MANAGED CARE REFORM: Opponents Spent $60 Million
Insurance companies, trade groups and other opponents of managed care reform spent $60 million to lobby Congress in the first half of 1998, an average expenditure of $112,000 per member of Congress. The industry's lobbying tab dwarfs the $14 million spent by reform advocates such as the American Medical Association, the AFL-CIO and the Association of Trial Lawyers of America, and even outstrips the $40 million spent by the tobacco industry to defeat comprehensive anti-smoking legislation earlier this year. The AP/Philadelphia Inquirer reported that the "figure does not include $11 million spent on advertising against the managed care legislation, nor millions of dollars in campaign contributions that opponents of new regulation made in the just-concluded congressional campaigns." Ron Pollack, executive director of Families USA, said, "It certainly does show that the industry spared little effort to try to defeat patients' rights that are so popular all across the country" (Salant, 11/28). Some opponents of regulation, however, questioned the accuracy of the numbers. American Association of Health Plans spokesperson Susan Pisano said, "AAHP was at ground zero in this campaign, and to us these numbers seem wildly inflated." She added that the figures are trumpeted by "opponents of a reasonable policy discussion who are trying to change the subject." Others were simply unapologetic about their expenditures. "We didn't have legislation pass in the last Congress, and that was our objective," said Dan Danner, chair of the Health Benefits Coalition. "Stopping trial lawyers and their agenda of allowing patients of HMOs to sue the companies that provide them the health care was a chamber top priority," said Frank Coleman of the U.S. Chamber of Commerce, which spent $8 million to defeat regulation, more than any other group. Kim Ross, chief lobbyist for the Texas Medical Association, questioned "why health plans don't use lobbying funds on medical care." He said, "If this were about patient care, they would be shifting the money into patient-care aspects and therefore dissipating some of the (consumer) insurrection. What this is really about is control and power. It speaks volumes about their intent" (Ornstein, AP/Dallas Morning News, 11/28).
Patients' Rights: Round Two
"Bolstered by this month's Congressional elections," and buoyed by a more sympathetic Republican leadership, Democrats plan to make another run at significant managed care reforms when the next Congress convenes. The Los Angeles Times reports that "[k]ey administration and congressional leaders are already suggesting compromises to break a logjam on the issue." While any legislative package would almost certainly include guaranteed emergency room coverage and an external appeals process, the major sticking point is still likely to be the right to sue health plans, which the president and many Congressional Democrats support (Rubin, 11/30). Appearing on "FOX News Sunday", Sen. Bill Frist (R-TN) said, "We need a strong internal appeals process, a strong binding external appeals process. We need to fix the system. I can tell you from health care that there is no way to bring a hundred trial lawyers into the room to solve this problem. You've got to fix the system." Sen. John Breaux (D-LA), another key player in the managed care debate, seemed to agree. He said, "Giving the patient just the right to sue, as to whether they need a liver transplant, they could be dead by the time a decision in the court is ever reached. That doesn't help the patient. I'd like to see something that establishes a right to a procedural administrative appeal that gets a decision quickly" (11/29). Expect the insurance lobby to mount another counterattack, however. Danner said, "This will be a large effort once again. The stakes are very high" (AP/Inquirer, 11/28).
Post Weighs In
An editorial in Saturday's Washington Post argues that managed care reform will likely provide an early test of the Republican leadership's willingness to compromise. "It's simpler than such subjects as campaign finance, it has great resonance with the public, and the bill is fairly well developed," the paper notes. The Post, however, remains lukewarm on the right-to-sue issue, saying that "litigation of decisions such as these seems to us the last thing the society should want; Congress should try the appeals process first." While the editors laud managed care for reining in costs at a time when one-seventh of the U.S. population lacks insurance, they conclude: "Without some form of cost containment, care will become even less accessible. The need is to place some controls on the cost-controllers while leaving them with the power to do their job. It's a difficult, serious issue, and the Republican leadership treats it with contempt at its peril" (11/28).