Managed Health Care Reform Reaches Critical Stage

The fight over whether to tighten federal regulation of managed health care moved into a make-or-break phase Thursday in Congress as lawmakers sought to hammer out a compromise on two versions of a patients’ bill of rights.

If they are to deliver a bill to President Clinton by Easter as they have promised, Republican leaders will have to reconcile a tough House bill with a version passed by the Senate that has weaker patient protections and would cover far fewer people. And like members of a dysfunctional family, lawmakers of both parties have as much to gain from a standoff as from a resolution.

On the Republican side, House members who worry that the November elections could cost their party its shaky House majority want a bill that Clinton can sign so they can boast to voters of their pro-consumer record. Furthermore, nearly a third of the Republican conference voted with Democrats for strong patient protections.

On the other side of the Capitol, Republican senators face little risk of losing control in November, and they have less reason to give ground.

Congressional Democrats, for their part, have no desire to move toward the weaker Senate version of the bill and expect to stay united and close to the White House position.

“Both parties are caught between the populism of this issue and the interest groups that they are close to,” said Larry Levitt, a senior analyst at the Kaiser Family Foundation.

Further complicating the negotiation is a cacophony of rhetoric from interest groups, including insurers, doctors, employers and lawyers, all of whom have a huge financial stake in what kind of bill--if any--becomes law. Physicians, public health groups and consumer advocates support the stronger House bill, while the insurance industry, health maintenance organizations and employers prefer the Senate bill, though not enthusiastically.

President Clinton weighed in before the conference even started. In remarks at the White House, he warned that he would veto any bill that failed to cover all Americans or that lacked a way for a patient to recover substantial damages from a health plan in court if the plan’s decision results in the patient’s injury or death.

A bipartisan group of lawmakers joined Clinton at the White House event, designed to rally support for a strong bill. Chief among the GOP leaders was Rep. Charlie Norwood (R-Ga.), a dentist who is also co-sponsor of the bill that passed the House, and Sen. Arlen Specter (R-Pa.), who co-sponsored a bipartisan compromise bill that failed in the Senate.

Clinton emphasized that polls show a majority of Americans of both parties support more regulation of HMOs. He left the door open for alternatives to the House approach on liability but emphasized the importance of giving patients leverage through better access to the courts.

“I will not sign legislation that is a patients’ bill of rights in name only,” Clinton said.

At the other end of Pennsylvania Avenue, Sen. Don Nickles (R-Okla.), assistant majority leader and the conference’s chairman, who is widely viewed as a deeply partisan player, took pains to strike a conciliatory tone and commit himself to working toward a compromise that both chambers could approve.

“It would be easy with differences so significant between the two bills for this not to happen,” Nickles said. “But . . . let’s try to work out things as aggressively as possible.”

Nickles said that his plan is to complete work on areas where there is common ground, such as the need to ensure access to specialists, emergency room services and pediatric care, and then turn to the fundamental philosophical differences between the bills.

The House bill, for instance, would guarantee all patient protections to the 160 million Americans in group and individual health plans. By comparison, the Senate bill applies different protections to different groups. Thus, people with individual insurance plans of the kind often purchased by the self-employed would have few federal protections, whereas those who work for large multi-state companies that self-insure would be guaranteed access to specialists, clinical trials, emergency room care and an independent appeal if their health plans denied them a treatment they requested.

However, Nickles and Rep. Thomas J. Bliley Jr. (R-Va.), chairman of the House Commerce Committee, underscored that they want to ensure there is no increase in the cost of health care as a result of the bill and that the overall health care system is not undermined. One of the criticisms of the bipartisan House-passed legislation is that, by opening up HMOs to more lawsuits, the cost of health care could rise. Estimates by the nonpartisan Congressional Budget Office, however, found that the increase would be relatively small: 5% over five years.

Leading the Democrats in the conference are Sen. Edward M. Kennedy (D-Mass.) and Rep. John D. Dingell (D-Mich.). Both support the House version of the bill.

Absent from the conference was Norwood, who is out of favor with his leadership for pushing hard to pass a strong patients’ bill of rights.

House Republican leaders, angry that 68 rank-and-file GOP members led by Norwood voted with Democrats, decided to exclude Norwood and his close colleague Rep. Greg Ganske (R-Iowa), who is also a physician, from participating in the conference.

A wild card in the conference’s outcome is whether whatever compromise is reached will be strong enough to win over those House Republicans who sided with Democrats on last year’s vote.