Senate Republicans are putting the finishing touches on legislation that would give consumers new protections against restrictive health plans, including a requirement that insurers pay something for care provided by any doctor patients choose.
GOP sources, insisting on anonymity, said members of a task force drafting the proposal are expected to agree that health plans requiring patients to use certain doctors who accept the plan's prices also should have to pay outside doctors if a patient is willing to pick up extra costs.However, members of the Republican task force led by Majority Whip Don Nickles had not yet decided whether to insert a provision expanding patients' rights to sue their health plans, the sources said.
Better opportunities for patients to take health plans to court are a key demand of consumer groups and are included in rival legislation backed by the White House and congressional Democrats, which has set off one of the most politically charged debates in the run-up to the fall elections.
Wherever the GOP task force comes down on the issue, they are expected to propose that insurance companies be required to have a process patients can use to appeal to an outside arbiter when coverage of care is denied.
Other points that remain undecided by the task force include whether to bar insurance companies from charging higher prices to people genetically predisposed to certain illnesses and whether to expand the availability of tax-exempt medical savings accounts, sources said.
Sen. Phil Gramm, R-Texas, said "we're close to having it done."
The measure is likely to assure patients' trips to the emergency room will be covered by insurance if they had good reason to believe their visit was warranted.
Also, women are expected to be guaranteed the right to choose an obstetrician/gynecologist as their main doctor, skirting some health plans' requirement for prior authorization before appointments.
Several sources said GOP senators on the task force favor granting full tax deductibility to the self-employed for health insurance costs, but need to make sure they can identify the roughly $3 billion needed to pay for it. A costlier provision to give the same tax deductibility to people whose employers do not provide health insurance is less likely to be included, these sources said.