GOP Managed Care Bill Passes in House

The House narrowly passed a managed care bill Friday that Republican leaders promised would give patients a stronger hand in dealing with managed health care plans without raising the price of health insurance.

The 216-210 vote broke almost entirely on party lines, with only 12 Republicans, including Tom Campbell of San Jose, voting against the bill. Three Democrats voted for it.

The measure would give millions of patients the right to appeal their health plans’ treatment decisions to an independent medical reviewer. Women could use an obstetrician-gynecologist as their primary care physician, and workers whose employers offered only one health insurance plan would gain the right to go to doctors outside the plan.

Before the House voted for the Republican plan, it turned down a Democratic alternative with more far-reaching patient protections by a vote of 217 to 212.

The American Medical Assn. and an array of other medical and consumer groups lobbied hard for the Democratic bill. Ten Republicans voted for it, including Brian P. Bilbray of San Diego and Steve Horn of Long Beach.

President Clinton threatened to veto the Republican bill, arguing that it would do little to stop many managed care plans’ most abusive practices and would not apply at all to people who buy insurance individually.

“This bill leaves out millions of Americans; it leaves out critical patient protections and it adds ‘poison pill’ provisions which undermine the possibility of passing a strong bipartisan patient bill of rights this year,” Clinton said in a statement.

The Senate is planning to debate its version of managed care legislation in September.

Managed care plans, which limit access to expensive treatments, tests and medical specialists in order to hold down costs, now provide care for more than 75% of privately insured Americans.

The Republican bill, while short of what Clinton is seeking, represents a sharp turn from Republican leaders’ pledge six months ago to block any such legislation. Since then, patient protection has emerged as a potentially key issue in November’s congressional elections, and Republicans decided they could not afford to give the issue to the Democrats.

“The concerns about changes in the health-care delivery system are real,” said Rep. John Boehner (R-Ohio), chairman of the Republican conference. “There’s no member of Congress that goes anywhere in their district that doesn’t end up hearing about it, and it’s obvious that our opponents decided that this is the No. 1 issue in the fall campaign.”

Even so, many Republicans expressed reservations about the bill they passed. Some wanted stricter regulations; others said the party was taking a dangerous first step toward a government-run health care system.

“I’d prefer not to have the government involved at all in health care,” said Rep. John T. Doolittle (R-Rocklin). “This bill is intrusive, and I don’t like the heavy-handed regulatory approach.”

Worried about the sharp divisions in their ranks, the GOP leadership wrote the bill behind closed doors, bypassing traditional committee action and public hearings.

Democrats complained that the bill would leave crucial decisions entirely up to managed health care plans.

“It’s a fake, it’s a fig leaf, it’s a sham, it’s a charade, it’s cosmetic, it’s ineffective and it won’t work to solve the real problems, the real concerns that the American people have in this area,” said House Minority Leader Richard A. Gephardt (D-Mo.).

Gephardt then made an emotional and personal appeal for support for the Democratic alternative, dubbed the “patient bill of rights.”

“I sat with my son when he was sick in the hospital with other parents of other kids who had cancer, and they said, ‘My policy doesn’t cover this treatment.’ And when you are sitting in that hospital room and you have a loved one who is dying and you cannot get the treatment they need and you’re begging for it, you’ll want this patient bill of rights and you’ll want it now.”

Gephardt’s son recovered from a serious form of cancer.

Representatives of employer groups and managed care plans criticized the House Republican bill but said it is less onerous than the Democratic plan.

“This debate has been defined by politicians, pollsters and Hollywood producers,” said Karen Ignagni, president of the American Assn. of Health Plans, referring to the film “As Good as It Gets,” which portrays a mother’s disgust with her HMO’s failure to treat her son’s asthma.

“Now is the time to look at the real impact on real people,” Ignagni added. Her organization represents 1,000 health plans nationwide.

Employer groups said their main concern is with the prospect of still more government regulation of health insurance.

“This sets a precedent that Congress will move to micro-managing health plan operations and contract provisions,” said Paul Dennett, vice president for health policy of the Assn. of Private Pension and Welfare Plans, which represents employers.