When President Clinton and Republican presidential nominee Bob Dole agreed during their final debate that managed-care plans should be banned from implementing "gag clauses," passing legislation to impose such a ban seemed like a slam dunk.
But even though the bill's main sponsor, Rep. Greg Ganske, M.D. (R-Iowa), has rounded up 251 co-sponsors, far more than the 218 votes needed to pass the measure, the bill is bottled up in committee amid concerns that it is too broadly written.
With Congress moving in slow motion as Republican leaders try to devise a strategy for the year, Ganske has tried to jump into the void with his legislation, introducing the bill on Feb. 5.
However, the atmosphere now is unlike the last session of Congress, when a similar bill banning gag clauses was included in the Republican budget legislation. GOP leaders have told Ganske this year that he must go through the usual committee system rather than leapfrogging over the committees that have jurisdiction over the bill.
Without revisions, the bill is unlikely to come before the House for a vote. So far Ganske has been unwilling to alter it.
The bill would prohibit a health plan from placing any oral or written restrictions on medical communications between participating physicians and patients. It also would ban restrictions on doctors disclosing financial incentives and strike down requirements that physicians participate in utilization review programs.
It's the last two clauses, relating to financial incentives and utilization review, that have concerned some lawmakers, including Rep. William Thomas (R-Calif.).
According to Thomas, chairman of the House Ways and Means health subcommittee, the Ganske bill as drafted would extend beyond medical communications. For example, as written, the bill would allow a physician to disclose proprietary information, such as a managed-care plan's fee schedule.
He also contends the utilization review provisions would improperly interfere with health plans' efforts to control the use of medical resources.
"Right now, I am most concerned about the scope of the bill," Thomas said. He added that he also is concerned about how far the federal government should intrude into private employment agreements.
What Thomas would prefer is that plans be required to disclose their financial arrangements, thus leaving the disclosure of potentially sensitive information up to the plan, not individual physicians.
HCFA recently issued a directive to plans enrolling Medicare and Medicaid beneficiaries that did just that.
Managed-care plans, which have called the Ganske bill an unnecessary intrusion into a private transaction between a plan and a physician, also prefer the HCFA approach.