With support building for a bipartisan managed-care reform bill, Republicans offered a draft proposal of their own last week but still had not settled on a final bill.
The draft, crafted by Reps. Tom Coburn (R-Okla.) and John Shadegg (R-Ariz.), resembles another pending bipartisan bill more closely than previous Republican efforts. It would:
* Give patients the right to sue if personal injuries resulted from plans' negligence but would protect plans from punitive damages if they follow the recommendations of external panels that reviewed the medical cases.
* Protect employers who provide health coverage from lawsuits if the employers do not exercise "discretionary authority" to make decisions on claims.
* Require plans to pay for care delivered in emergency rooms without pre-authorization from the plans.
A spokesman for Coburn said the congressman hoped to release the final legislative language soon, pending approval from House Speaker
J. Dennis Hastert (R-Ill.).
The draft bill represents a last-ditch effort by Republicans, who hold the majority in both the House and the Senate, to develop a consensus on the managed-care issue. A previous attempt to agree on a compromise Republican bill in the House failed. That attempt died before Congress recessed on Aug. 6.
Last month, the Senate passed a watered-down managed-care reform package written by Republicans that doesn't allow patients to sue their plans. It does allow patients to appeal coverage decisions within the plans and outside them.
Some House Republicans, unsatisfied with the Senate's effort and the indecision of their own leadership, have signed on to more aggressive legislation.
Those Republicans include Reps. Charlie Norwood (R-Ga.) and Greg Ganske (R-Iowa), who teamed up with liberal stalwart Rep. John Dingell (D-Mich.) earlier this month to write the bipartisan managed-care bill (Aug. 9, p. 8).
The bipartisan bill boasts 20 supporters, including Democratic leader Rep. Richard Gephardt (D-Mo.). That bill also has the backing of the Clinton administration and the American Medical Association.
Both the White House and the AMA issued statements endorsing the Norwood-Ganske-Dingell bill on Aug. 23, the same day the Republican draft was released.
Support from such high places will make it difficult for the Republican bill to compete with the bipartisan offering, observers said.
The insurance industry was cautiously pessimistic about the draft Republican bill.
"It's important to see the final detail, and we're still waiting on that," said Susan Pisano, spokeswoman for the American Association of Health Plans. "The introduction of this bill shows that there are a variety of views about the issue, and a variety of ways to approach it."