The battle in Washington over managed-care regulation is red-hot, and it is keeping the coffers of political candidates in the black as a number of health groups step up their spending.
With about six months remaining until the Nov. 3 midterm elections, groups that support regulation are spending $2.4 million vs. opponents' expenditures of $1.8 million, according to the not-for-profit Center for Responsive Politics, which tracks election spending (See chart).
The most ambitious spenders in the fight have been Blue Cross and Blue Shield plans and their national association. So far, they have contributed about $1 million to a variety of campaigns. Of that, about $360,000 came from various Blues political action committees, with the remainder coming from "soft money" donations. Soft money is not limited and goes directly to the political parties rather than to a specific candidate. PAC contributions are limited to $10,000 per candidate in each election cycle.
There are several managed-care regulation proposals before Congress. The most notable are the "Patient Access to Responsible Care Act," sponsored by Republican Rep. Charlie Norwood, a Georgia dentist, and the "Patients' Bill of Rights Act of 1998" sponsored by Democrats Sen. Edward Kennedy of Massachusetts and Rep. John Dingell of Michigan.
GOP leaders in the House have developed their own package while Republican leaders in the Senate continue to work on yet another plan.
Most of the plans include a number of patient protections such as a requirement that health plans pay for an emergency room visit if a "prudent layperson" would think the trip was necessary.
Both the Norwood and Kennedy plans would make it easier for beneficiaries to sue a health plan if coverage was delayed or denied. That provision is not in the GOP leadership package.
However, the Republican plan includes a number of provisions not in any other plan. For example, the GOP plan would set up health insurance purchasing pools called "health marts" and would reform the medical malpractice system.
The Blues, along with other managed-care and insurance groups, say the bills would increase costs and cause employers to drop health insurance.
But supporters say the bills are needed to curb abuses by HMOs.
Among the most ardent supporters of the plans are nonphysician practitioners such as chiropractors and optometrists. Those groups stand to benefit from the Norwood bill, which bars HMOs from discriminating against limited license practitioners and requires their payment to be equal to M.D.s' payment for performing the same service.
"This is a very expensive fight," said Jennifer Shecter, an analyst for the Center for Responsive Politics. "This is a major bottom-line fight for these groups, and this is a strong election-year issue."
Other health groups also are spending big this campaign cycle.
The AMA, which traditionally leads all health groups in PAC spending, is again out front (See chart). Over the past three months, the AMA has dished out more than a half million dollars to candidates, bringing its total for the 1997-1998 election cycle to more than $1 million. The AMA supports the Kennedy managed-care regulation bill.