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[House Document 107-42]
[From the U.S. Government Publishing Office]

                                     

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
                                           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.
    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.
          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 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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