Congress Split Over Suing HMOs

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Should you have the right to sue your HMO or health plan over improper medical treatment? Yes, say the Democrats, because without the right to litigate there's no way for patients to hold health plans accountable for their decisions. No, says the GOP -- the right to sue would simply divert money away from health care and into the pockets of wealthy trial lawyers. "The issue of litigation is the primary difference between the parties' competing health plan reform bills," says TIME Washington correspondent Karen Tumulty. "This being an election year, they're going to fight this one down to the wire."

The GOP's bill, formulated in response to an earlier White House-backed package, reflects a substantial turnabout from Republican opposition to the reforms proposed by President Clinton last fall. "Republicans running for reelection were finding that their party's apparent support of the insurance companies was working against them," says Tumulty. Both parties now agree on reforms that would speed access to specialist care, make HMOs pay for unnecessary emergency room treatment when it was reasonable for the patient to assume there was a crisis, give patients access to more information on treatment options, and subject disputed coverage decisions to speedy third-party review. What they can't agree on is a mechanism for enforcing those changes.