Senate Majority Leader Tom Daschle (D-SD) (pictured) has indicated that he plans to allow a House-Senate conference on two differing versions of managed health care reform legislation to move forward this year.  Both the House and Senate have approved versions of “Patient’s Bill of Rights” (PBOR) legislation, but the two bills contain considerable differences.  The White House has been very specific with its veto threats, and conference negotiations will be difficult.
 
The Senate passed a wide-ranging PBOR bill sponsored by Senators Ted Kennedy (D-MA), John McCain (R-AZ), and John Edwards (D-NC) in June.  S. 1052 offers a variety of so-called “patient protections” designed to make managed care more attractive to consumers, such as: (1) ensuring that female patients have access to ob/gyns as their primary care physicians; (2) allowing parents to select pediatricians as their children’s primary care physicians; (3) ensuring that patients have access to specialists without first seeing a “gatekeeper” physician; (4) guaranteeing access to emergency room care without prior approval; (5) expanding access to clinical trials for critically-ill patients; and (6) eliminating so-called “gag orders” that prevent doctors and patients from discussing the full range of available treatments.
 
S. 1052 also establishes a two-tier review process for patients to appeal benefit denials, and would allow patients to sue their health plans when benefit denials cause harm to the patient.  Employers could be sued if they participated in the decision to deny benefits.
 
The House passed a more conservative version of PBOR legislation in August.  H.R. 2563, whose chief sponsors are Representatives Greg Ganske (R-IA) and John Dingell (D?MI), is similar to S. 1052, but a last-minute deal negotiated by Representative Charlie  Norwood (R-GA) and President Bush significantly narrows the opportunity for patients to file lawsuits in state courts.
 
Efforts to pass HMO reform legislation in the past have collapsed as Democrats and Republicans have been unable to agree on the liability provisions and the scope of the legislation.  However, one key element of the negotiations this time around may be the personal relationship that has developed between President Bush and Sen. Kennedy, who successfully collaborated on education reform legislation.  All of the major players want a PBOR bill, and, if one is not passed, failure to do so likely will become a campaign issue in the upcoming November elections.