Democratic lawmakers want to legislate patient protections for all Americans enrolled in managed care plans. Republicans say other people are already protected by state laws, and that federal protection is unnecessary. Both parties do agree on protections that would give patients more direct access to certain kinds of specialists, such as pediatricians or gynecologists. But Democratic lawmakers want the law to guarantee that a patient's doctor, not the patient's HMO, will ultimately decides what treatment is necessary. A recent managed care advertisement Democrats also want to give patients the right to sue for punitive damages if they feel their HMO was responsible for injury resulting from its decisions.
Republican lawmakers favor outside, independent reviews, instead of lawyers, to handle complaints.
They say the threat of lawsuits would raise costs, drive up premiums and make insurance unaffordable for companies to offer employees or for people to buy themselves. The Republicans also argue for a written grievance process to help with determining treatment. They claim the Democrats' plan to give doctors control over treatment decisions reverts to the old system, where doctors sometimes ordered tests or treatments that were arguably unnecessary and insurance companies paid the bills regardless. But some supporters of the Democratic legislation claim Republicans want a bill that is unenforceable. Democrats say the Congressional Budget Office has projected the Democratic version would cost pennies per day per patient.