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"That's what they do," Clemente continues. "They run the ads in districts where people are up for re-election. The ads put the candidate's name out there and make it sound like he's doing the right thing, which helps him get re-elected. They're designed to cover a bad vote. They're taken out to cover politicians."
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 one of the bill's most zealous supporters.
But before Republican senators got their business-backed bill to the Senate floor for debate, Democrats brought up their own version of the Norwood-Dingell bill. Fifty of 55 Republicans, including Ashcroft, voted to table it, cutting off any debate or a vote on the bill.
Ashcroft's press offices in St. Louis and Washington, D.C., did not return phone calls for this story.
For the next nine months, the HBC poured millions of dollars into issue ads on radio and TV for Republicans who said they would vote for the business-backed bill. The ads depicted the Norwood-Dingell Patients' Bill of Rights as a big-government boondoggle. They warned that if consumers were allowed to sue HMOs, the cost of health insurance would rise so significantly, many people would lose their health coverage.
In addition to its ad campaign, the HBC began making what, by June 1999, would add up to $1.3 million in campaign contributions. It was an intense front, Clemente of Public Citizen says, for more reasons than the alleged increase of health-care costs. "This goes way beyond health care," Clemente says. "This goes to the heart of the ability of the government to do any regulatory stuff. It's more ideological. It's 'Can the government essentially pass laws that require new regulations?'"
In the first six months of 1999, Ashcroft, a champion of cutting back government regulations, accepted $20,500 from HBC members, the seventh-highest recipient of HBC money in the Senate, according to the Center for Responsive Politics in Washington, D.C.
When the HBC-backed bill finally came to the Senate floor that July, Ashcroft offered what would be the most controversial part of the entire proposal. His amendment was actually an amendment to another amendment offered by Sen. Dick Durbin (D-Ill.). Under Durbin's proposal, all consumers with private insurance could sue their HMOs in state courts. They could also sue their employers if they had a direct say in what services were or were not provided.
Instead of allowing consumers to sue, Ashcroft's amendment required HMOs to provide an appeals process. In other words, a patient who felt he or she had been denied medically necessary care could appeal to an outside reviewer -- a physician -- who would decide the matter. If the reviewer decided the HMO had erred, it would be required to provide the denied service and no more than $10,000 in punitive damages.
On the surface, the amendment looked like a consumer victory, and Ashcroft would later write in a letter to Sen. Don Nickles (R-Okla.), the assistant majority leader: "I offered this amendment in response to concerns from both Missouri physicians and the American Medical Association." A subsequent press release from his office stated: "Included in the Senate-approved Patients' Bill of Rights legislation was a provision written by Senator Ashcroft, and supported by the American Medical Association, that gave ... Americans new legal rights to timely health care."
Asked whether Ashcroft indeed offered an amendment that reflected the AMA's position, Reardon responds bluntly: "He did not."
Although Ashcroft's measure required a reviewer who was a physician, it allowed the managed-care plan to hire the reviewer. Even then, the reviewer could only decide whether the delayed or denied treatment was "medically necessary" as defined by the managed-care plan. "It's totally unacceptable," Reardon says. "Now the health-care plans can say, 'Physicians are making medical decisions.' Well, the allegiance of the physicians they hire will be with the health plan. You're talking about an external reviewer hired by the health plan who works for the health plan.
"The external review should be done by an independent body that is external and independent, and the decisions it makes should be binding. It's unacceptable for the health plan to hire the reviewer."
Vuylsteke, from the Missouri Bar Association, agrees that Ashcroft's amendment isn't as consumer-friendly as it seemed: "The trouble you have with these appeals panels is that they are not timely in many cases, and, of course, you're talking about trying to appeal something when a person is really, really sick. They're going to have to go out and hire an attorney and so forth while they're sick. The whole thing is designed to put more pressure on a patient and discourage them from questioning the decisions of the health plan."
On July 15, 1999, Ashcroft's amendment was adopted by the Senate anyway, as was the entire HBC bill. The vote was 53-47.
Meanwhile, over in the House, the Norwood-Dingell bill was scheduled for a vote, and the AMA didn't spare a dime on its own campaign to get it passed. In August 1999, the group took out newspaper ads in 37 cities calling on House members to support the Patients' Bill of Rights. In a press release, Reardon issued the organization's most forceful statement yet: "I'd like to alert patients and the public that strong forces are at work against them on the issue. The insurance industry has diverted more than $100 million from patient care to pay for an irresponsible propaganda campaign intended to scare patients and intimidate members of Congress."