Opening Statement of Hon. Fortner Pete Stark, M.C., California

Hearing on Patient Protections in Managed Care

April 24, 2001

At this point in the game, there is broad agreement on the patient protection provisions of a real, effective patients' bill of rights.

There is also widespread agreement in the House that the set of protections need to apply to each and every person in private health insurance. That has been a point of contention with certain colleagues in the Senate, but here in the House there is agreement that a patients' bill of rights needs to afford a basic set of protections that act as a floor in each and every state and for each and every person in private insurance.

There is also vast agreement that we must have a strong, independent appeals process in order to assure that patients get the care they need and have paid for with their premiums and that are guaranteed under the new law.

However, at this point we come to the giant chasm in philosophy that has stymied ultimate agreement for too long. I hope some of our witnesses here today have a solution.

That chasm is the issue of liability. Why shouldn't plans be accountable - i.e held liable -- if their negligence harms or kills a patient? If someone suffers personal injury or death as a result of a decision made by their health plan, shouldn't that health plan be held liable in the same way his/her doctor would be? If a doctor commits medical malpractice, there is no question that you can sue that doctor under personal injury law. The same is true of a hospital. However, under today's laws, a health plan is often protected from any liability even if it was the direct action of the plan that caused the patient's harm or death.

I don't want courts deciding what is appropriate medicine any more than my colleagues on the other side of the aisle. I want health plans providing the appropriate care up front so that patients are not forced to go through the appeals process or to court. But, if a health plan inappropriately withholds or delays needed care, I want a patient to have access to an independent appeals process that will work.

The only way that an appeals process will be an effective means of resolving disputes with health plans is if there are REAL consequences - which means real financial consequences - for health plans not going along with the determination of the independent appeals entity.

Without a strong, effective liability component in the legislation, health plans will continue to deny appropriate care, delay treatment, and continue many of today's abusive practices that result in substandard care for patients because it will continue to be in their financial interest to do so.

Including effective liability provisions in the legislation isn't just about enforcement. It is also about providing people with real remedies when they are injured or killed by a plan's bad decision. The liability system must be one to which consumers will have adequate access. That is why maintaining liability at the state court level is so important. The federal courts are overloaded, they lack the expertise in tort cases, and they are difficult for consumers to access. The state courts have always been the venue for medical malpractice and personal injury cases and they are the appropriate venue for the vast majority of managed care cases as well.

So, that is the rub. We agree we need a bill, but we absolutely disagree on what is the best venue for people to enforce their rights and get remedies if they are injured or killed by a plan's action or inaction. I am tired of passing legislation at the federal level and sending out press releases saying we've solved the problem - when our solutions haven't worked. We passed CHIP, but still have more than 10 million uninsured children. We passed HIPAA and people are still denied health insurance coverage through the use of exorbitant premiums that price people out of the coverage. We have an opportunity here to pass a bill that will really assure patients of better quality care - and redress if they don't get the quality care they deserve and have paid for with their premiums. I urge my colleagues to join with me in seizing that opportunity.

Of course, we have a strong bipartisan bill that has been introduced this year, H.R. 526, The Bipartisan Patient Protection Act of 2001. In the last Congress, the House overwhelming passed a patients' bill of rights with broader liability protections. We've modified the liability section of the new bill in order to address concerns that have been raised. This new legislation has the support of a majority of the US Senate - where our actions were stymied last year. And just yesterday the CBO confirmed yet again that we can afford to guarantee strong patient protections and accountability. The bottom line is that providing the all of protections in the Bipartisan Patient Protection Act, including accountability, will cost employees less than $1.25 -- less than a gallon of gas or a loaf of bread -- per person per month.

During this debate, independent surveys have shown repeatedly that a strong majority of both patients and employers are willing and able to cover these costs. This legislation is a strong model for reform and I urge my colleagues to take a close look at it.

I look forward to hearing from the distinguished panel of witnesses before us today and expect that the question and answer session will be quite lively. Thank you again, Madame Chairwoman, for addressing this important issue. I hope our next meeting on this topic will be to take long overdue action on the problem.