Patient Protection During the 107th Congress: Side-by-Side Comparison of House and Senate Bills

Publication Date: August 2001

Publisher: Library of Congress. Congressional Research Service

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Research Area: Health

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Abstract:

This report compares the major provisions of the Senate- and House-passed patient protection bills of the 107th Congress. S. 1052 and H.R. 2563 offer various approaches to regulate employment-based health plans and insurance issuers relating to access to providers, disclosure of plan information, grievances and appeals, confidentiality, and health care lawsuit reform among other provisions.

On June 29, the Senate passed S. 1052, the "Bipartisan Patient Protection Act." The bill had originally been introduced in slightly modified forms by Senators McCain, Kennedy and Edwards as S. 283 and later as S. 872. S. 1052 was amended on the Senate floor. In the House, a similar bill was originally introduced by Representatives Ganske and Dingell as H.R. 526 and a modified version, H.R. 2563 was introduced on July 19, to incorporate many of the amendments included in the Senate passed bill. On August 2nd the House passed H.R. 2563, adding two amendments on the floor before passage. The most significant differences between the House- and Senate-passed bills are in the provisions expanding patients' legal remedies against their health plan providers when medical care is unjustly denied and the denial results in harm. Other differences found in the bills include provisions applying the protections to federal health programs, prohibiting discrimination on the basis of genetic information, and encouraging health insurance coverage expansions.

Each of the bills would apply to group health plans and health insurance issuers offering health insurance coverage in both the group and individual markets for insurance. Both bills define a process for allowing states that have already passed patient protections at the state level to apply those laws in lieu of the federal laws although the House version is more limited than the Senate version.

At the heart of the debate on patient protection are different approaches to increasing access to legal remedies for persons denied access to medical care when the denial causes substantial harm or death. Under current law, enrollees in employer-sponsored plans can only sue their HMOs for benefits due under the Employee Retirement Income Security Act (ERISA). State law causes of action, which include consequential and punitive damages, are not available and ERISA does not provide for such damages. S. 1052 would expand the damages allowed under federal claims for benefits that arise fromcontract disputes and questions of coverage and would amend ERISA so that disputes at the state level over the medical necessity of covered benefits are not pre-empted. H.R. 2563 would amend ERISA to create a federal cause of action under certain conditions when a designated decision maker failed to exercise ordinary care in making a determination on a claim. State courts would have concurrent jurisdiction over claims under this new federal cause of action, which means that state courts could hear those claims, the federal law would apply, but the state courts' procedural rules could be used to process those claims.