On January 19, Senator Tom Daschle (D-SD), Minority Leader of the Senate, resubmitted the Democrats’ Patients’ Bill of Rights (S. 6). As the first Democratic bill of the 106^th Congress, Daschle’s action indicates the Democrats’ interest in making managed care reform a top priority.

Background: Just before the end of the 105^th Congress, the Senate, defeated a motion (50-47) offered by Senate Minority Leader Thomas Daschle (D-SD) to act on the House-passed "Patient Protection Act" (H.R. 4250) a Republican bill. Both Republicans and Democrats blamed each other for their failure to find agreement on how to bring the managed care issue to the Senate Floor. Four Republicans crossed over party lines to support Daschle. The 4 are Christopher Bond (R-MO), Alfonse D’Amato (R-NY), Lauch Faircloth (R-NC), and Arlen Specter (R-PA). D’Amato and Faircloth, as we now know, lost their elections.

American Academy of Pediatrics Action: In the last Congress the Academy supported both S. 1890, "The Patients’ Bill of Rights Act of 1998", and S. 2416, "Promoting Responsible Managed Care Act of 1998" because both bills included several of the key children’s provisions outlined below. Unfortunately, the Republican bills fell short in this regard.

In addition, the Academy had endorsed S. 1808, "The Children’s Health Insurance Accountability Act of 1998" introduced by Senator Jack Reed (D-RI). This legislation established a set of managed care standards that are specific and unique to children, including:

• Access to pediatricians;
• Access to pediatric specialty services;
• Continuity of care for a period of time if the physician is terminated from the plan or if the health plan is changed by the employer;
• Access to emergency care, using the "prudent layperson" standard for access to emergency services for children;
• Procedures for the provision of services to enrollee children with special health care needs;
• Internal and independent external appeals and grievance procedures that require review by appropriate pediatric experts;
• Disclosure of health information to consumers that includes measures of structures, processes and outcomes in a manner that is separate for both the adult and child enrollees using measures that are specific to each group;
• Ongoing internal quality assurance program that measures health outcomes that are unique to children;
• Utilization review criteria established with input from those with expertise in pediatrics.

S. 1808 was designed to serve as the children’s piece to any other larger managed care legislation moving through Congress. While many provisions of S. 1808 were already included in Academy-supported managed care legislation (S. 1890 and S. 2416) the Academy will continue our efforts to include the standards (outlined above) in any managed care legislation that Congress considers this year.

The 1998 election results may make it more likely that managed care legislation will be acted on in the 106^th Congress. The House Democrats picked up 5 seats, and 5 is the number of votes by which the Democratic Patients’ Bill of Rights Act (H.R. 3605) fell short last summer when it was defeated July 24^th by a vote of 217-212. Republican leaders will have to decide whether to let managed care reform remain as an obstacle between the two parties or work with Democrats to pass a compromise version in the new Congress. Senate Majority Leader Trent Lott (R-MS) already has said that the Senate will return to the issue this year, but that does not guarantee that Congress will pass legislation.

While many challenges obviously remain, the fact is, there is an opportunity for the 106^th Congress to pass responsible managed care legislation that will benefit both children and pediatricians. The PPC will join with the Academy’s efforts toward that end.

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Last Modified: March 14, 2001