August 2, 2001
WASHINGTON, Aug. 1 — President Bush
and Representative Charlie Norwood, the leader of a six-year campaign to
enact a patients' bill of rights, said tonight that they had agreed on
compromise legislation, clearing the way for House passage of the measure
this week.
The agreement stunned Mr. Norwood's
allies in Congress, who were meeting to discuss strategy at the moment
he was going to the White House to shake hands on the deal with Mr. Bush.
"Congressman Norwood and I have reached
an agreement on how to get a patients' bill of rights out of the House
of Representatives," Mr. Bush said.
The agreement, a personal triumph
for Mr. Bush, spares him from what could have been a major political embarrassment
if the House had voted for the original version of Mr. Norwood's bill,
in defiance of Mr. Bush's earlier threat to veto it.
Appearing with Mr. Bush at the White
House, Mr. Norwood, a Georgia Republican and onetime dentist, said: "The
bottom line and the goal is, we want to change the law. And the last time
I looked, that's pretty difficult to do without the presidential signature."
The compromise, reached after weeks
of talks between Mr. Norwood and the White House, would make it easier
for patients to sue insurance companies in state court and to collect damages
in cases where care is wrongly denied. But the agreement would allow employers
to take steps to protect themselves from liability.
Senate sponsors of the patients'
rights bill denounced the agreement. The chief Senate sponsor, John McCain,
Republican of Arizona, said it "favors the H.M.O. over the patient."
Senator Edward M. Kennedy, Democrat
of Massachusetts, said he was pleased Mr. Bush accepted the substantive
protections of the Senate bill, but said the agreement "makes these rights
unenforceable." And "a right without a remedy is not an effective right,"
Mr. Kennedy said.
The other principal sponsor of the
Senate bill, John Edwards, Democrat of North Carolina, called the deal
"a bad proposal." It would, he said, maintain the privileged legal position
that health maintenance organizations have under existing law.
The House plans to take up the patients'
rights legislation on Thursday, a day before Congress is scheduled to begin
a monthlong summer recess. Mr. Bush and Mr. Norwood said their agreement
would be translated into legislative language, which can be offered as
an amendment to the bill. House Republican leaders said the amendment and
the bill would almost surely be approved because they would have support
from Mr. Norwood, the White House and Speaker J. Dennis Hastert of Illinois.
Lawmakers of both parties respect Mr. Norwood, and many have said they
will follow his lead.
"Norwood gives you the Good Housekeeping
seal of approval," said John P. Feehery, a spokesman for Mr. Hastert. "He
will bring along a lot of undecided House members."
Mr. Feehery gave some details of
the agreement. Injured patients, he said, would have a federal right to
sue H.M.O.'s and insurers in state court. The scope of insurer liability
would be defined by federal law.
Patients could recover damages equal
to the full amount of any lost wages or other financial losses. Payments
for pain and suffering and other noneconomic damages would be limited to
$1.5 million. A plaintiff could also recover up to $1.5 million in punitive
damages if a health plan refused to provide care ordered by independent
medical reviewers.
Under the agreement, an employer
could be sued if it directly participated in a decision to deny claims
for health benefits promised to employees. But an employer could protect
itself by naming an outside entity known as a "designated decision- maker"
to rule on claims and bear the legal liability.
In June, by a 59-to-36 vote, the
Senate passed a similar bill giving patients a much broader right to sue
health plans for improper denial of care. Both bills define a wide range
of rights for people with insurance, guaranteeing access to emergency care,
medical specialists and an independent medical review of decisions denying
benefit claims.
The biggest unresolved issue between
Mr. Bush and Mr. Norwood had been the patients' right to sue H.M.O.'s and
insurers when they believed they had been injured because of improper delay
or denial of care.
Mr. Bush had said the Senate bill
and the original Norwood bill would have permitted explosive growth in
lawsuits, raising the cost of insurance and, thus, the number of Americans
without coverage.
Mr. Bush said the agreement illustrated
the bipartisan cooperation he promised to bring to the nation's capital,
and he praised Mr. Norwood for practicing "the art of what is possible."
The issue of where suits are filed
is important; plaintiffs' lawyers say that experience suggests they can
win larger verdicts at the state level than they can in federal courts.
Under pressure from Mr. Norwood and
others in Congress, Mr. Bush made a significant concession, agreeing that
patients denied care should be able to hold their health plans accountable
in state courts, not in federal court as he had wanted.
Under the Senate bill, patients could
sue insurers in state court for medical decisions, or in federal court
for administrative decisions. In federal court, there would be no limits
on damages for economic loss or pain and suffering, and patients could
win up to $5 million in civil penalties resembling punitive damages. In
state court, damages would be subject to the limits of state law, if any
such caps existed.
Under the agreement, patients could
sue an H.M.O. even if independent medical reviewers had found no justification
for their claims. But in those cases, the patients would have a higher
burden of proof than if they had prevailed in the external review process.
There would be a legal presumption that the decision of the external reviewers
was correct, but patients could disprove that assumption with enough evidence.
The legislation would set the first
comprehensive federal standards for health insurance, which has been regulated
mainly by the states. States could continue to enforce their laws, provided
they were at least as stringent as the federal standards.
If the House passes the bill, as
expected, the next step would be for the two chambers to try to resolve
their differences in a conference committee. The Senate negotiators would
probably include Senators McCain, Edwards and Kennedy.
Polls have repeatedly shown that
voters want Congress to pass a patients' bill of rights and trust Democrats
more than Republicans to handle the issue. Lawmakers of both parties, but
especially Republicans, feared they would be pilloried by their opponents
if they failed to pass a bill before next year's elections.
With formal language still not available
late this evening, some Democrats said the vote should be delayed until
Friday or September.
Representative Marion Berry, an Arkansas
Democrat and co-sponsor of the Norwood bill, said: "The compromise amounts
to nothing more than a loosely stated idea. We haven't seen the actual
legislative language, and we don't expect to see it until we are asked
to vote on it."
Moreover, Mr. Berry said: "I consider
this a breach of a bipartisan effort that has been going on for years.
There was nothing bipartisan about the White House approach to this issue."
Representative Greg Ganske, an Iowa
Republican who helped write the Norwood bill, was surprised by the agreement.
"Charlie cut his own deal with the White House," Mr. Ganske said. "He did
not share any information with us."
Mr. Norwood had often said he would
consult his co-sponsors before making any deal. Mr. Norwood acknowledged
that "the general reaction wais disappointment."
He defended his action, saying, "The
deal had to be cut by somebody, and I was the someone elected to do it."
By ROBERT PEAR