Facing a self-imposed deadline of Aug. 4, House Republicans last week lurched toward release of a managed-care reform bill, but by week's end they were struggling to draft language acceptable to all GOP factions.
With two committees at an impasse over enrollees' right to take their health plans to court, House Speaker J. Dennis Hastert (R-Ill.) decided to bypass the two House committees with jurisdiction over employer-provided healthcare plans.
Hastert ordered Reps. Michael Bilirakis (R-Fla.), chairman of the House Commerce Committee's healthcare panel, and John Boehner (R-Ohio), chairman of the Education and Workforce employer-employee relations subcommittee, to begin drafting consensus legislation.
After a House GOP conference late last week, Majority Leader Richard Armey (R-Texas) said the legislation wasn't completed. But he said a vote on a managed-care bill, tentatively scheduled for Aug. 4, is "certainly within the realm of possibility."
The chief sticking point has been whether to give enrollees the right to sue health plans for injuries or death resulting from coverage denial.
Democrats, as well as some Republicans, have insisted on such a right, but the GOP leadership wants to route such disputes through an external grievance mechanism.
The American Hospital Association this year has not come out in favor of any patient-protection legislation. After opposing legislation last year, the AHA supported a House-passed bill sponsored by the GOP leadership, which included a very limited right to sue.
With a five-vote majority, the leadership has a narrow line to walk. Without an option allowing enrollees to take plans to court, their plan could lose the support of such members as Reps. Charlie Norwood (R-Ga.), a dentist, and Greg Ganske (R-Iowa), a surgeon. Including the right to sue could jeopardize the votes of more conservative members of Congress.
Either way, losing just a few GOP votes means that legislation cannot pass.
"We want a patients' right of review," Armey said. "Are we going to allow Democrats to shanghai this and protect the lawyers' right to sue?"
Rep. John Dingell (D-Mich.), senior Democrat on the Commerce Committee, said he'd spoken with the Republicans drafting the legislation and found their patient appeals measures "not acceptable."
Last month, the Senate passed a managed-care reform package that doesn't give patients the right to sue their plans. It gave them an opportunity to appeal coverage decisions internally and outside the plan.
Congress will adjourn for the traditional August recess after this week. When members return after Labor Day, they are expected to debate spending and tax cut legislation, measures that also may include Medicare reforms (See Washington report, p. 30). If managed-care reforms don't pass this week, the issue may be stalled until October.