The release last week of the Senate and House Republicans' final plans for managed-care regulation sets the stage for what likely will be the most explosive legislative issue remaining this year in Congress.
Senate Republican leaders unveiled a managed-care regulation plan that is the most limited of all the proposals released to date. They expect to have the proposal drafted into a bill later this week. House GOP leaders, meanwhile, have introduced the final version of their own bill, which includes a number of provisions that aren't in the Senate version.
Both GOP plans share many "patient protection" measures with their corresponding Democratic alternatives, sponsored by Sen. Edward Kennedy of Massachusetts and Rep. John Dingell of Michigan.
For example, all the proposals would allow direct access to obstetricians/gynecologists and pediatricians for women and children.
The most significant area where the plans diverge is over beneficiaries' ability to sue a health plan that has delayed or denied coverage.
The GOP bills expand penalties if a plan refuses to comply with the decision of an external review board, which would be called upon in controversies involving health plans that are exempted from state laws under the Employee Retirement Income Security Act.
The Democratic plans take a different approach. They would make it easier for beneficiaries to sue when the plan delays or denies coverage. Republicans staunchly oppose such provisions, which they contend will increase litigation but not healthcare quality.
Last week, at a rally to support the Democratic bills, President Clinton said the health plan liability provision was the most important piece of the managed-care regulation puzzle. He stopped short of threatening a veto if the measure was not included in a congressional package, however.
Republican leaders in both the House and Senate pledged a vote on their plans before Congress adjourns for its traditional August recess.
Those pledges, and Clinton's challenge, raise the matter of managed-care regulation to a level not attained by a health issue since the 1994 debate over healthcare reform. Both sides held rallies. The Democrats' included a number of secret witnesses who alleged wrongdoing by health plans. Not to be outdone, the Republicans staged an event outside the George Washington University Ronald Reagan Emergency Center.
When all the rallies are done, one issue that likely will make a difference is cost.
Last week the Congressional Budget Office released its analysis of the Democratic proposal. The CBO said the bill would raise insurance premium costs by about 4%. Of that, 1.2 percentage points would come from the health plan liability provision.
Employers would deal with most of the additional cost by dropping health insurance, raising costs to workers or decreasing wages, the CBO warned.
Democrats said the CBO analysis shows their plan would cause only a marginal increase in premium costs while affording patients needed protections.
Republicans said a 4% increase would cause millions of people to lose their health insurance.
Another measure of the potency of the managed-care regulation issue is the amount of advertising it is engendering. Last week the AFL-CIO started a $1 million campaign in support of the Democratic plan. The advertisements are running in 21 congressional districts, considered swing districts in the upcoming November election. Business and insurance groups countered with an ad campaign that attacks the bills in 15 districts, many overlapping with the labor campaign. The groups would not divulge how much they were spending on the ads.
Meanwhile, Rep. Greg Ganske, (R-Iowa), who has tested the House GOP leadership's patience in its tortuous journey to healthcare quality legislation, last week resigned his position on a national Medicare commission because of conflicts with fellow Republicans.
Ganske, a Des Moines plastic surgeon who first sponsored legislation banning "gag clauses," appeared with Clinton at the rally.