President Clinton's call last week for federal patient-protection legislation has resurrected an opposing political coalition reminiscent of the one that trounced his national healthcare reform effort.
Small-business groups angrily denounced the concept of federal mandates as excessive red tape that will make coverage prohibitively expensive for small employers. Large-business and managed-care groups, as well as congressional Republicans, also looked at Clinton's proposal with suspicion, warning against burdensome regulations, higher costs and government-run healthcare.
Consumer groups, meanwhile, backed Clinton, just as they did on healthcare reform. And they were joined by all but one member of the White House's 34-member Advisory Commission on Consumer Protection and Quality in the Health Care Industry, which last week endorsed a "consumer bill of rights."
Clinton drew on the bill of rights when urging Congress to adopt patient protections, although he didn't propose any specific legislation.
In Clinton's favor is the approach of the 1998 mid-term elections, which could make members of Congress reluctant to oppose legislation cast as pro-consumer.
"They have to make sure that the position they're going to stake out is a politically viable one in an election year," said Richard Pollack, executive vice president of the American Hospital Association, referring to opponents of patient-protection legislation. "The politicians are going to be much more sensitive to what works and how it's going to play out in public."
But business groups had a ready response. "It's pretty clear that there are a lot of costs associated with implementing the bill of rights, and it will lead to a greater number of uninsured (people)," said Vicki Caldeira, a lobbyist for the National Federation of Independent Business.
Indeed, that was a sentiment reflected by commission member S. Diane Graham, the commission's lone voice of opposition to the 64-page bill of rights.
"We are setting in motion a process that will end up with Washington driving up costs . . . and denying thousands of Americans their healthcare," said Graham, chairman and chief executive officer of Stratco, a mechanical and chemical engineering firm based in Leawood, Kan.
The release of the bill of rights ends eight months of deliberations by the commission, which was appointed in March to look at quality and consumer issues in healthcare.
In endorsing the bill of rights last week, Clinton acknowledged the opposition and its link to his failed healthcare reform plan.
"There is an emerging consensus in America that while people may not have wanted to bite the whole apple at once in 1994, almost the whole populace wants to keep nibbling away at the apple until we actually have solved the problems of cost, accessibility and quality for all responsible American citizens," Clinton said.
Clinton accompanied his endorsement of the bill of rights with a call for "appropriate" federal legislation to ensure that health plans do not violate those rights.
He urged voluntary compliance by health plans and instructed federal agencies to incorporate the bill of rights into their contracts with health plans to cover Medicare beneficiaries, federal workers and military retirees, their families and dependents of active-duty personnel.
As part of the calls for improved access, information and participation in treatment decisions, the bill of rights affirms some of the top issues of patient-protection legislation on Capitol Hill.
The bill of rights explicitly urges coverage of emergency services in situations in which a "prudent layperson" would believe his or her health to be in immediate jeopardy; access to an adequate network of providers, including specialists; and elimination of "gag clauses" in contracts between physicians and health plans.