With last week's release of the House Republican managed-care reform plan, focus now shifts to the Senate, where passage of such reform measures is far from a sure thing, and to several House committees where passage is near certain.
A House task force chaired by Rep. J. Dennis Hastert (R-Ill.) developed the plan after four months of deliberations. It has yet to be drafted into legislative form and introduced as a bill.
The task force also included the chairs of most of the House committees and subcommittees that have jurisdiction over healthcare.
The plan immediately was attacked by both those who thought it went too far and those who thought it didn't go far enough.
Democrats said the plan didn't go far enough, and managed-care and business groups said it would drive up costs and lead to an increase in the number of uninsured.
The GOP leaders were successful in picking off one group, however. The National Federation of Independent Business, which had joined other business groups in opposing all other managed-care regulation plans, supported the proposal primarily because it included a measure to allow small businesses to join insurance purchasing cooperatives.
The House GOP plan includes many of the core patient protections included in nearly every managed-care reform plan on Capitol Hill, including both the Democratic "Patients' Bill of Rights" and the "Patient Access to Responsible Care Act," sponsored by Rep. Charlie Norwood (R-Ga.).
Among them are:
Requiring health plans to pay for an emergency room visit that a "prudent layperson" would consider necessary.
Allowing direct access to OB-GYN specialists and pediatricians without first going through a gatekeeper.
Banning health plans from actions that hinder effective doctor-patient communications.
Expanding the ability of patients to appeal health plan coverage decisions.
The House GOP plan also includes a number of core Republican health initiatives. Among them are medical malpractice reforms, the expansion of medical savings accounts and an increase in tax incentives for the self-employed to buy health insurance (See related story, p. 12).
The GOP plan also calls on the General Accounting Office to report at several intervals on how the U.S. Justice Department implements its recently released guidelines for use of the federal False Claims Act.
Hastert said the task force's proposal will go through as many as four House committees with jurisdiction over its components: Commerce, Education and the Workforce, Judiciary, and Ways and Means.
He said it isn't clear yet whether the entire proposal will be referred to each committee or whether they will deal with the portions over which they have authority-much as the House did when it passed health-insurance reform legislation in 1996-and stitch the bill together before it is sent to the full House.
Hastert said he didn't expect the committees to make changes to the plan, since most of the committee chairs sat on the task force and agreed to the framework.
Hastert said he expects the House to pass the bill before Congress adjourns for its yearly August recess. He said he's "99% sure we're going to have a bill we can put on the president's desk."
The state of affairs in the Senate is much less clear. The Senate counterpart to the House GOP healthcare task force is being led by Sen. Don Nickles of Oklahoma. Nickles has been adamant that he does not believe federal legislation to regulate managed care is necessary. However, under pressure from Senate Majority Leader Trent Lott (R-Miss.), Nickles is reportedly nearing completion of a package.
Hastert said he has kept Nickles informed about what the House task force has been doing, including sharing the House group's legislative language.
"We are not finished with our work yet, so I would not want to characterize how similar the bills would be," Nickles said last week. "We will not pass legislation that will raise the cost of healthcare premiums, drive more Americans into the ranks of the uninsured or create a massive new federal bureaucracy."