THE WHITE HOUSE

Office of the Press Secretary

PRESIDENT CLINTON AND GOVERNOR CARNAHAN URGE THE CONGRESS TO ACT NOW TO

            PASS A STRONG, ENFORCEABLE PATIENTS' BILL OF RIGHTS 
        New Independent Analysis Highlights the Flaws in the 
                         Senate Republican Bill

Today, President Clinton, along with Missouri Governor Mel Carnahan, will highlight a new legal analysis documenting how the Senate Republican "Patients' Bill of Rights" passed just last week would actually undermine state-based accountability provisions already available under current law. This review, produced by respected legal scholars at George Washington and Rutgers Universities at the request of Congressman Dingell (D-MI), concludes that enactment of the Senate Republican bill would be "far worse than were Congress to enact no measure at all."

In addition to highlighting this new analysis, the President will detail other serious shortcomings of the Senate Republican bill, which passed just last week without attracting a single Democratic vote. Specifically, he will point out that this flawed legislation would: fail to provide full protections to more than 135 million Americans; allow health plans to subject patients accessing emergency care to financial penalties; fail to guarantee real access to specialists; and establish a wholly inadequate enforcement mechanism that prevents plans from being accountable when they make harmful decisions. He will stress that the Congress is one vote away from achieving a majority vote for the bipartisan Norwood-Dingell legislation, which has been endorsed by over 200 health care provider and consumer advocacy groups. Finally, the President will praise Governor Carnahan for his leadership in passing a strong state version of the Patients' Bill of Rights and for illustrating that meaningful patient protections passed at the state level has had no negative impact on premiums or the number of the uninsured.

NEW LEGAL ANALYSIS CONFIRMS THAT THE SENATE BILL IS AN EMPTY PROMISE. The President will highlight the release of a new legal analysis documenting how the Senate Republican "Patients' Bill of Rights" passed just last week would actually undermine state-based accountability provisions already available under current law. The Senate bill would:

• Leave more than 135 million Americans without the guarantee of full protections. The protections in the Senate bill, most of which are limited to self-insured health plans, would apply to only 2 percent of HMOs nationwide -- less than 1 in 10 people in managed care.
• Allow health plans to subject patients accessing emergency care to high financial penalties. The Republican amendment allows plans to penalize patients who did not receive prior authorization before going to the emergency room by requiring them to pay higher levels of cost sharing. Patients should not pay a high financial penalty because they did not have time to stop during their emergency and call their plan.
• Fail to guarantee true access to necessary health care specialists. A plan could meet the requirements of the Senate bill by providing "access" to a specialist who was hundreds miles away from the patient or did not have an available appointment for months.
• Fail to provide access to important clinical trials. The Senate bill limits access to clinical trials for patients with cancer. Patients with Parkinson's, Alzheimer's, multiple sclerosis, and other diseases would not be guaranteed access to appropriate clinical trials and potentially lifesaving treatments.
• Establish a wholly inadequate enforcement mechanism that prevents patients from holding health plans accountable when they make harmful decisions. The new legal analysis released today concludes that the liability provisions in the Senate bill would preempt state law, effectively wiping out accountability protections that many states like Missouri, have passed and would replace it with:
• A new "bad faith" standard that is virtually impossible to prove and is a much higher standard of proof than any medical malpractice standard applied to physicians and other health care professionals. This is the usual standard applied for punitive damages - not economic and non-economic remedies;
• A requirement for plaintiffs to show that "substantial harm" resulted from the plan's action, and in so doing, would effectively exclude chronic conditions that did not meet this standard; and
• A massive loophole that protects plans from liability for damages at all if a self-insured plan contains other types of benefit options - as most currently do.

PRESIDENT CLINTON CITED THE MISSOURI EXPERIENCE TO DEBUNK SCARE TACTICS OF THE OPPONENTS OF MEANINGFUL PATIENT PROTECTIONS. The President will praise Governor Carnahan for leading the way in enacting strong patient protections at the state level. While agreeing with the Governor that the only way to cover all Americans in all plans is to enact a Federal Patients' Bill of Rights, the President will praise the Missouri legislation for illustrating that meaningful patient protections can be enacted into law without any negative impact on premiums or the number of the uninsured.

PRESIDENT CLINTON UNDERSCORES THAT THE SENATE IS WITHIN ONE VOTE OF PASSING A REAL PATIENTS' BILL OF RIGHTS. The President will underscore today that the Senate is only one vote away from passing a strong, enforceable, Patients' Bill of Rights, similar to the bipartisan Norwood-Dingell Patients' Bill of Rights. That legislation, endorsed by over 200 health care provider and consumer advocacy groups, is the only bipartisan proposal currently being considered that includes:

• Protections for all Americans in all health plans; -- Protections for patients accessing emergency room care from financial sanctions; -- Guarantees that assure access to necessary and accessible health care specialists; -- Guarantees that assure access to a fair and timely internal and independent external appeals process to address health plan grievances; -- Meaningful enforcement mechanisms that ensure recourse for patients who have been harmed as a result of a health plan's actions.

PRESIDENT CLINTON REITERATES THAT HE WILL NOT SIGN A PATIENTS' BILL OF RIGHTS THAT REPRESENTS AN EMPTY PROMISE. Today, the President will reiterate his refusal to enact legislation that does not provide strong patient protections for all Americans in all health plans and include meaningful enforcement mechanisms. To date, there is no legislation other than the Norwood-Dingell bill that meets the Administration's fundamental criteria of real patient protections and accessible and meaningful court-enforced remedies.

CLINTON-GORE ADMINISTRATION'S LONGSTANDING COMMITMENT TO PROMOTING PATIENTS' RIGHTS. The Administration has a long history of promoting patients rights, and President Clinton has already extended many of these protections through executive action to the 85 million Americans who get their health care through federal plans - from Medicare and Medicaid, to the Federal Employees Health Benefits Plan (FEHBP), to the Department of Defense and the Veterans Administration. The Administration's record on patients' rights include:

• Appointing a Quality Commission to examine potential quality concerns in the changing health care industry. In 1997, the President created a non-partisan, broad-based Commission on quality and charged them with developing a patients' bill of rights as their first order of business. The Quality Commission released two seminal reports focusing on patient protections and quality improvement.
• Challenging Congress to Pass a Patients Bill of Rights. In November of 1997, the President accepted the Commission's recommendation that all health plans should provide strong patient protections and called on the Congress to pass a strong enforceable patients' bill of rights. He also called on the Congress to make passing the patients' bill of rights a top priority in his 1998, 1999, and 2000 State of the Union Addresses.

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