House Republican leaders have rejected the idea of trying to pass managed-care reforms incrementally and will try to push through a comprehensive measure this year, healthcare sources said last week.
House Speaker J. Dennis Hastert (R-Ill.), who has pledged a vote on "patient protection" legislation this year, rejected the notion of moving a number of narrowly drawn bills through several House committees, instead focusing on a single, all-encompassing patient-protection bill, sources said.
The decision represents a calculation that it would be easier to limit Democrats' ability to amend a single piece of legislation than to keep control of numerous bills.
Democrats want to add measures that would open health plans to more lawsuits from enrollees or require that physicians alone determine whether services are medically necessary.
The narrow bills would have been built around such single issues as emergency room coverage, prohibition of "gag clauses" in contracts between plans and physicians, or access to obstetricians, gynecologists and pediatricians. Those are issues on which there is broad bipartisan agreement, and they would allow the GOP leadership to claim that it had acted on patient protection without opening the door to more explosive legislation on medical necessity or liability issues.
The argument for narrow bills was to use the House debate rules, which require that amendments be relevant to any bill being debated. By making a bill address only a narrow issue, few amendments could be ruled germane.
The fear was that if such amendments get to the full House, where Republicans hold a razor-thin six-vote majority, the Democrats would be more likely to prevail if amendments on the more controversial issues face a vote.
But the House leadership has decided that trying to pass between four and seven narrow bills would increase rather than reduce the opportunity for Democrats to offer amendments.
Managed-care lobbyists said they support the decision. "We didn't want to go through four different battles," said one lobbyist, who asked not to be identified.
Karen Ignagni, president of the American Association of Health Plans, made a case for the GOP to draft comprehensive legislation "straightforwardly."
"I think it's important for both parties to present a position on where they stand," Ignagni said.
So far, at least seven major managed-care reform bills have been introduced, including legislation from the GOP leadership in both the House and Senate, Democratic leadership in the Senate and the chairmen of key committees.
No action has been taken on any legislation. Hearings are expected to begin soon.
Ignagni said she expects more lawmakers to introduce legislation in coming weeks.