The managed-care industry's stinging defeat on patient-protection legislation has launched a round of finger-pointing as healthcare groups that opposed the bill try to assess blame.
The villains range from trial lawyers, whose class-action suits against health plans heightened pressure for legislation, to the electorate, which believes that managed-care plans routinely deny needed care.
But some industry leaders also blame the plans themselves for creating the anecdotes that persuaded the public and politicians that the government needs to regulate managed-care practices.
The House Republican leadership also has provoked the ire of some healthcare lobbyists because it conceded the chief issue of debate: whether to allow lawsuits against health plans for damages resulting from the denial of covered benefits.
Chip Kahn, president of the Health Insurance Association of America, said HMOs lost because they have been the targets of a smear campaign. "I think the world's been turned upside down," Kahn said. "I think the public is misperceiving the issue, and politicians are taking advantage of it."
Others said the industry itself was as much to blame. "For all the good decisions that a Group Health (Cooperative of Puget Sound) or Henry Ford (Health System) might make, there's Acme Managed Care making bad decisions," said one healthcare lobbyist fighting the legislation, who asked not to be identified.
But an employer lobbyist, who also didn't want to be named, blamed the Republican leadership. By endorsing a bill that allowed some liability, the leadership showed it had conceded the issue of enrollee lawsuits. That opened the door to a victory for the bipartisan bill-and its broader liability provisions-which the leaders were trying to defeat, the lobbyist said.
The House voted 275-151 on Oct. 7 in favor of legislation sponsored by Reps. Charlie Norwood (R-Ga.) and John Dingell (D-Mich.) (Oct. 11, p. 2).
Although health insurers and managed-care plans fought many provisions in the legislation, they were most resistant to a measure that would let managed-care enrollees sue plans for damages resulting from coverage denials.
The bill allows enrollees to sue in state court before undergoing an administrative grievance process.
In passing the bill, the House rejected proposals that didn't allow enrollees to sue health plans or that restricted lawsuits to federal courtrooms only after an administrative appeal.
The bill moves to a House-Senate conference committee to resolve differences with the Senate version of the legislation passed in July (See chart, p. 8). That version doesn't allow lawsuits.
Republican and Democratic leaders in the House and the Senate are likely to appoint delegates to the conference committee before Congress adjourns for the year, but the panel is not expected to produce a compromise document until next year.
Rep. William Thomas (R-Calif.), who co-sponsored a GOP alternative bill that allowed suits in federal court, said he didn't know how the conference would resolve the differences. "How many crosses between a Chihuahua and a Great Dane have you seen?" Thomas asked.