President Clinton and congressional Democrats last week previewed their election-year healthcare agenda, the centerpiece of which will be federal legislation enforcing protections for managed-care enrollees. Democratic pollsters have advised the administration and lawmakers that voters support controls on managed-care plans.
As he did at the release late last year of a White House healthcare commission's consumer, or patient, bill of rights, Clinton again said he supported legislation that would guarantee managed-care enrollees' access to specialists, emergency care and a grievance and appeals process.
"You cannot justify putting people who pay their insurance premiums and are working hard . . . at the kind of risk that so many Americans are at risk of today because they don't have the consumer protections that ought to be elemental in a society like this," Clinton said.
The White House has not decided whether to write its own legislation or support a bill being drafted by congressional Democrats, a White House aide said.
The aide said Clinton and congressional Democrats agree on what protections should be included, but they still are discussing how the protections would be enforced. Options range from voluntary adherence to allowing consumers to file lawsuits against plans. The administration also is considering what role private accreditation could take in ensuring quality in health plans.
Congressional Democrats, meanwhile, sounded a more partisan tone, calling on Republican leaders to end their opposition to patient protection legislation.
"Empty promises of voluntary codes are not enough," said House Democratic Leader Richard Gephardt (D-Mo.). "If necessary, I'm looking forward to fighting the Republican opposition and their industry allies."
Those allies will launch their own counterattack shortly in an advertising campaign. A coalition of business and managed-care groups, including the American Association of Health Plans, the Health Insurance Association of America, the National Federation of Independent Business and the U.S. Chamber of Commerce will unveil a campaign designed to show that regulating managed-care plans will cause a rise in insurance costs and a decline in employer support for healthcare coverage.
But the issue does not break cleanly along partisan lines. The leading managed-care regulation bill in the House was introduced by Reps. Charles Norwood (R-Ga.), a dentist, and Greg Ganske (R-Iowa), a reconstructive surgeon.
That fact notwithstanding, Democrats say they will use managed-care regulation as the anchor of their election-year strategy.
"We need a populist issue, and our best bet is the managed-care bill of rights," said Celinda Lake, a Democratic pollster with Lake Sosin Snell Perry. "The HMO issue has tremendous potential . . . as a populist issue where you want government on your side."
Julie Goon, vice president of federal affairs at the American Association of Health Plans, said: "Political attacks do not advance the national discussion or advance quality. Our concern is that the legislative process will produce government mandates and micro-management."