A controversial Texas law passed last week gives limited antitrust relief to physicians to negotiate collectively with health plans.
But it stops far short of giving independent practitioners the full complement of rights and protections afforded workers in regular labor unions, which fall under the National Labor Relations Act.
Critics said the measure, passed in a conservative, right-to-work state and signed into law by Republican Gov. George W. Bush, was designed to further the cause of broader federal antitrust relief for doctors.
Its passage came two days before the House Judiciary Committee held hearings on legislation sponsored by U.S. Rep. Tom Campbell (R-Calif.) that would carve a special antitrust exemption for competing physicians (See story, p. 3).
"If you can pass this in Texas, why not nationally?" asked Ward Tisdale, a spokesman for the Texas Association of Health Plans.
Nevertheless, medical societies claimed a concrete victory against giant insurers such as Aetna U.S. Healthcare, which is on the verge of acquiring Prudential HealthCare (See story, p. 18).
Texas Medical Association President Alan Baum, M.D., said the "bullying and stonewalling of the more aggressive plans will most certainly slow to a halt."
The association's vice president of public policy, Kim Ross, said the law will pressure health plans to be more responsive to physician concerns, which could negate the need for formal negotiations.
The Texas Hospital Association did not take a position on the bill, said a THA spokeswoman.
The law creates an exemption to federal antitrust law for independent physicians by placing their talks under the supervision of the state attorney general. Without a state-sanctioned exemption, federal law prohibits collective bargaining by competitors.
The attorney general will have broad discretion to set the scope of negotiations, approve proposed contract terms and limit the size and composition of physician negotiating units (See chart).
Health plans and employers opposed the measure, saying it would lead to higher prices.
"The Texas legislation has gone too far," said Karen Ignagni, president and chief executive officer at the American Association of Health Plans.
Physician union leaders said it did not go far enough.
Barry Leibowitz, M.D., president at the National Doctors Alliance, which represents about 15,000 physicians affiliated with the Service Employees International Union, said the Texas law offers "very limited remedies to private practitioners."
For example, the negotiations are voluntary and nonbinding on the part of health plans, and physicians may not negotiate fees unless the attorney general determines that it would promote patient care.
"It would have been better for the Texas Legislature to adopt a resolution asking Congress to amend antitrust laws," said Leibowitz, who personally supports the Campbell antitrust relief although the SEIU has no position.
Jack Seddon, executive director at the Tallahassee, Fla.-based Federation of Physicians and Dentists, said the law is "not the best. It was written to avoid antitrust complications."
Nevertheless, Seddon said the federation, which has about 200 dues-paying members in the state, plans to file for approval to represent physicians under the new law when it takes effect Sept. 1.