The House plans to vote later this week on an insurance reform bill that aims to expand health insurance for workers who change jobs or lose their employer-sponsored coverage.
Two House committees blessed the measure last week, but it was unclear whether House Republican leaders would insist on pushing for controversial provisions the White House has vowed will lead to a veto. Among those provisions are the expansion of medical savings accounts for non-Medicare patients and medical malpractice reform.
While Republican leaders continued to push for the measures publicly, some provider group lobbyists said last week that they sensed the House leadership was moving toward a streamlined health insurance reform plan similar to the one sponsored in the Senate by Sens. Nancy Kassebaum (R-Kan.) and Edward Kennedy (D-Mass.).
President Clinton has repeatedly said he would sign the Kassebaum-Kennedy bill. Kassebaum has insisted that no amendments should be added to the bill.
"It's our commitment to get a bill that the president will sign and that we can get agreement with the Senate on," said Rep. J. Dennis Hastert (R-Ill.), head of the House Republican healthcare reform task force.
Some Republicans say the medical savings account measure and malpractice and antitrust reforms are necessary to ensure that health insurance policies will be more affordable.
Now, the MSA measure is included in only one of those three insurance reform bills, the one passed last week by the House Ways and Means Committee. Malpractice and antitrust reform measures would have to be added when the bills reach the Rules Committee early next week.
House Commerce Committee Chairman Thomas Bliley Jr. (R-Va.) said he will recommend that his committee's version of the bill go to the floor untouched, but he offered no assurances that the GOP leadership would follow his recommendations.
On consecutive days last week, the House Ways and Means and Commerce committees approved slightly different insurance reform bills. They will be combined by House GOP leaders into one package.
Both bills aim to expand health insurance coverage by making policies more available to workers who lose or change jobs or have pre-existing conditions.
The Ways and Means-passed bill also includes a number of fraud-and-abuse provisions supported by hospital groups.
The first would require HHS to issue "advisory opinions" to providers on Medicare fraud-and-abuse issues on a timely basis. Advisory opinions are issued on a case-by-case basis and can give providers guidance before a transaction is completed.
Providers say the advisory opinions are necessary because federal fraud-and-abuse statutes are vague, and some have yet to be issued in regulation form.
"We agree that (HHS) should go after bad guys, but they should not have speed traps where providers don't know the rules or the rules are too vague," said Mary Greely, executive vice president of the Federation of American Health Systems.
The second provision sought by providers would extend exemptions from federal anti-kickback rules to various forms of managed care, including provider-sponsored networks and partially capitated plans. Providers say the exemptions would foster managed care in federal health programs.
Democrats opposed to loosening the fraud-and-abuse rules, led by Rep. Fortney "Pete" Stark (D-Calif.), made several attempts to strip the provisions from the GOP bill but were defeated on straight party-line votes.