determined by attending physician in consultation with patient; and provides for full coverage of second opinions by specialists in appropriate medical field. [Vote 203, 7/14/99] XXXX Voted to Deny Health Protections to More Than 100 Million Americans. In 1999, XXXX Voted to deny basic health protections to more than 100 million Americans. [Vote 202, 7/13/99] XXXX Voted Against Ensuring Insurance Coverage for Emergency Room Care. In 1999, XXXX voted against the Graham amendment to S.1344, which was an amendment to require group health plans to cover emergency room treatment and follow-up care for plan members without prior authorization if a “prudent layperson” would determine that the member requires immediate medical attention. [Vote 201, 7/13/99] XXXX Voted to Limit Application of Patient’s Bill of Rights. In 1999, XXXX cast a crucial vote for an amendment to the Patient’s Bill of Rights Act by Sen. Nicles that provided that the Act would not apply to any health plan if its application in a year caused or would cause the plan’s premiums to rise by more than 1%. The amendment also stipulated that the Act would not apply to any health plan if its application caused or would cause a decrease in 1 year of more than 100,000 in the number of privately insured Americans.[ Vote 200, 7/13/99] XXXX Cast Crucial Vote To Limit Appeals Against Insurance Companies That Deny Medical Care. In 1999, XXXX cast a crucial vote for an amendment to the Patient’s Bill of Rights Act by Sen. Frist, which struck the section of the Kennedy bill regarding appeals of adverse coverage decisions. The Frist amendment would enact provisions that would differ from the Kennedy bill provisions in two main respects. First, instead of enacting a Federal definition for the term "medical necessity," it would enact criteria for internal and external reviewers to consider. The second major difference from the Kennedy bill is that the Frist amendment would limit the internal and external appeals disputes that could be considered to disputes regarding medical necessity and appropriateness and to denials of treatments based on their experimental or investigational nature. Non-medical disputes, such as legal or administrative disputes, would continue to be handled by insurance regulators. [Vote 199, 7/13/99] XXXX Cast Crucial Vote; Against Allowing Women to Choose Their OB/GYN as Primary Heath Care Providers. In 1999, XXXX cast a crucial vote against the Robb amendment to S.1344, which was an amendment to allow women in group health plans to designate an obstetrician/gynecologist as their primary care physician, and to determine, with their physicians, using generally accepted medical standards, the appropriate length of a hospital stay following a mastectomy, lumpectomy or lymph node dissection for the treatment of breast cancer. It also would allow self-employed individuals to fully deduct the cost of their health insurance on their federal taxes, the cost of which would be offset by an extension of Superfund taxes. [Vote 198, 7/13/99] XXXX Voted Against Providing Access to Emergency Rooms and Specialists. In 1999, XXXX voted to kill the Dorgan amendment to S.1233, which was an early version of the Patients’ Bill of Rights. This was an amendment to guarantee access to emergency rooms, specialists, clinical trials, and prescription drugs. It was an amendment to hold HMOs accountable when its decisions lead to injury or death, and to ensure that doctors, not HMO bureaucrats, make health care decisions. [Vote 182, 6/22/99] McConnell Voted to Limit Protections In Patients’ Bill of Rights. In 1999, McConnell voted for the Lott amendment to S.1233, which was a Republican version of the Patients’ Bill of Rights that did not ensure that doctors, not HMO bureaucrats, make health care decisions, and only covered one-third of those in HMOs, among many other provisions. [Vote 181, 6/22/99] XXXX Voted for Medical Malpractice Reform that Limited Patients Rights. In 1998, XXXX voted for medical malpractice reform measures that limited rights of injured patients to hold their doctors accountable. [Vote 144, 5/20/98] XXXX Cast Crucial Vote Against Strong Patients’ Bill of Rights. In 1998, XXXX cast crucial voted against a Patients’ Bill of Rights that would generate access to health coverage. [Vote 73, 4/2/98] 182