doi: 10.1161/hc3201.097055
(Circulation. 2001;104:e9011.)
© 2001 American Heart Association, Inc.
Circulation Newswriter
Controversial Patient Rights Bill Set for Contentious Conference
The US House of Representatives passed a controversial version of the "Patients’ Bill of Rights" on August 3, 2001, the last day before it began its August recess. The bill’s differences from the Senate version passed earlier set the stage for a heated conference session in which leaders from the House and Senate will try to resolve the differences between the 2 bills. The task for legislators will be to craft a version of the law that President Bush will sign but that will also maintain significant provisions to protect patients. Some experts fear that the result will be the same as that for bills passed during the Clinton administration—no law.
The bill was considered a victory for President Bush, who had opposed earlier versions that established broad guidelines for suits under the proposed legislation. The new version from the House is the result of frenzied negotiation between the White House and one of the bill’s primary sponsors, US Representative Charlie Norwood (R-Ga). President Bush, in a White House–released statement, said, "Today’s action brings us an important step closer to ensuring that patients get the care they need and that HMOs are held accountable."
However, US Representative Richard Gephardt (D-Mo) said that the bill faces a rocky future because the President had not gotten input from Democrats during the Norwood negotiations. "This could have been a bipartisan bill, but the White House squandered that opportunity," said Gephardt in a statement released by his office. "Instead, what we have is a Republican bill, a bill that will now go into an endless conference committee. This is exactly what the HMOs want."
The compromise language in the bill allows patients to sue health maintenance organizations (HMOs), but it would limit punitive damages to $1.5 million and damages for pain and suffering to that amount as well. According to the New York Times in a story in its August 3, 2001, edition, damages from economic losses if medical decisions were made improperly would be unlimited.
The fate of the bill may hang on the difference between the words "a" and "the," the Times said in a story in its August 4, 2001, edition. In the Senate version of the bill, the patient who sues must show that the health plan was negligent and such negligence was "a proximate cause" of personal injury or death. In the House version, the patient must show that the health plan’s negligence was "the proximate cause" of injury or care. The small difference means that the patient had to have died as a result of the negligence and not because of a chronic condition or severe injury or acute disease with negligence as a contributing factor.
The Senate version gives patients more access to the courts as a remedy, while the House bill limits the damages a patient can collect and the basis for suits. Alan D. Bloom, senior vice president and general counsel of Maxicare Health Plans, a managed care company in Los Angeles, told the New York Times: "The plaintiff bar was finally figuring out how to get around Erisa. This new legislation stops that momentum and probably gives the HMOs more protection than they are losing."
However, the measure in the House was criticized on both sides of the issue. Donald Young, MD, interim President of the Health Insurance Association of American, said in a released statement: "The Patients’ Bill of Rights legislation that passed the House of Representatives tonight remains a deeply flawed bill. This bill still permits lawsuits in state courts with the potential for 50 different, inconsistent, and varying interpretations of federal law. It does not stem the tide of expensive lawsuits that will drive up the cost of health care coverage. And worst of all, this bill will result in more Americans—particularly the most vulnerable, lower-income workers and their families—joining the rolls of the uninsured."
On the other side of the issue, Judy Waxman, deputy executive director of Families USA, said, "The House of Representatives failed to pass a bill that would provide true patient protections for our nation’s health care consumers. The Norwood Amendment, which passed by a narrow margin, ensures that the cards are stacked against patients who have been improperly denied care by their HMO. While the Ganske-Dingell-Norwood bill was intended to protect patients, the Norwood Amendment protects HMOs by providing special protections that are not available to physicians, nurses, hospitals, and other health care providers. Congress can still pass significant patient protections this year. We urge the House-Senate conferees to craft a bill that will hold HMOs accountable and provide Americans real patient protections."
Employer’s HMO Premiums Rise as High as 50%
Instead of the 11% increase anticipated in a survey late last year, large US employers are now seeing their premiums for health maintenance organizations (HMOs) rise dramatically. Twenty percent is normal, and some firms are seeing premium increases of >50%, according to Mercer/Foster Higgins in a client advisory posted on the firm’s website (http://www.wmmercer.com/usa/english/index.html). Each year, the Mercer/Foster Higgins National Survey of Employer-Sponsored Health Plans is a benchmark for human resources managers.
The firm said the reasons for the unexpected increase are complex, but they cited:
- Consolidation in the healthcare provider sector that allows hospitals, physicians, and others to bargain for increases.
- An aging population that has resulted in the even spreading of risks in HMO populations, reducing the "skimming" effect that allowed the insurers to reduce premium costs.
- Cost-cutting measures by HMOs have gone as far as they can.
- The possible passage of the Patient’s Bill of Rights, which insurers anticipate will increase their costs.
The increases in costs are expected to bite into the pocketbooks of employees and employers. In the year 2000, the cost per employee enrolled in an HMO was $3713, with employees paying 
$800 of that amount. A premium increase could take as much as $17 extra out of workers’ pockets each month.
Births to Teens Hit Record Low in Last Decade
Although fertility rates in the United States have risen in the past decade, the number of births to teen mothers dropped 22%, resulting in a record low of 48.7 births for every 1000 girls aged 15 to 19 in the year 2000, according to the US Centers for Disease Control and Prevention (CDC).
The birth rate for "young teens" between the ages of 15 and 17 dropped 29% during this time period, according to a news release from the CDC. However, births to teens aged 18 to 19 years fell only 1%.
Among black teens, the birth rate dropped 31%, the highest decline recorded in an ethnic group during the decade. In a released statement, US Department of Health and Human Services Secretary Tommy Thompson said, "The continued decline in the teen birth rate is very encouraging news. When teens postpone parenthood, it benefits not only their lives, but society as a whole."
The CDC attributed the decline in part to a leveling off of sexual activity among teens as well as increased contraceptive use among teens who are sexually active. In addition, the economic boom of the 1990s may have prompted many teens to forgo families for an education and/or well-paying jobs.
Overall, the US fertility rate increased 3% between 1999 and 2000. The CDC also noted that out-of-wedlock births reached a record high of 33.1% of all births in the year 2000. The rate the year before was 33%.
Most Low-Income Adults Do Not Qualify for Medicaid
An estimated 13 million adults whose annual incomes are <200% of the federal poverty level cannot qualify to receive Medicaid or other public health insurance, according to a July 19, 2001 report from Families USA, a patient advocacy group. The number represents 81% of adults in this income classification.
The report said individuals who work full time and earn the minimum wage of $5.15 per hour make too much to qualify for Medicaid in 26 states. The income limits for the federal/state insurance program are set by the states.
In addition, the report, which is based on Census information from the late 1990s, found that poor adults with little or no income, no serious disability, and no children do not qualify for Medicaid in 43 states. "Most of the public and many policymakers believe that Medicaid provides a health care safety net for all low-income people," said Ron Pollack, director of the Washington DC-based consumer advocacy group. "This myth is grossly inaccurate and discourages corrective action that could significantly reduce the number of uninsured in this country." The Families USA report is available online at http://www.familiesusa.org/media/pdf/holesreport.pdf.
West Nile Virus Spreading
The US Centers for Disease Control and Prevention (CDC) is warning the public of the risk of West Nile virus as the mosquito-borne disease continues to spread across the United States. The first presumptive case of the disease in a person in Florida was discovered in mid-July and sparked the CDC warning.
The disease is similar to another mosquito-borne illness called St. Louis encephalitis and can cause illness and possibly fatal encephalitis. It spreads through the bite of infected mosquitoes, but it can infect humans, types of birds, horses, and possibly other animals. There is no evidence that it can be spread from person to person. The CDC recommends the development of long-term mosquito control programs and public education about residential mosquito control and personal prevention measures.
House Legislation Would Ban Cloning
The US House of Representatives voted on July 31, 2001, to ban all cloning of embryos, including the cloning that would be used for research. In doing so, they rejected arguments from scientific groups that opposed the bill because it would limit scientific research.
The bill, which was endorsed by President Bush, passed by House by a vote of 265 to 162, which meant that many Democrats crossed the aisle to vote with Republican colleagues for the legislation. Those who violate the federal ban could receive as much as a 10-year prison sentence and a $1 million fine. It makes it a crime to use "somatic cell nuclear transfer" in which the nuclear content of an egg cell is replaced with that of a fully developed adult cell. The resulting embryo would be a "clone" of the adult from whom the nuclear matter was taken, according to the Boston Globe in a story in its August 1, 2001, edition.
The bill would not only ban cloning for reproductive purposes but also for research. "This so-called therapeutic cloning crosses a very bright line that should give us pause," said Representative Tom DeLay, Republican majority whip. "It is an unholy leap backward in its evocation of the darker hours of the 20th century."
Researchers had pointed out that the technology could possible lead to new transplants that would not be rejected by the patient’s immune system, according to the Globe. It could lead to a host of cures for diseases such as Alzheimer’s, Parkinson’s, muscular dystrophy and multiple sclerosis.
Death Rate Higher in Elderly with Low Cholesterol
Elderly patients with low cholesterol levels (Lancet. 2001;358:351–355) had a higher death rate in a study performed by investigators in the Honolulu Heart Program. In a longitudinal assessment of changes in both lipid and serum cholesterol concentrations over 20 years, the researchers found that only the group with a low cholesterol concentration (2.09 to 4.32 mmol/L) over a significant period of time had a significantly higher mortality rate.
"Our data accord with previous findings of increased mortality in elderly people with low serum cholesterol and show, for the first time, that long-term persistence of low cholesterol concentration actually increases risk of death. These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (<4.65 mmol/L) in elderly people," said Irwin Schatz, MD, professor of medicine at the University of Hawaii John A. Burns School of Medicine.
In the article, Dr Schatz and his colleagues said, "The reasons for these results are not clear. Perhaps they indicate a selective mortality: those individuals who are susceptible to the biological effects of high serum cholesterol die before they reach 75 years. The individuals who are left would be a select group with lower cholesterol and whose genetic makeup or other factors protect them from the effects of higher cholesterol concentrations. To some degree, the Honolulu Heart Program data support this hypothesis—there are few individuals with truly high concentrations of cholesterol remaining in this population."
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