The best-laid plans of physicians and Republicans can often go awry.
Consider this: A doctors' union, the Federation of Physicians and Dentists (FPD), thought it would scare off opponents of a federal physician antitrust bill by encouraging its 8,500 members to "reward their friends and punish their enemies."
Specifically, that meant boycotting the products of Merck & Co., whose subsidiary, Merck-Medco Managed Care, had opposed the bill. Merck-Medco subsequently withdrew from the coalition opposing the measure.
Meanwhile, a number of House Republicans were already begging House Speaker J. Dennis Hastert to delay a scheduled floor vote on the bill, which would allow individual physicians to collectively bargain with health plans over fees and other contract terms.
Many House members had signed on as co-sponsors to the bill, introduced by Rep. Thomas Campbell (R-Calif.), believing that a vote would never happen. These members saw publicly backing the Campbell bill as an opportunity to appease doctors without having to pass the controversial bill, which is opposed by nurses, hospitals, insurers and employers.
Both strategies backfired. Though the House vote was delayed until at least this week, it will take place.
Instead of weakening the opposition, the FPD's boycott strengthened the resolve of opponents and gave them ammunition in their battle against the bill.
And instead of quelling physicians' demand for legislation, the large number of Republican co-sponsors actually gave credibility and momentum to the measure in the House. That culminated in the 26-2 vote in the House Judiciary Committee that sent the bill to the House floor, where it's awaiting action.
"Things get dangerous when people say it's a free vote," said Karen Ignagni, president of the American Association of Health Plans, which opposes the Campbell bill. "People (in Congress) haven't done a full evaluation of this bill, and some members have told us that it's more about funding their campaigns than it is about healthcare policy."
News of the boycott of Merck surfaced on May 23, just days before a House vote on the measure was expected to occur.
That news fueled the doubts that many Republicans had about the bill, said one healthcare lobbyist.
"It gave members of Congress something tangible to point to and say, `We need to think about this,' " the lobbyist said.
Another lobbyist working against the Campbell bill, who also asked not to be named, called the boycott "manna from heaven."
The Antitrust Coalition, which represents more than 50 organizations opposed to the Campbell bill, sent copies of news articles about the boycott to all 13 members of the Rules Committee, three of whom were co-sponsoring the bill. The committee determines the timing and nature of floor action on a bill.
But Jack Seddon, executive director of the FPD, insisted that his members' actions had nothing to do with the postponement of the Campbell vote.
"I heard (insurance lobbyists) were carrying copies (of the Merck story) around," Seddon said. "What's comical about them using it is that if there's any group of people who place restrictions on what drugs can be prescribed, it's the people who come up with the formularies that block out certain drugs unless the doctors jump through a bunch of hoops."
The news also played a role in the meeting between Hastert and the House Republican caucus, which was seeking a delay in the House vote on the Campbell bill.
Fifty House Republicans, led by Rep. Anne Northup (R-Ky.), signed a petition asking Hastert to delay the vote on the Campbell measure. According to House rules, if 50 or more members of the majority petition the speaker, the speaker must hear them out.
Such petitions by the ruling party are rare, since the members tend to be in step with the speaker.
At the May 24 meeting, Northup referred to news reports of the boycott and told her colleagues this could be a sign of things to come under the Campbell bill. A spokeswoman for Northup did not return calls for further comment.
The House Republicans voted 87-53 in favor of delaying the vote on the Campbell bill. However, the caucus must have a two-thirds majority to overrule the speaker, so the petition failed by seven votes.
Several healthcare lobbyists told MODERN HEALTHCARE that the combination of the Republican petition and the federation's boycott gave House leaders enough pause that they ultimately postponed consideration of the bill.
But that's not what Campbell told the media in a blistering statement May 26, in which he blamed Hastert and his fellow Republicans for the delay.
"What happened was outrageous and (is what) causes so many Americans to grow disenchanted with our political system," said Campbell, who is running against Sen. Dianne Feinstein (D-Calif.) for the Senate. "When I saw this under (former House Speaker) Newt Gingrich, I stood up to him. I hope I do not find myself repeating that a month from now. The speaker has made a commitment that this bill will be moving to the floor in June. And I expect that commitment to be honored."
Campbell is hoping that his success in garnering more than 200 sponsors for his bill and his tough stance against the Republican establishment will boost his flagging Senate campaign.
In March Feinstein won 53% of the vote in California's open Senate primary election, and Campbell won only 22%. Since then, Feinstein has raised nearly twice as much for her war chest than Campbell, according to a recent New York Times report.
In his statement on the delay, Campbell likened himself to Sen. John McCain (R-Ariz.), who attracted a lot of national attention and support as the upstart Republican presidential candidate.
"Sen. McCain attracted all the enthusiasm he did because of his candid description of this town--the `Death Star,' he called it," Campbell said. "He was right: Washington needs an overhaul. This bill should have passed four months ago."
Campbell is not alone in blaming Hastert.
Ross Rubin, a board member of Physicians for Responsible Negotiation (PRN), the union created a year ago by the American Medical Association, questioned Hastert's assertion that the House Rules Committee, in postponing the vote on the Campbell bill, acted independently of the speaker's wishes.
"We've found only one instance in the last 50 years when the speaker didn't get his way (with the Rules Committee)," said Rubin, who is also the former acting executive director of the union.
The House delayed its vote with the belief that House leaders could pick off some of the bill's sponsors, he added.
"It was a case of pure political discomfort among the GOP delegates with taking on two major constituencies," Rubin said, referring to physicians and insurance companies.
With Elizabeth Thompson