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Pittsburgh Post-Gazette

President Bush struck a deal yesterday with a key Republican lawmaker on a compromise patients’ bill of rights, but the terms of the agreement threatened to destroy a bipartisan coalition considered crucial to the bill’s success.

Leading lawmakers behind the drive for strong consumer protections in the legislation condemned the compromise as inadequate.

Nevertheless, the House of Representatives is likely to approve it today, almost entirely with Republican votes, according to a House Democratic strategist. Before it can become law, however, the legislation must be reconciled with a stronger consumer-protection version passed by the Democratic-majority Senate in June. With Democrats overwhelmingly opposed to Bush’s terms, it remains uncertain whether Congress will enact the legislation this year.

Bush announced his deal with Rep. Charlie Norwood, R-Ga., after a late afternoon meeting at the Oval Office. Norwood, a former dentist, is generally conservative but is a longtime advocate for patients who forged a coalition with Democrats on the issue.

The president courted him intensely in the hope that he could bring Republican moderates into a compromise that might pass the House, where Republicans hold a six-member majority.

“The White House is confident this agreement will pass the House,” said Bush spokesman Ari Fleischer.

Terms defining the right to sue are the only significant difference dividing Republicans from Democrats on the measure.

The legislation otherwise would guarantee insured patients access to specialists, longer hospital stays, emergency room care and certain experimental treatments that are currently uncovered by most plans.

Although the Bush-Norwood deal would permit lawsuits in either state or federal courts, they could be judged only under federal rules that are far more restrictive for plaintiffs than most state malpractice laws are.

The agreement also would cap damages at both state and federal levels, although it would not limit the out-of-pocket costs patients could recover.

Damages for pain and suffering would be limited to $1.5 million. Damages aimed at punishing the insurer for bad decisions would be limited to $1.5 million.

“It does protect the patients of this country. We have accomplished the very goals we set out” to achieve, Norwood said.

He added that his central goal was to change the law, and “the last time I looked, that’s pretty difficult to do without the president’s signature.”

Bush has threatened to veto the legislation if it does not meet his standards.

One leading Norwood partner in his bipartisan House coalition complained bitterly yesterday that Norwood had sold them out.

“Charlie Norwood cut his own deal with the White House,” said Rep. Greg Ganske, R-Iowa. “There is no deal as far as the coalition is concerned.”

Ganske, who like other former allies had often said Norwood had his complete confidence, accused him yesterday of “acting the savior.”

Democrats initially withheld comment while they huddled behind closed doors, planning how to react.

The key question at issue in the Bush-Norwood deal and the entire legislation is how far patients can go in suing their managed-care health-insurance plans if they feel they have been injured by the plans’ medical decisions.

Ganske and other patient advocates had sought a broad new right to sue health insurers in state or federal courts, with damages set by the states in state courts and capped at $5 million in federal court. Similar terms were approved by the Senate.

Bush had said he would permit only a limited right to sue, arguing that lawsuits and large damage awards would drive up the already-high cost of health insurance and force employers to drop or reduce coverage for their employees.

Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights, denounced the Bush-Norwood deal.

“The Bush compromise must not be allowed to supersede more generous state laws, such as those enacted in California and Texas,” Court said, noting, for example, that Californians have a right to sue for unlimited damages.

Also, if patients lost appeals in newly created independent medical-review panels then decided to sue in either state or federal courts, they would have to meet a higher legal standard of proof than they did in bringing their cases before the panel.

Speaker Dennis Hastert, R-Ill., who has supported only a limited right to sue, said in a statement: “We are finally on the right path to a balanced approach to health care reform. We should not put trial lawyers first. We should put patients first.”

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