Thanks to several Republican physicians in Congress, strong patient protection legislation has a better chance of passing in the House this fall. But prospects for a tough patients' "bill of rights" in both houses of Congress still are uncertain.
House Republican leaders were set to take a breather during Congress' summer recess in early August when a few of their colleagues broke ranks and joined Democrats in the push for stronger legislation for patient rights than that passed by the Senate in July. The Senate proposal was approved with a predictable party-line vote of 53 to 47.
Seeking to squelch the possibility that the bipartisan proposal would move forward, leading House Republicans scrambled to put together a new proposal to satisfy the wayward members of their party.
While it's not clear what kind of patient rights bill will come to the floor in September, observers are confident that the House will pass a significantly stronger bill than the Senate.
The more difficult task will be crafting a bill that will be acceptable to the entire Congress because members of both bodies are struggling to decide whether they want legislation that favors physicians and patients or the managed-care industry.
The likelihood of House action on a patient rights bill seemed slim in late summer, given that Republicans couldn't agree on a plan and Democrats are outnumbered there by 222 to 211. Then on Aug. 5, Reps. Charlie Norwood (R-Ga.), a dentist, and John Dingell (D-Mich.) introduced the Bipartisan Consensus Managed Care Improvement Act of 1999 (see chart).
Working fast to respond to the bipartisan bill, House Speaker Dennis Hastert (R-Ill.) and other Republican leaders presented their own bill a day later, which was crafted by Reps. Tom Coburn, M.D., (R-Okla.), a family physician, and John Shadegg (R-Ariz.). The Hastert bill would allow patients to take disputes with payers to an independent panel, to choose doctors outside of a plan's network and to have easier access to gynecologists, obstetricians and pediatricians.
Following the introduction of the legislation, Hastert acknowledged that Republicans need to include liability protection in their bill. The current proposal would allow patients to sue health plans when harm results from the denial of covered benefits.
Republican physicians were behind the sudden shift in the political winds, says Paul Ginsburg, president of the Center for Studying Health System Change in Washington. As doctors, the representatives understand the issues facing physicians and were able to exert more influence than traditional lobbyists for doctors' groups, he says.
Thomas Reardon, M.D., a general practice physician and president of the American Medical Association, agrees that the House's Republican physicians have been quite influential. Although Norwood and Coburn originally worked together to draft Republican managed-care reforms, Coburn broke with Norwood and Iowa's Greg Ganske, M.D., a surgeon, over the right of patients to sue.
"We've worked very effectively with physician members in the House," Reardon says. The AMA's messages, he says, "resonated better" with Republican doctors who have credibility with their nonphysician colleagues. Reardon says that the bipartisan bill is a good starting point for a patient rights bill and contains most of what the AMA wants.
Another important influence was the high level of public interest, Ginsburg says. "Members feel that they should be for something" rather than on the fence or opposed to legislation, he says.
"The Republican leadership is not going to lose control," Ginsburg adds. "They will move as far as they have to to keep Republicans in control of the agenda."
Bart Fleming, senior consultant at PricewaterhouseCoopers in Fairfax, Va., agrees. "There's no way that Speaker Hastert can let a Democratic bill through," says Fleming, a former associate administrator and executive associate administrator of HCFA in the 1980s.
But how far the Republican leadership will have to move is unclear. Laura Diamond, media relations manager at the American Association of Health Plans, points out that "a lot of things are unfolding over the August recess. We're doing a lot of grass-roots work, and things could change as a result of members hearing from their constituents back home."
The AMA's Reardon agrees: "We're going to look at both plans and see if we can forge a consensus working with the grass roots at home. The AMA will not let up the pressure."
Even if doctors get what they're after and a strong patients' bill of rights passes in the House, that doesn't guarantee a strong proposal will emerge from the House-Senate conference to reconcile the bills, Fleming says. Reardon says, "It will be up to the House to stand up to the Senate to make sure they don't gut it (the House legislation)."
Fleming points out that Congress also has other distractions, such as tax cuts, Medicare and Social Security, and it's unclear whether patient rights will get the attention it needs to move forward.
In addition, elections in 2000 are a factor, Fleming says.
"We're one legislative session away from the election," he points out. "If you get a bill that both sides can buy into, the issue seems to be neutralized. On the other hand, if they (Republicans and Democrats) can't get together, then it will become an election issue" they can use against each other.
To try to resolve the issue before then, physician groups and the AAHP will spend millions of dollars on television, radio and print advertising to sway voters and representatives.
Power to the patientHighlights of the Bipartisan Consensus Managed Care Improvement Act of 1999
Source: Office of Rep. Charlie Norwood (R-Ga.)