President Clinton laid out an ambitious healthcare agenda in his State of the Union address last week, but it received a lukewarm reception from provider groups and an even cooler response from GOP leaders.
In many ways, the speech was anticlimactic because much of what was included had been leaked over the past several weeks.
For example, Clinton called for enactment of legislation implementing the "healthcare bill of rights," produced in November 1997 by his Advisory Committee on Consumer Protection and Quality in the Health Care Industry.
"Medical decisions ought to be made by medical doctors, not insurance company accountants," Clinton said to bipartisan applause.
Among other things, the bill of rights would prohibit gag clauses, expand patients' appeals rights, force insurers to pay for emergency room visits when patients had reason to believe the visits were necessary and tighten rules on access to medical records.
Managed-care and business groups criticized the measure.
"Consumer protection laws could cause premiums to increase," said a statement from the Health Benefits Coalition, which includes the National Federation of Independent Business, the U.S. Chamber of Commerce, the American Association of Health Plans and Premier. "The last thing Washington should do in the name of `consumer protection' is leave millions of Americans unprotected."
"We're very disappointed that he thinks the bill of rights has to become law," said Susan Nestor, managing director of legislative policy at the Blue Cross and Blue Shield Association. "We are very opposed to federal legislation."
Richard Pollack, executive vice president of federal relations for the American Hospital Association, said the AHA supports many aspects of the bill of rights but is concerned about writing many of them into legislation.
"Some of these (provisions) should be implemented through a voluntary option or through private accreditation," Pollack said.
Clinton also reiterated in his speech that early retirees should be allowed to buy into Medicare at age 55.
But in the GOP response to the State of the Union address, Senate Majority Leader Trent Lott (R-Miss.) said allowing early retirees into Medicare would further weaken the financial condition of the Medicare Part A trust fund.
Pollack said the AHA is concerned that early retirees would not be asked to pay all Medicare's costs, leaving hospitals to make up the difference.
Laura Thevenot, chief operating officer of the Federation of American Health Systems, said her group believes Clinton should wait until the National Bipartisan Commission on the Future of Medicare -- created by balanced-budget legislation last year -- has reported on the issue of early retirees before trying to extend Medicare to that group.
Clinton also called for a significant increase in funding for the National Institutes of Health.
Much of what the president wants, including expanded federal healthcare fraud measures, will be included in his fiscal 1999 budget, which is expected to be sent to Congress Feb. 2 (See related stories, p. 8).