The Washington Post
Sunday, Aug. 5, 2001; Page A5

In the last month, the Democratic-led Senate and the Republican-led House have each passed a bill to create federal safeguards for patients in managed care. The measures would require health plans to provide many of the same services, but they differ substantially in the power they would grant patients to enforce those rights.

Comparison on: Whom the Law Covers | Where Lawsuits Against HMOs May Be Filed | Damage Awards | Employer Liability | Access to Doctors | Emergency Room Treatment | Prescription Drugs | Clinical Trials | Tax Provisions

Whom the Law Covers
Senate	House
All Americans in health plans who have group or individual insurance coverage. Same.

Where Lawsuits Against HMOs May Be Filed
Senate	House
Patients may sue health plans over care in state court. Cases involving contract disputes must be filed in federal court. Patients must first finish bringing their complaint to an outside appeals board, unless the delay would cause immediate harm or death.	Patients may sue plans over care in state court under new federal legal rules that would dictate damage awards, standards of proof, and other terms. Patients must first complete an outside appeals process. If they lose, they can sue anyway but face a much higher legal burden to prove their health plan was wrong.

Damage Awards
Senate	House
In state courts, patients can collect whatever state law allows. In federal court, patients may collect unlimited noneconomic damages and punitive damages of up to $5 million.	In either state or federal court, patients can collect up to $1.5 million in noneconomic damages. They also can collect up to $1.5 million in punitive damages in rare cases when a health plan has refused to provide care, even after ordered by an outside appeals board. These limits preempt laws in states that allow higher damages, but states with lower damage limits can keep their own caps.

Employer Liability
Senate	House
Tries to shield employers from getting tangled in lawsuits by workers against health plans. Lets people sue companies only if the companies participate directly in health care decisions.	Tries to shield employers from getting tangled in lawsuits by workers against health plans. Lets people sue companies only if the companies participate directly in health care decisions. In addition, restricts lawsuits against employers to federal court.

Access to Doctors
Senate	House
Guarantees patients direct access to pediatricians and obstetrician-gynecologists. Requires insurers to offer a kind of plan that gives a choice of doctors, at a higher cost.

Emergency Room Treatment
Senate	House
Health plans must pay for care at the nearest emergency room. This includes emergency services, care to medically stabilize the patient and "post-stabilization" care.

Prescription Drugs
Senate	House
Even if a health plan has a formulary of drugs it typically pays for, the plan must allow patients other drugs, at no extra cost, if their doctor says they are necessary.

Clinical Trials
Senate	House
Health plans must pay routine medical costs for patients participating in clinical trials approved or funded by the National Institutes of Health, the Food and Drug Administration, the Defense Department or the Department of Veterans Affairs.

Tax Provisions
Senate	House
None	Allows permanent, unlimited access to medical savings accounts. Creates "association health plans" that allow small employers to band together to buy coverage through professional or trade groups.