Congress began what may be the last phase in the years-long debate over national regulation of managed-care practices, but the outcome appears as unclear as ever as House-Senate negotiators convened last week to resolve the huge differences between their two versions of legislation.
The key points of dispute haven't changed. Patient advocates and health plans are still feuding over whether enrollees may sue their plans for damages resulting from the denial of covered benefits and whether the federal government should regulate plans already covered by state rules, as House legislation would require.
Some new areas of disagreement are emerging, however, making it possible that the legislation could grow to encompass such issues as public reporting of medical errors or physician unionization.
But if the legislation grows, so too might its list of opponents. Inclusion of a medical-errors reporting measure could draw hospitals into the battle in a way they haven't been drawn in before and could turn physicians, who have carried the flag in the managed-care reform campaign, against the legislation.
Hospitals and physicians fear public reporting could spur new lawsuits against them (See related story, p. 2).
"A number of members (of Congress) are hearing what doctors and hospitals are saying about trial lawyers," said Karen Ignagni, president and chief executive officer of the American Association of Health Plans. "Physicians and hospitals are beginning to sound a lot like the health plans."
In the first formal meeting of the 33-member House-Senate conference last week, Assistant Senate Majority Leader Don Nickles (R-Okla.), who also is serving as conference chairman, outlined an ambitious schedule that could preclude adding more contentious issues to the legislation.
Nickles said he wants the conference to produce a compromise bill by the end of March, with passage by both houses of Congress by Easter.
"I think we have a much greater chance of passing good legislation, not so partisan . . . if we work sooner rather than later," Nickles said.
In a White House event aimed at maintaining the political pressure on Congress, President Clinton called for a "strong, enforceable" patient-protection measure and urged bipartisan agreement.
But whether such agreement can be reached is questionable. Congressional Democrats see patient protection as one of their key issues in a campaign to win a majority in the House.