Lobbyists Sour Lawmakers on Patients’ Bill of Rights

Two Caterpillar Inc. executives flew in from East Peoria, Ill., in early February to let their hometown congressman, Republican Ray LaHood, know how unhappy they were that he had co-sponsored legislation to protect patients in managed care plans.

If the bill becomes law, they warned, it will cost the company, the largest employer in LaHood’s district, millions of dollars. Now LaHood is considering taking the rare step of withdrawing as a co-sponsor.

If he does, he will add his name to a growing list of lawmakers who are succumbing to a carefully orchestrated lobbying campaign by scores of employers and managed care companies.

The bill, which responds to a widespread feeling among consumers that they are helpless to challenge adverse decisions by their managed care plans, had won 227 House co-sponsors--more than half the members. With support from both parties, legislation reining in the managed care companies seemed on a sure road to enactment.

Now, in the face of the lobbying juggernaut, the bill formally has lost the support of six Republicans, including David Dreier of San Dimas. Other sponsors have said that they cannot vote for the bill if it comes to the House floor.

And its chief sponsor, Republican Rep. Charles W. Norwood Jr., a Georgia dentist, is rewriting key provisions to ease the bill’s effect on employers.

“Whether there will be legislation this year is now a question,” said Frank McArdle, a health care consultant for Hewitt Associates, an international health care consulting firm.

The success of the opposition to managed care regulation tells a classic story of how even legislation that appears to have broad public support can crumble in the face of a sophisticated lobbying campaign by powerful special interests.

The companies that oppose the legislation have spared no expense. Their efforts include a $1-million-plus television advertising campaign, fly-ins by company executives, a substantial grass-roots mail campaign and public relations efforts in key states.

A number of the business groups that have mobilized against the managed care bill had waged a similar offensive against President Clinton’s 1994 proposal to provide health insurance for all Americans. This time their ranks are bolstered by managed care companies and insurers, which are lobbying hard against further regulation of their industry.

Last month, on the first day that LaHood was visited by Caterpillar officials, executives from about 50 manufacturing companies knocked on the doors of more than 100 other lawmakers. That blitz was organized by the National Assn. of Manufacturers, a founding member of the Health Benefits Coalition, which opposes managed care regulation.

“The first mission was to slow down what looked like an avalanche of support for the legislation, and that was accomplished very successfully,” said coalition Chairman Dan Danner, a lobbyist for the National Federation of Independent Businesses.

Every other Friday morning, representatives of the 35-plus groups in the coalition gather in the federation’s conference room just a few blocks from Capitol Hill to plot strategy and compare notes. In addition to working with the coalition, each organization has its own lobbying campaign.

For instance, the American Assn. of Health Plans has chosen to rally opposition by calling regional press conferences that predict dire consequences for individual states if Congress passes a patients’ rights bill.

Its press releases warn that legislation would probably increase health insurance premiums by 10%, causing a “devastating human and economic impact.” So far it has released data in Oklahoma, Louisiana, California and Ohio.

In California, many of whose House members have signed onto Norwood’s bill, the study claims that 36,700 jobs would be lost, take-home pay would decline by $380 and 454,782 people would lose their health insurance altogether. The cost to California businesses of providing insurance for workers would rise by $2.3 billion, the study says.

In fact, Norwood’s bill is only one of several to tighten regulation of managed care plans. Other bills seek to raise insurance prices by smaller amounts.

The Congressional Budget Office estimates in a still-unreleased report that the patients’ rights advocated by Clinton, which include access to emergency rooms and a right to appeal health plans decisions, would raise premiums by less than 1%.

Still, the price argument resonates with the public, which seems ready to believe the worst, even though the reality is that some steps would be expensive and others, such as the right to appeal, could cost less than $1 or $2 a month per person.

A survey by Harvard University and the Kaiser Family Foundation of attitudes toward managed care found that 74% of Americans favor the patients’ bill of rights endorsed by President Clinton, but that support drops to just 33% if an increase in insurance costs results.

It was the cost argument that gave LaHood pause when the Caterpillar lobbyists swooped down on him. “I had no idea what impact [the bill] would have on companies like Caterpillar,” LaHood said. “This is a really significant cost for employers.”

Slowing Norwood’s bill was relatively easy. It is replete with provisions--such as requirements to make it harder for plans to limit the number of participating doctors--that are easy to characterize as expensive and bureaucratically burdensome.

By contrast, many Democrats in Congress are crafting a bill whose elements were endorsed recently by Clinton’s commission on health care quality, whose members included business and managed care representatives. That bill, which probably would cost far less than Norwood’s, could prove a tougher target for the business and managed care lobbyists.

“A more modest bill is harder to fight,” said Julie Cantor-Weinberg, an NAM health care lobbyist. The deciding factor, she said, will be whether constituents continue to demand that lawmakers respond to what they see as managed care’s shortcomings.

“The key test will be the next few weeks,” Cantor-Weinberg said. “Congress has a long Easter recess coming up. What will they hear when they go back home?”

Bob Blendon, a professor of health policy at Harvard, said that Republicans can afford to yield to the business and managed care lobby as long as the public remains uncertain about what the government should do to remedy what’s wrong with managed care.