Charlie Norwood is trying again on patient protection, but he's doing so without some of his healthcare allies.
Two years ago the Georgia Republican congressman introduced a patient-protection bill with 65 co-sponsors and the strong support of chiropractors, nurse-anesthetists and other limited-license practitioners, who stood to gain from provisions prohibiting their exclusion from health plan networks.
Earlier this month, Norwood, a dentist, introduced the 1999 version of his managed-care bill with no co-sponsors and silence from limited-license practitioners, who are mad because the nondiscrimination language is not included this time around.
In removing the provision, Norwood appears to recognize the
realpolitik of scoring a legislative win: He is willing to lose the support of those providers who helped him garner 234 co-sponsors for his Patient Access to Responsible Care Act of 1997 in order to gain support elsewhere.
The congressman could win the backing of well-heeled physician groups such as the American Medical Association, which opposed PARCA for competitive reasons.
Norwood's new bill, the Access to Quality Care Act, is the first shot in what is likely to be Congress' second HMO regulation battle. It already has insurers and managed-care plans firing back.
"I clearly think the removal of the anti-discrimination language was an effort to pull our group in," said Camille Sorosiak, co-chairwoman of the Patient Access to Specialty Care Coalition, which represents medical specialty groups. Sorosiak also is assistant director of federal government relations at the American College of Cardiology.
Norwood spokesman John Stone characterized the omission of the nondiscrimination language as Norwood's attempt to get the most support he could from clinicians.
"That was the only thing we could not get consensus in the medical community on," Stone said. "There's not a thing (that remains) in that bill that's not universally, strongly supported in the medical community."
He said Norwood will continue to try to develop anti-discrimination language that both physicians and limited-license practitioners can support.
But the damage may already have been done. A pro-PARCA coalition consisting of groups representing the limited-license practitioners has made the nondiscrimination language one of three principles any legislation will need to get the coalition's support.
Norwood is "trying to appeal to a broader audience," said Pamela Phillips, vice president of government affairs at the American Chiropractic Association. "We are very concerned."
The cost of losing his former allies may go beyond the patient-protection battle. Limited-license practitioners, led by such groups as the the American Association of Nurse Anesthetists, the American Association of Oral and Maxillofacial Surgeons, the American Dental Association and the chiropractic association, heavily bankrolled Norwood's 1998 re-election campaign.
They accounted for $95,000 of the $227,764 that health professionals poured into his easy victory over Democrat Marion Denise Freeman, according to the Center for Responsive Politics, a Washington-based advocacy group. Norwood raised a total of $1.2 million, with healthcare organizations by far his biggest contributors. The next largest group was the insurance industry, which gave just $29,000.
But if the nonphysician practitioners are beginning to abandon Norwood's ship, physicians aren't exactly leaping aboard. The AMA is examining the legislation and hasn't endorsed it, said AMA spokesman James Stacey.
The specialty-care coalition hasn't endorsed it, either, but Sorosiak said the exclusion of the nondiscrimination language "moves us one step closer to being able to endorse the Norwood bill."
Managed-care lobbyists, meanwhile, said they aren't concerned about the attempt to get the physician community on board because they believe most physicians were behind Norwood last year anyway.
Despite its opposition to PARCA, AMPAC, the AMA's political action committee, gave $5,000 to Norwood's re-election campaign.
Another uncertainty is how the Democratic and Republican leadership will address managed-care reforms this year. New House Speaker J. Dennis Hastert (R-Ill.) said he will reintroduce the GOP bill he helped to shape last year, which HMOs viewed as less regulatory than Norwood's measure.
The Democrats, meanwhile, are expected to push a more regulation-intensive proposal.