Introductory Statement on S. 2083
Mr. President, according to a Kaiser Family Foundation and Harvard School of Public Health survey of non-elderly Americans with private health insurance, one-half reported that they had a problem with their health insurance plans in the…
Mr. President, according to a Kaiser Family Foundation and Harvard School of Public Health survey of non-elderly Americans with private health insurance, one-half reported that they had a problem with their health insurance plans in the previous year. They cited delays and denials of coverage or care as their two most common problems. They also said they worried that if they became sick, their health plans would be more concerned about saving money than providing the best treatment. For those in managed care plans, such as HMOs, over two-thirds had this concern.
And they have good reason to be concerned. Let me tell you about two of the many people, who were hurt when HMO decided it needed to save money. Ruby Calad had a hysterectomy and her doctor recommended that she stay in the hospital longer than a day. Cigna, Ruby's insurance company said one day was enough. So Ruby went home, but she was soon in the emergency room because she had developed serious complications. Had Ruby been able to stay in the hospital longer, as recommended by her doctor, this would not have happened.
Juan Davila suffers from diabetes and arthritis. His doctor prescribed VIOXX for his arthritis because it had a lower rate of bleeding and ulcers than drugs on the formulary developed by Aetna. But instead of approving the VIOXX, Juan was required to enter a step program and try two other medications before VIOXX could be approved. He was given naprosyn--a cheaper drug--and three weeks later was rushed to the hospital. He had developed bleeding ulcers, which caused a heart attack and internal bleeding. Juan survived but now cannot take any pain medication that is absorbed by the stomach.
These examples show why medical decisions should be made by doctors, not HMO bureaucrats, and in 2001, the Senate, in a bipartisan vote of 59-36, passed S. 1052, the Bipartisan Patient Protection Act to make sure that happened. Yet, intransigence from the House leadership and the White House prevented that bill from becoming law. Nearly 3 years later, we still have not acted. So, today, I am introducing the exact same bipartisan bill that passed in the Senate in 2001.
This bill provides comprehensive protections to all Americans in all health plans. It says to all Americans who have health insurance, you have rights and protections. It says to HMOs, you have responsibilities and will be held accountable for your wrongful and harmful actions.
This bill ensures that patients have the right to have medical decisions made by their doctors and not HMO bureaucrats. Patients will have the right to see a specialist and go to the closest emergency room for treatment. They will be able to keep the same doctor throughout their medical treatment and appeal adverse claim decisions to an independent reviewer. And if they are injured by a decision made by the HMO, they will have the right to hold their HMO accountable in a court.
A meaningful patients bill of rights is long overdue. I urge my colleagues to support this legislation.