Will the Real John Ashcroft Please Stand Up?

Missouri's junior senator says he is a pro-consumer health-care reformist. But the insurance companies, HMOs and big business, which give him millions, think he's on their side.

The political view from John Ashcroft's Washington, D.C., office was probably anything but pastoral two months ago on June 22.

For one, the normally conservative American Medical Association (AMA) had unleashed an ad campaign in Missouri that morning accusing Ashcroft of carrying water for the insurance industry by voting against the consumer-tailored Patients' Bill of Rights.

For another, a group of senior citizens picketed his St. Louis office that day, charging that the senator had accepted campaign contributions from the pharmaceutical industry in exchange for his repeated votes against a prescription-drug benefit for Medicare beneficiaries. The protesters arrived just days after the Kansas City Star implied in a report that a $50,000 contribution from the drug firm Schering-Plough was made to Ashcroft in exchange for his support of a patent-extension bill that would shower the company with hundreds of millions of dollars at the expense of consumers.

Ken Vuylsteke, chairman of the medical legal committee of the Missouri Bar Association, says Ashcroft's amendment "is another roadblock on the way to getting needed care.... It's really illusory and, in fact, would reduce the rights consumers already have."
Greg Lahann/Newsmakers Photos
Ken Vuylsteke, chairman of the medical legal committee of the Missouri Bar Association, says Ashcroft's amendment "is another roadblock on the way to getting needed care.... It's really illusory and, in fact, would reduce the rights consumers already have."
John Ashcroft, who from 1994-98 accepted more than $600,000 in campaign contributions from the Business Roundtable and about $250,000 from the health-insurance industry, became a zealous supporter of a patients' bill of rights that the American Medical Association called "a sham."
Richard Ellis/Newsmakers Photos
John Ashcroft, who from 1994-98 accepted more than $600,000 in campaign contributions from the Business Roundtable and about $250,000 from the health-insurance industry, became a zealous supporter of a patients' bill of rights that the American Medical Association called "a sham."

But then the day took a defining turn.

First there was Ashcroft's diplomatic and measured response to a maneuver engineered by Democrats, forcing reluctant Republicans to vote to create a prescription-drug benefit for Medicare recipients. "I think its intention is good, and I think many of its proposals appear to be in line with what the people would want and expect," Ashcroft said from the Senate floor, "but without having an opportunity to read it and inspect it, to understand it and understand its costs, I think it is unwise to vote in its favor."

Later that night, Ashcroft told the AMA that after listening to constituents' concerns, he would indeed support the group's Patients' Bill of Rights -- which, among other things, proposed holding insurance companies legally liable for their misconduct. It was a proclamation the AMA immediately applauded: "The Senator last night affirmed his support of the AMA's efforts to pass a bipartisan Patients' Bill of Rights," an AMA press release announced on June 23.

Two weeks later, an ad appeared in the St. Louis Post-Dispatch, a full-page, full-blown thanks to Ashcroft "for supporting a Patients' Bill of Rights that's right for Missouri." Although the ad wasn't paid for by the AMA or Ashcroft, its sponsors clearly supported the senator's votes on health-care reform.

"It's right to improve our health care," the ad stated in bold capital letters. "It's right to help the uninsured.... It's right to stand up to special interests.... It's right to protect businesses and families.

"Thanks, Senator Ashcroft, for working for the right health care reform."

Had the senator indeed shed his growing image as a politician owned and operated by big business, a politician who sidestepped Medicare reform and who ignored calls for help from constituents who felt herded and corralled into a managed-care system that wasn't working? On the surface, it appeared Ashcroft's detractors were all wrong about his positions on two of the most wide-ranging and controversial issues of the health-care debate.

But as events after June 22 would show, image became one thing and reality another.

During his "State of the Union" address in January 1998, President Bill Clinton called on Congress for a patients' bill of rights in response to swelling demands by the 161 million Americans with private health insurance that something be done about the disastrous state of managed care. In essence, bean counters, not physicians, were making treatment decisions, and when they made the wrong ones to save money, patients had no recourse.

Despite Congress' foul mood over Monica Lewinsky that year, Rep. Charles Norwood (R-Georgia) stood up and wildly applauded the president, even waved at fellow Republicans to do the same. Because many of his peers, particularly Ashcroft, were out of humor at the time, most of them ignored Norwood.

But they couldn't for long. The bipartisan patients' bill of rights Norwood sponsored that session with Rep. John Dingell (D-Mich.) -- and co-sponsored by 60 Republicans and Democrats -- was hailed by the AMA, the American Association of Retired Persons, Public Citizen and Families USA.

It was a sweeping measure. If a patient, for instance, chose to sidestep a gatekeeper physician and use a gynecologist or other specialist within the HMO network as her primary physician, the plan would have to allow that. If a person had severe chest pains and rushed to the nearest emergency room without calling the HMO first, the health plan would still be required to pay for the visit. If a pediatrician decided a child with cancer should see a specialist outside the patient's HMO network, the plan would be required to pay for that, too.

By far the most controversial provision of the bill, though, allowed consumers to sue their health-care plans in state courts for damages resulting from the unnecessary delay or denial of treatment.

The right to sue in state courts was a critical provision. Currently, about one-third of the 161 million Americans covered by private health insurance are in "self-insured plans," which means their employer sets aside a pool of money to pay for the workers' health-care needs and hires a managed-care company to administer it. Under federal law, beneficiaries in self-insured plans cannot sue their employer or managed-care company in state court if they are denied medically necessary treatment. They can only sue in federal court, and if they win, they can only collect the cost of the denied treatment. In short, the only risk for bad medical decisions made by employers or managed-care companies is that they may ultimately only have to pay for the denied treatment. Federal law does not allow beneficiaries to sue for punitive damages.

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