs, would only make it more difficult for Americans to afford health care coverage in the first place. I believe it

is possible to provide patients a meaningful remedy when they

have been wrongly denied care, without causing other Americans

to lose coverage. A responsible remedy for patients should protect

employers from the high costs of being subject to multiple causes

of action in multiple venues and should provide a reasonable cap

on damages.

As you requested, I have enclosed the principles by which I will

gauge any piece of Federal legislation. I do not believe that any bill

currently before the Congress meets all of these principles. However, I applaud the efforts of Members on both sides of the aisle

who have stepped forward to address this issue. I believe we can

work together to reach bipartisan agreement this year on a strong

Patient’s Bill of Rights that protects all Americans, does not override the patient protections already adopted by states, and avoids

costly litigation.

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I look forward to working with you and all Members of Congress

to enact these principles into law so soon as possible. I also look

forward to working with you to provide access to health care for the

millions of Americans without health insurance.

Sincerely,

GEORGE BUSH.

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PRINCIPLES FOR A BIPARTISAN PATIENTS’ BILL OF RIGHTS

PATIENT PROTECTIONS SHOULD APPLY TO ALL AMERICANS

A federal Patients’ Bill of Rights should ensure that every person

enrolled in a health plan enjoys strong patient protections. Because

many states have passed patient protection laws that are appropriate for their states, deference should be given to these state laws

and to the traditional authority of states to regulate health insurance.

PATIENT PROTECTIONS SHOULD BE COMPREHENSIVE

A federal Patients’ Bill of Rights should provide patient protections such as: access to emergency room and specialty care; direct

access to obstetricians, gynecologists and pediatricians; access to

needed prescription drugs and approved clinical trials; access to

health plan information; a prohibition of ‘‘gag clauses’’; consumer

choice; and continuity of care protections.

PATIENTS SHOULD HAVE A RAPID MEDICAL REVIEW PROCESS FOR

DENIALS OF CARE

Patients should have the right to appeal a health plan’s decision

to deny care through both internal review and independent, binding external review.

THE REVIEW PROCESS SHOULD ENSURE THAT DOCTORS ARE ALLOWED

TO MAKE MEDICAL DECISIONS AND PATIENTS RECEIVE CARE IN A

TIMELY MANNER

Slow and costly litigation should be a last resort. Patients should

exhaust their appeals process first—allowing independent medical

experts to make medical decisions and ensuring patients receive

necessary medical care without the expense or delay of going to

court.

FEDERAL REMEDIES SHOULD BE EXPANDED TO HOLD HEALTH PLANS

ACCOUNTABLE

After an independent review decision is rendered, patients

should be allowed to hold their health plans liable in federal court

if they have been wrongly denied needed medical care.

PATIENT PROTECTION LEGISLATION SHOULD ENCOURAGE, NOT

DISCOURAGE, EMPLOYERS TO OFFER HEALTH CARE

Employers, many of whom are struggling to offer health coverage

to their employees, should be shielded from unnecessary and frivolous lawsuits and should not be subject to multiple lawsuits in

state court. Increased litigation will only result in higher health

care costs, potentially forcing employers to drop employee health

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coverage altogether. Only employers who retain responsibility for

and make final medical decisions should be subject to suit.

Americans want meaningful remedies, not a windfall for trial

lawyers resulting in expensive health care premiums and

unaffordable health coverage. To protect patients’ rights without

encouraging excessive litigation, damages should be subject to reasonable caps.

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