After more than a year of intense partisan fighting, Congress last week reached agreement on a health insurance reform plan that would make it easier for people who change jobs to keep their coverage.
Republicans and Democrats, including President Clinton, praised the agreement and, at week's end, the legislation appeared to be near passage. The House voted 421-2 to approve the measure and the Senate began debating the bill as Congress prepared to take its summer recess.
Clinton said the compromise package "appeared to be a victory for the American people." However, he stopped short of pledging that he would sign it.
One of the last issues to be resolved turned out to be good news for providers. Under the compromise bill, the Justice Department would be required to give providers trying to form joint ventures guidance on whether the transaction would violate federal laws.
"Hospitals are being encouraged by Republicans and Democrats to come together and form networks, and they need to be able to get straight answers from law enforcement entities as to whether what they want to do is legal under the anti-kickback statutes," said Thomas Nickels, vice president of federal relations for the American Hospital Association.
Justice Department officials said they objected to the measure because they lack the resources to grant individual opinions and were concerned providers would use the opinions to circumvent federal laws.
The bill also makes significant changes to federal anti-fraud laws. New laws expand the rules but also make it more difficult for authorities to prove their case against providers. The bill would require that providers know a fraudulent action violates federal law before courts can order civil monetary penalties. That loosens a current standard under which monetary penalties can be ordered if providers should have known their transactions violated the law.
For courts to apply criminal penalties, prosecutors would need to demonstrate that providers knowingly and willfully violated the laws.
Republicans also agreed to rewrite provisions in the bill designed to keep the cost of individual insurance policies affordable for those who lose their employer-sponsored coverage. Democrats had objected that the bill would have made coverage available but only at a prohibitively high price.
The Senate first passed the health insurance measure by a unanimous vote in April. The House passed a similar but more controversial bill in March.
Democrats objected to a provision in the House plan to spur the growth of medical savings accounts and to the inclusion of medical malpractice reforms. Republican leaders fought a Senate provision that would have required insurers to offer the same level of mental health benefits as for other services.
After months of negotiations, the two sides finally agreed to drop the medical malpractice and mental health measures and to pare back the MSA proposal.
The compromise allows for a pilot project limited to 750,000 policies for employees of companies with fewer than 50 workers and the self-employed. Anyone without insurance also could enroll in an MSA and would not count toward the cap.