Managed-Care Reform...Again

Congress is turning back again to managed-care reform, with Democrats and Republicans trying anew to forge a bipartisan consensus on issues such as: what options exist for a cancer patient whose health insurance company refuses to cover a quasi-experimental treatment. That particular possibility is addressed by the Kennedy-McCain Bipartisan Patient Protection Act of 2001, which is getting support from both sides of the aisle. When an insurance company denies payment for a particular cancer treatment, the patient could sue the insurance company and the employer for up to $5 million in punitive damages and an unlimited amount of economic or noneconomic damages in federal court. "Medical necessity" lawsuits, which are a slightly different issue, would be restricted to state courts with damages allowed up to the limit of that state’s law. Of course, concern about a potential proliferation of lawsuits is what killed passage of any managed-care legislation in the last session of Congress. The Kennedy-McCain bill (authored by Sen. Ted Kennedy, D-Mass, and Sen. John McCain, R-Ariz) steps back slightly from some of the right-to-sue provisions that Democrats were pushing last year. But the bill goes further than many Republicans were willing to go in 2000.