June 22, 2004 - U.S. Representative Mike Doyle (PA-14) joined a number of other Members of Congress in introducing H.R. 4628, the Patients' Bill of Rights Act of 2004, in a response to yesterday's Supreme Court decision. On Monday, the Court severely restricted the right of Americans to sue their health maintenance organizations (HMOs) for denying them the treatment recommended by their doctors in cases where the denial of that treatment resulted in injury or death.

"People have to be able to hold HMOs responsible for decisions that result in devastating injuries or death," Congressman Mike Doyle said today. "That's why I joined Congressman Dingell and a number of other Democrats in introducing legislation to establish a federal law allowing patients injured by the decisions of their health plans to seek compensation for those injuries."

Under the Patients' Bill of Rights Act of 2004, patients will be guaranteed certain rights under their health insurance plans including:

• Basic standards for access to care, including clinical trials;

• The ability to gain access to their own doctor, and doctors able to communicate with the patient without fear of HMO retaliation;

• Medical decisions about patient care will be made by doctors according to sound medical principles, not HMO bureaucrats;

• A fair, independent external review process if needed care is denied by their HMO; and

• The right to hold their health plan accountable if their HMO's negligent medical decision resulted in injury or harm.

"I was a cosponsor of similar legislation in past Congresses," Congressman Doyle observed. "Unfortunately, that bipartisan legislation was opposed by the Bush Administration and the Republicans in control of the House and Senate and it was killed. Instead, President Bush and the Republicans in Congress have been working to protect HMOs from being held accountable for such decisions through their 'tort reform' bills reducing the incentives for HMOs to pursue the best health outcomes for their patients. With no chance for the passage of a federal bill, the effort to establish patient protections then shifted to the passage of protections at the state level. But now that the Supreme Court has invalidated most of the state-passed protections, the only way to ensure that all patients in HMOs have certain basic guaranteed rights is the passage of a federal Patients Bill of Rights law."

On Monday, the Supreme Court issued a decision on two cases - Aetna Health v. Davila and Cigna Healthcare v. Calad - in which the HMO's challenged the Texas law granting patients the right to hold HMO's accountable for denying them needed medical care. The case clarified existing case law providing a right to accountability under state law in certain circumstances. Unfortunately, the Court's decision on the two recent cases dramatically reduces the ability of patients to challenge HMOs that deny them care.

The new bill, H.R. 4628, is very similar to HR 2563, which Congressman Doyle cosponsored in 2001, and which was killed by Congressional Republicans.