Limited-license practitioners were among the earliest and most enthusiastic supporters of managed-care regulation. But when all was said and done, they weren't able to get much of what they wanted into the bill that passed the House last month.
Their fate is a study in Washington politics and the dangers of picking the wrong horse in a three-horse race.
Early in the debate over managed-care regulation, Rep. Charlie Norwood (R-Ga.) introduced the Patient Access to Responsible Care Act, or PARCA. Among the bill's most ardent supporters were limited-license practitioners, such as chiropractors and podiatrists. But with the passage of the GOP leadership's House bill, PARCA is essentially dead for this year.
Earlier this year, however, the groups formed the Patient Access to Responsible Care Alliance to push the Norwood bill. They even bought ads to support it. And they contributed generously to Norwood's re-election campaign. According to the Center for Responsive Politics, Norwood has received more than $130,000 in the 1997-1998 election cycle from health professionals, mostly the Patient Access to Responsible Care Alliance.
The groups supporting PARCA had a wish list that included three provisions, all of which were included in PARCA. First and most important, PARCA barred contracting and reimbursement discrimination against healthcare providers just because they aren't physicians. PARCA also required plans to offer enrollees a point-of-service product and allowed enrollees to sue their health plans for harm resulting from coverage denials. Health plans are shielded from such actions under the federal Employee Retirement Income Security Act, or ERISA.
The AMA, which opposed PARCA, contributed $3,500 to Norwood's campaign. The association faulted the Norwood bill chiefly because of the provision most sought by the PARCA Alliance -- the ban on discrimination based on licensing. The AMA claimed such a measure would cause providers to sue, demanding the same compensation that physicians would get for the same services.
The bill that eventually passed the House included no anti-discrimination provision. It did not make it easier for patients to sue their health plans. It did include a point-of-service provision, but even the groups that support the measure say that provision is so watered down that it will have little effect.
As action on managed-care regulation moves to the Senate in September, PARCA supporters hope they can get either a strong point-of-service provision or an anti-discrimination provision inserted into the bill considered there.
So what went wrong? That depends on whom you talk to.
According to Norwood, his decision to back a bill that didn't include the anti-discrimination provision was a practical one.
Norwood decided to support the less-regulatory GOP leadership bill because he thought it was the only measure that could be sent to the White House this year, spokesman John Stone said. Norwood thought PARCA could pass the House but would never survive the Senate, Stone said.
"No one knows what the mood of Congress is going to be next year," he said. "In looking at the political landscape, (Norwood asked) `How do we get something done this year?' "
Norwood may try to push a stand-alone bill this year or next year that would allow more lawsuits against health plans.
Some say the limited-license practitioner groups were up against overpowering opponents. The AMA opposed the anti-discrimination provision, and the business community opposed the expansion of health plan liability.
"The AMA and business. Beating both of them would be a pretty tall order," said one healthcare lobbyist who asked not to be identified.
Others say provider groups picked the wrong bill to support, since the GOP leadership never backed PARCA.
But regardless of the reason for their defeat, the groups that supported PARCA have not cooled toward Norwood.
In fact, in a written statement criticizing the Republican bill, the PARCA Alliance applauds Norwood for focusing public attention on the issues surrounding managed-care coverage.
"He has made significant contributions to what can yet be meaningful congressional action on this issue," wrote the alliance.
Even up to the time of the House vote, Norwood kept telling his backers that things would be all right.
Jay Witter, assistant director of government relations at the American Chiropractic Association, said Norwood told the alliance he would try to strengthen the point-of-service provision and add an anti-discrimination measure to the bill. In the end, however, it did not happen.