Fates of patient protection legislation remain in doubt.

Even though the US House of Representatives passed the bipartisan Norwood-Dingell patient protection bill in early October, the fate of the long-awaited bill designed to reign in managed care remains in doubt. The final word will emerge from a House and Senate conference committee charged with resolving the differences between the bills the two chambers passed. The bills have two major differences. The House bill covers a majority of privately insured patients and gives them the right to sue their managed care companies; the Senate legislation is much more limited in the scope of patients it covers and does not include the right to sue. The bill that emerges from the conference committee still must be signed into law by the president. Whether or not he will sign the bill depends on the provisions of the bill that emerges. Most House Republicans opposed the provision that would make managed care companies liable in state courts in the event that care is denied and the patient suffers injury or death as a result. Making such suits possible would require amending the Employee Retirement Income Security Act (ERISA), which currently provides patients with no legal recourse if the decision of a health plan results in harm. ERISA preempts state law when companies are self-insured or go across state lines. Moderate Republicans instead preferred a substitute bill introduced by Tom Coburn (R-Okla), who is a physician, and John Shaddegg (R-Ariz) that would require suits be filed only in federal courts and would limit the liability of plans. The vote by the House of Representatives brought praise from the American Medical Association, the nation’s largest organization of doctors, which has been pushing for strong patient protection legislation for 5 years. AMA President Dr Thomas Reardon called the vote “a real win for American patients.” Both bills included strong language that would allow patients to obtain emergency care when such care was, in the judgment “of a prudent layperson,” needed. Major provisions of the Norwood-Dingell bill include: