Opening Statement of Hon. Nancy L. Johnson, M.C., Connecticut, 
and Chairwoman, Subcommittee on Health

Hearing on Patient Protections in Managed Care

April 24, 2001

Today's hearing begins the Subcommittee's examination of issues related to a Patient's Bill of Rights. When we started exploring legislative solutions to protect patients from bad actors in the health insurance market, there was much disagreement regarding what the federal legislation should look like. There was even a large degree of uncertainty as to whether Congress should enact any federal protections.

I am happy to say that after eight years of examining managed care reform legislation, there is now a great deal of consensus as to what a federal patient protection bill should encompass. There is also strong, bipartisan agreement that Congress should act quickly to extend patient protection to all Americans. I hope we can achieve that goal this year. The time to enact a real patients' bill of rights is long past due.

In response to rising health care costs and the desire to provide more preventative care, many employers have turned to health maintenance organizations (HMO's) and other managed care arrangements. While managed care has been helpful in moderating costs, and may have helped reduce the number of uninsured, many believe the pressure to constrain costs has squeezed health providers and has inserted insurance managers into the doctor-patient relationship.

In 1998 and again in 1999, the House passed legislation to protect patients enrolled in managed care plans and to ensure timely access to covered benefits. However, both pieces of legislation failed to become law.

Earlier this year, President Bush issued principles to guide legislators as Congress crafts a patients' bill of rights. Those principles state that new protections should apply to all Americans, patients should be allowed to go to Federal court after exhausting an independent, external medical appeals process and there should be appropriate employer protection with caps on damages.

I am encouraged by President Bush's principles, which I think strike the right balance between appropriate accountability and costs. I think there is significant agreement on both sides of the aisle on the underlying patient protections, such as access to OB/GYNs, access to specialists, prudent layperson standard for emergency rooms, and disclosure of plan information.

However, I remain concerned about some proposals, which would do real damage to employer provided health care and could increase the number of uninsured. Some are advocating additional, unlimited lawsuits as a panacea to better quality health care. We have seen the effect of unlimited lawsuits on health care providers, with malpractice insurance premiums increasing dramatically. Just yesterday, the Philadelphia Inquirer reported that hundreds of doctors will shut down their offices today and got to Harrisburg to lobby their state representatives to grant them relief from soaring malpractice insurance premiums. The problem has gotten so bad, 11 percent of doctors have left the state to escape high premiums.

I don't believe we can sue our way to better care. Ultimately and foremost, we should be trying to ensure that patients get the right medical care when they need it. A strong, independent external appeals process conducted by doctors, not lawyers or laymen, will ensure patients get that care. Health plan enrollees should also be required to exhaust the medical review process prior to pursuing court remedies. Why establish an external review process which utilizes medical experts, if that process can be circumvented by lawyers?

In an attempt to develop consensus on the issue, today we will hear from the major interest groups on their perspectives on managed care reform. The Patient Access Coalition, which collectively represents more than 300,000 physicians will stress the underlying patient protections that Congress has been debating for a number of years. The American Medical Association, which also represents about 300,000 physicians, and the Association of Trial Lawyers of America will emphasize their belief that ERISA plans should be exposed to unlimited liability. Finally, we will hear a consumer perspective and from an employer representing the National Association of Manufacturers, providing the view from someone paying for health care and trying to do what's right for its employees.

The time is ripe for Congress to act. We have spent too much time stressing our differences rather than trying to build common ground. The President has indicated his willingness to sign a real patient bill of rights. It is up to us to deliver legislation to his desk.