Patients' Bill of Rights: It's The Senate Versus The House

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Showdown: Bill Frist and John Edwards

We've moved into Week Two in the long and contentious battle over a patients' bill of rights, with no end in sight. Wednesday and Thursday President Bush met with Senate moderates, urging them to compromise — especially if it's a compromise that favors a GOP version of the bill. The President has begun a p.r. campaign for the Republican-sponsored House patients' bill of rights, which places substantial curbs on patients' ability to sue their health plans. Eventually, the House and Senate bills will merge, and the President will get a compromise bill — which he will either veto or sign into law.

The House bill is starting to look like the GOP's last best hope for an outcome resembling victory: This week, the Senate defeated (by a vote of 56-43) a Republican-sponsored amendment to eliminate employer liability in health care lawsuits. "They concluded that the benefits of letting people sue the employer were much smaller than the potential cost," sponsor Phil Gramm said after the vote. The Senate also defeated (61-39) a move by Iowa's Charles Grassley to send the Democrats' bill back to committee (a classic stall tactic).

The crux of the current disagreement: Whether employers who provide health insurance should be subject to lawsuits if they participate in a health care decision that ultimately harms an employee. Democrats say yes, arguing employers are often actively involved in health care decisions and therefore should be responsible for those choices; Republicans disagree, warning the threat of lawsuits could force employers to drop insurance coverage altogether.

Meanwhile, Senate Majority Leader Tom Daschle continues to wield serious threats, promising his colleagues they will not be excused for the July 4th holiday unless they produce a bill.

The Lowdown

The Democrats' plan, sponsored by Senators Edward Kennedy, John Edwards and Republican John McCain, would allow mistreated, misdiagnosed or neglected patients to sue their health plans in both state and federal court, because, the sponsors argue, patients should be able to skirt the long waiting times and bureaucracy plaguing the federal judicial system. The bill also allows wronged patients to receive unlimited punitive damages in state court (unless state law dictates otherwise) and awards in federal court of up to $5 million. This plan also permits employees to name employers as defendants in insurance-related lawsuits.

The Republican measure, sponsored by Bill Frist, Democrat John Breaux and Independent Jim Jeffords (and backed by the White House) sets up an extensive appeals process to weed out frivolous lawsuits. It also limits suits to the federal system and puts a $500,000 cap on damages. Republicans argue the Democrats' bill would leave health plans open to catastrophic legal costs and raise the price of insurance premiums, forcing employers to drop coverage. In the end, the White House argues, the unlimited-damages approach could leave millions of Americans without insurance. (Democrats contend their plan would cost just 37 cents a month more than the GOP plan).

What do the Senators at the heart of the debate have to say? Edwards and Frist answered's questions about their competing bills:

Read Senator Edwards' response

Read Senator Frist's response