The coalition of business and insurance groups that brought down the Clinton health reform plan in 1994 finally has found something else to fight: the specter of the Clinton health reform plan.
The groups are gearing up for what surely will be a nasty fight next year over the regulation of managed care.
On one side, favoring increased regulation, are physicians (who never miss a chance to take a swipe at managed care), consumer groups (which are riding the anti-managed-care wave), congressional Democrats (who know a good election-year issue when they see one) and some congressional Republicans (most prominently the physicians, who apparently hate managed care more than they hate big government).
On the other side are business groups (which hate regulation and don't want to pay for new "body part" mandates), managed-care groups (which are probably sick of getting beat up) and Republican leaders (who hate regulation and are tired of getting beat up, too).
If that were all there was to the battle it would be an easy call: opponents of new regulation in a romp.
But there's a wild card.
Aligned with the pro-regulation forces is the Clinton administration (which also knows a good election-year issue). During the 1996 campaign President Clinton decided to form a commission to examine quality in the healthcare system. For some reason, health plans were worried that a panel including representatives from unions, consumer groups and public health organizations would become a venue to bash managed care.
Conveniently, the commission will release a "consumer bill of rights" this month that the administration is likely to translate into legislation early next year.
Expect to hear a solid endorsement of some managed-care regulation during Clinton's State of the Union address early next year. Expect to hear the words "patient protection" used a lot. Expect to hear horror stories. Expect to hear numerous anecdotes and personal stories about trips to the doctor. Expect to see campaign ads professing politicians' deep concern for consumers in their struggle with the healthcare system.
Let's face it, this is the kind of populist rhetoric that strikes a chord with many people.
The bills are likely to include provisions requiring external grievance procedures for HMO patients, mandating that plans cover emergency services and clinical trials, and barring plans from discriminating against patients on the basis of health status.
To overcome the bully pulpit enjoyed by the White House, opponents of managed-care regulation bills are already working to frame the issue.
This is where the Clinton health reform plan comes in.
Earlier this month, GOP leaders invited other lawmakers to a briefing given by representatives of insurance companies and business groups. The briefing was titled "ClintonCare Returns: The Trojan Horse Strategy."
House Majority Leader Richard Armey (R-Texas), in a letter to other GOP leaders announcing the briefing, wrote, "While many have described (the managed-care bills) as quality bills, it is clear that these initiatives may be hijacked as a way to implement the defeated Clinton Health Plan."
The Republicans' belief that Clinton harbors a master plan is based on a speech he gave in September to a union gathering. During the speech, Clinton admitted he had not given up on his healthcare reform plan.
"If what I tried before won't work, maybe we can do it another way," Clinton said. "That's what we've tried to do a step at a time until we eventually finish this."
Emphasizing the "Return of ClintonCare" theme has energized the Republican base.
According to an internal memo of the Health Insurance Association of America circulating recently in Washington, GOP leaders have told business and insurance groups that if they want the anti-managed-care legislation defeated, the groups had better give the Republicans some political cover.
"The message we are getting from the House and Senate leadership is that we are in a war and need to start fighting like we're in a war," the memo said.
You probably remember that during the debate over the Clinton plan in 1993 and 1994 the HIAA ran a $15 million series of ads featuring a fictional yuppie couple, Harry and Louise, that savaged the Clinton plan. The ads changed public opinion and made it easier for congressional opponents of the plan to attack it without fear of election-day reprisal.
It appears the Republicans would like to see that strategy repeated.
"Get off your butts, get off your wallets," the HIAA memo quoted Senate Majority Leader Trent Lott (R-Miss.) as saying.
To that end, a number of business, insurance and managed-care groups have formed a coaliton called the "Health Benefits Coalition: For Affordable Choice and Quality." Among its members are the National Federation of Independent Business, the U.S. Chamber of Commerce, the National Association of Manufacturers, the American Association of Health Plans, the Healthcare Leadership Council and the HIAA.
Members are planning a number of grass-roots activities during Congress' two-month year-end break. They are also considering an ad campaign and other informational activities. The messages will be that it is the private sector that can deliver quality, not the government, and that mandates increase costs and cause employers to drop insurance coverage.
And you thought the Clinton health plan was history.
To Congress for finally confirming new HCFA Administrator Nancy-Ann Min DeParle. "Administrator-designate" just doesn't carry the same cache as "administrator."
To Sens. Tom Harkin (D-Iowa) and Jon Kyl (R-Ariz.) for holding up the nomination in the first place. No one questioned DeParle's qualifications. Nevertheless, her nomination was delayed for pure politics. This is within the rules of the Senate but comes very close to an abuse of power. Remember, HCFA administrators are people, too.