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BMJ. Jul 24, 1999; 319(7204): 209.
PMCID: PMC1116314

US Senate passes patients’ bill of rights

For the first time since managed health care was introduced, the US Senate has passed a bill that would protect the rights of health insurance customers. But the Republican sponsored bill, passed last week, offers far fewer patients’ rights than the bill proposed by the Democrats.

The so called “Patients Bill of Rights”—which was passed by the Senate by 53 votes to 47, with two Republicans joining the Democrats in opposition—provides $13bn (£8bn) in tax breaks for health care and provides an appeal process for patients whose insurer refuses a specific treatment. Republicans voted down, however, an amendment offered by the Democrats that would have set up procedures allowing patients to sue insurance companies for denying them medical procedures.

The Republican bill also substantially waters down Democratic provisions giving doctors the right to override restrictions on treatment made by health insurance officials. While Senate Democrats offered case studies of patients who had been denied life saving procedures, Republicans and the health insurance industry argued that more expansive reforms would raise the cost of insurance and so cause more Americans to go without.

Richard Coorsh, spokesman for the Health Insurance Association of America, the main lobbying group for the industry, said: “We think that there needs to be a distinction made be-tween the practice of medicine—which requires a doctor to do absolutely everything—and a covered benefit. When insurers review a claim, the responsibility is only for services covered by that contract.”

Other provisions of the Republican sponsored bill include the right to a hospital stay after a mastectomy recommended by a doctor and access to emergency room care outside network hospitals covered by a patient’s health insurance package.

Overall, however, the bill limits many of the expanded rights to the approximately 50 million people who have self financed plans, generally offered by large companies, in which patients are free to choose their doctor. Over 100 million Americans in the more restrictive plans that require visits to a predetermined list of “gateway doctors”—the plans that have received most complaints from consumers—would not enjoy the benefits from most provisions of the bill.


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