House Republican leaders who are developing what many say will become the leading managed-care regulation bill are loading it up with controversial items they hope will act as "poison pills" to doom the bill, critics charged last week.
Among the riders that may be attached are medical malpractice reforms and small-employer healthcare purchasing pools known as Multiple Employer Welfare Arrangements, or MEWAs.
A House GOP healthcare task force led by Rep. J. Dennis Hastert (R-Ill.) is developing the package. According to GOP aides, the group will release its proposal before the end of the month.
The task force's decision to expand the package also has led to the resignation of one of the group's most influential members. Rep. William Thomas (R-Calif.), chairman of the House Ways and Means health subcommittee, was frustrated over the direction the task force had taken, aides said. Thomas, who has been advocating since last year that Republican leaders act on managed-care legislation, also believed the group should have acted sooner.
Neither the malpractice nor MEWA provisions likely would pass the Senate. In 1997 the House passed a MEWA provision as part of a tax bill. But the Senate rejected a similar proposal, and the measure was dropped during negotiations to consolidate the two bills. The same thing happened with malpractice reforms in 1995. Meanwhile, the Clinton administration opposes both measures.
"It's clear we've already had some votes on some issues, and that either they can't make it through the Senate or won't be signed by the president," said Rep. Greg Ganske (R-Iowa). Ganske and six other Republicans have co-sponsored the leading Democratic managed-care regulation bill.
Ganske called the addition of the poison-pill items an "attempt to kill the legislation." Other sources say the controversial items are being added as a way to make the bill more palatable to rank-and-file Republicans who want a patient-friendly bill to vote on before the November 1998 elections. At the same time they want to make sure the bill will be unacceptable to the Senate and the Clinton administration.
Supporters of the healthcare task force proposal, most of whom also oppose the other managed-care regulation measures, said the addition of medical malpractice and MEWA provisions is an innocent attempt to distinguish the bill from the Democratic proposals.
In related developments, Senate Democrats said the full Senate would take up a comprehensive managed-care regulation bill as early as this week. Meanwhile, Rep. Charles Norwood (R-Ga.), the sponsor of the Patient Access to Responsible Care Act, unveiled a series of changes to his plan designed to shore up support.