PATIENTS’ RIGHTS: Changes Assure Passage Of GOP Bill
House Republicans secured a "razor-thin majority" (216-210) Friday to pass managed care reform legislation that would "allow patients and doctors more leeway in obtaining medical treatment and ... strip managed care companies of some protection against lawsuits from those who are denied care," the Baltimore Sun reports (Fokenflik/Weisman, 7/25). Republicans passed their proposal and defeated a Democratic alternative after the GOP "whip operation worked past midnight Thursday and throughout [Friday] morning to craft a series of small compromises" to secure support from the party's moderates and conservatives. Specifically, the "GOP leadership dropped a provision that would have permitted the sale of patients' medical records, and slightly strengthened parts of the bill that address emergency room coverage and a ban on 'gag rules.'" The Washington Post reports that Republican leaders also agreed to a request by Reps. Thomas Davis III (R-VA) and Constance Morella (R-MD) to remove "a provision that would have made medical savings accounts an option under" the federal employee health plan. Morella and Davis "reasoned that the MSAs would attract young, healthy workers and thus leave primarily older, sicker workers in the federal insurance pool." And in a bow to GOP conservatives, Republican leaders "pledge[d] ... to bring up next year" legislation that would make "individuals, instead of employers ... responsible for buying insurance" (Goldstein/Eilperin/Dewar, 7/25).
Rep. Marge Roukema (R-NJ) was one of 12 Republicans who voted against their leadership's bill. "The bottom line is whether patients will have better access to health care and whether doctors will be put back in charge of medical decisions. We are not there yet, but the (Democratic bill) takes us closer than the (Republican bill)," she said (Piore, Bergen Record, 7/25). The Los Angeles Times notes that ten Republicans voted for the Democratic patients' rights bill, including Reps. Brian Bilbray and Steve Horn of California (Rubin, 7/25). The 12 Republicans who voted against the GOP bill were: Tom Campbell (CA), Robert Barr Jr. (GA), Michael Crapo (ID), Helen Chenoweth (ID), Greg Ganske (IA), Constance Morella (MD), Marge Roukema (NJ), Michael Forbes (NY), Mark Sanford (SC), Henry Bonilla (TX), Kevin Brady (TX) and Ron Paul (TX). The three Democrats who voted for the GOP bill were: Pat Danner (MO), James Traficant Jr. (OH) and Virgil Goode Jr. (VA) (Washington Post, 7/25).
Good News On Costs
The New York Times reports that the Congressional Budget Office released an analysis of the GOP bill Friday which concluded that the plan "would not increase costs and would save Medicare and Medicaid $1.5 billion over 10 years." This analysis compares to a CBO finding that the Democratic bill "would increase consumer insurance costs by 4%" (Alvarez, 7/25).
The White House said President Clinton would veto the House GOP bill. "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. During the debate, House Minority Leader Richard Gephardt (D-MO) called the GOP bill a "fig leaf" and a "sham" that will fail to solve HMO problems (Los Angeles Times, 7/25).
Chip Kahn, president-designate of the Health Insurance Association of America, said his group is "disappointed" that the House took quick action on the "flawed" GOP bill. However, he said "he preferred the Republican approach to that of the Democrats, which would have opened up his industry to more lawsuits" (Baltimore Sun, 7/25). Karen Ignagni, president of the American Association of Health Plans, said, "This debate has been defined by politicians, pollsters and Hollywood producers. Now is the time to look at the real impact on real people" (Los Angeles Times, 7/25).
Senate Debate Next
Today's Wall Street Journal reports that "it isn't clear when" Senate action on managed care reform will begin. According to "[s]ome observers," the Senate "perhaps won't be able to pass any managed care bill." HIAA's Kahn said, "It's out in the miasma as to whether the Senate can pull it together" (McGinley/Seib 7/27). CongressDaily reports that Senate debate likely will be put off until after the August congressional recess (Norton/Rappaport, 7/24). Appearing on NBC's "Meet the Press," Sen. Bob Kerrey (D-NE) said "there's certainly a middle ground" in the Senate. However, he said any managed care legislation must give patients "a sufficient amount of power" to hold health plans accountable. On the same program, Senate Majority Whip Don Nickles (R-OK) downplayed the chance of compromise, saying there is "a big, philosophical battle" shaping up. He said the Democrats' bill is all about the right to sue. "And, frankly, the net result, if that happens ... you'd see health care costs skyrocket, you'd see people dropping their health care plans," he said (7/26).
Centrist Bill To Be Released Today
Sens. John Chafee (R-RI), Bob Graham (D-FL) and Joseph Lieberman (D-CT) are scheduled to unveil a "bipartisan managed care proposal" this afternoon (CongressDaily/A.M., 7/27). This proposal "would leave out some of the more contentious provisions offered by each party, including the Democrats' lawsuit language" (Love, AP/USA Today, 7/27).