HMO Reform, Now

Politics in the House of Representatives, so thuddingly partisan this year, became lively and unpredictable last week as 68 Republican legislators rejected the weak HMO reforms backed by their party leaders and voted for an ambitious patients’ rights bill by Reps. Charlie Norwood (R-Ga.) and John D. Dingell (D-Mich.).

The bill, which passed by a solid 275-151 margin and has the support of President Clinton, features protections championed by leading health groups like the American Medical Assn. But Republican leaders are still bent on killing the measure before it can be reconciled in a conference committee with a much weaker Senate version. Senate Minority Leader Tom Daschle (D-S.D.) says conferees should be named now and get to work, but Majority Leader Trent Lott (R-Miss.) says other legislation has a higher priority and that in any case the Senate and the House are too far apart to reach agreement any time soon.

That’s simply not true. Earlier this year, Lott did use his “final amendment” authority to push through the Senate a toothless HMO reform bill quite different from Norwood and Dingell’s measure. But prior to Lott’s high jinks, a majority of Senate Republicans and Democrats had embraced--and could now revive--a bipartisan measure by Sens. John H. Chafee (R-R.I.) and Bob Graham (D-Fla.) with some provisions similar to those in the House bill. Both bills, for instance, require managed care plans to base their decisions on generally accepted principles of medical practice; both bills require plans to pay for emergency room care, and, most important, both guarantee patients the right to appeal a plan’s denial of care to independent medical reviewers.

There is one key difference. The Norwood-Dingell bill would broadly expand patients’ ability to sue their health plans, and the Chafee-Graham bill would not. Norwood and Dingell claim their bill’s lifting of federal constraints on lawsuits would not substantially raise health care costs, but business leaders and their allies in the GOP rightly counter that there’s little evidence to back up their claim. On the contrary, health economists say recent large jury verdicts against health plans suggest that the costs of lifting current liability protections could be prohibitive.

However, the uncertainties over the right to sue should not stop all substantive reforms. The managed care status quo is clearly unsatisfactory.

Congress should focus on a genuine compromise, ensuring patients timely access to quality medical care through independent review and other safeguards while delaying action on the more controversial right to sue.

To Take Action: Sen. Trent Lott: (202) 224-6253. Sen. Tom Daschle: (202) 224-2321. Or go to www.latimes.com, click on Site Map, then Politics and scroll down to Get Involved.