FAMILIES USA FOUNDATION: THE PATIENT ADVOCATE

Testimony of Ronald Pollack, Executive Director of Families USA

Thank you Mr. Chairman, Ranking Member Kennedy and members of the Committee for inviting me to testify today. I am Ronald Pollack, Executive Director of Families USA, and like the members of Families USA and all United States citizens, I am a health care consumer that demands patient protection.

Families USA is a national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable health and long-term care for all Americans. Working at the national, state and community levels, we have earned a national reputation as an effective voice for health care consumers for over 15 years. We represent the consumer perspective in the state and national health policy debates and act as a watchdog over government actions affecting health care. We produce highly-respected health policy reports for both the public and government officials and act as a clearinghouse for information about the health care system. Families USA represents the consumers' voice and holds the government accountable for the health care its citizens deserve.

Background

Families USA has been a longstanding advocate for a comprehensive Patients' Bill of Rights. In analyzing the previous leadership managed care bills, Families USA found that only the Norwood-Dingell bill would establish essential protections for America's consumers. The other plans were missing key consumer protections including the right to a true external appeal of a health plan denial of care, access to out-of-network providers, and access to prescription drugs not on a health plans formulary. In addition to missing many key consumer protections, some proposals would not apply to millions of Americans who have their health insurance purchased by their employees. Families USA could only support the Norwood-Dingell bill because it assured consumers that doctor's decisions will prevail and that consumers have the right to sue their health plan for damages in the event of a wrongful denial of care. The Norwood-Dingell bill was the only bill out there that truly addressed the American public's concerns about managed care.

The Norwood-Dingell bill was passed by the House in 1999, but because of political dynamics no further action was taken. The goal of achieving patients' rights was been overshadowed by partisan lines and political wrangling.

We are here today to try to stretch across partisan lines and once again attempt at giving patients the rights they have long deserved. Thank you to Senators John McCain (R-AZ) and Edward Kennedy (D-MA) for introducing the Bipartisan Patient Protection Act of 2001. Supported by a bipartisan collection of lawmakers, Families USA believes that this bill is a strong patients' bill of rights and will allow individuals to sue their HMOs.

What S.283 Would Do For Consumers

Because the McCain-Kennedy bill is very similar to the Norwood-Dingell bill, Families USA chooses to support S.283 as its choice for a patients' bill of rights. The Bipartisan Patient Protection Act establishes common sense patient protections and will help restore America's trust in the health care system. We hope that introduction of this bill, and its bipartisan effort, will bring the issue back to the forefront of debate and let the Republican leadership know that we are serious about getting a real patients' bill of rights passed this year.

The Bipartisan Patient Protection Act would cover all 160 million privately insured Americans and would guarantee access to emergency and specialty care. The bill also requires health plans to tell consumers how to pay for out-of-network emergency room visits, how to access specialists and how to handle appeals. Specifically, the bill creates a two-pronged path for lawsuits. All cases involving issues of medical necessity will be dealt with in states courts, while cases involving contract terms will proceed through federal courts. This language is stronger than that contained in the Norwood-Dingell bill creating a stronger consumer protection bill.

Families USA believes that patients who suffer medical injuries as a result of managed care's cost containment features deserve compensation for those injuries. The McCain-Kennedy bill would put a system in place to ensure that this process occurred. The health insurance industry and employer groups believe that such rights could lead to frivolous lawsuits and outrageous compensation requests. This is not necessarily so. State experience shows that excess litigation may not necessarily result. Seven of the 38 states that allow patients to appeal medical decisions to external review boards, allow patients to sue their health plans. In the three years that Texas has allowed the right-to-sue, only 15 suits have been files, and the record is similarly low in other states mainly because the appeals process settles most cases before they go to court.

Families USA is heartened by the support for this legislation from members of the Committee. We commend their bipartisan efforts and praise them for recognizing the needs of the patient before the needs of their party. Every one of us in this room has been a patient before- been sick and vulnerable, frustrated and confused by the system. Everyone benefits from a patients' bill of rights.

We've waited long enough to establish basic consumer protections. Consumers want these protections. Candidates campaigned in support of consumer rights. Now Congress needs to stop stalling and pass true consumer protections. We now ask the Committee to ensure that happens by supporting S.283, the Bipartisan Patient Protection Act of 2001.

Mr. Chairman and members of the Committee, thank you again for the opportunity to testify before you today. Families USA looks forward to working with you on this critically important issue. I'd be happy to answer any questions you might have.