Despite heavy opposition from many sectors of the healthcare industry, the House passed landmark legislation late last week that would give competing physicians an exemption from federal antitrust laws to allow them to collectively bargain with health plans.
Doctors celebrated the 276-136 vote, calling it "a milestone victory" and mocking their critics.
"The full House has recognized that the antitrust laws need to be changed," said Donald Palmisano, M.D., a New Orleans surgeon and a member of the American Medical Association's board of trustees. The AMA lobbied hard for the bill's passage.
"We were told it would not pass the Rules Committee. Wrong. Told it would not be heard by the House. Wrong," Palmisano said.
Despite the bill's passage in the House, the Senate is likely to be much more hostile to such legislation.
In defeat, Karen Ignagni, president and chief executive officer of the American Association of Health Plans, which opposed the bill, said in a written statement: "The Campbell legislation is a bait and switch. The bill purports to address quality, but, in reality, is all about income protection for providers."
Also opposing the bill were hospitals, nurses, employers and consumers, which had formed the 50-member Antitrust Coalition along with insurers. The Federal Trade Commission and the U.S. Justice Department, the government's main antitrust enforcers, also oppose the measure.
Federal antitrust laws bar competitors from conspiring to fix prices charged for their services. In fact, a day before the House vote, a federal judge ordered two competing New York hospitals to dissolve their joint operating company through which they illegally fixed prices and allocated services (See story below).
"We are disappointed by the vote," said Thomas Nickels, senior vice president for federal relations at the American Hospital Association. "There are other solutions to the problems in healthcare other than this bill."
The AHA has long lobbied for antitrust relief for hospitals, but it opposed similar relief for doctors because hospitals believe it would disrupt the delivery of healthcare.
For hours, lawmakers debated six amendments to the bill, which was introduced by Rep. Thomas Campbell (R-Calif.). After contentious debate, they passed two changes and rejected four.
The House ultimately swallowed the biggest poison pill, an amendment by Rep. Tom Coburn (R-Okla.), by trade a family physician. Coburn's amendment exempts from collective-bargaining negotiations any discussions about requiring insurers to pay for abortions.
Two amendments that would have prohibited doctors from using their bargaining power to negotiate fees or billing terms were rejected by substantial margins. They would have limited doctors to jointly negotiating nonfinancial terms, such as the number of patients they would see in a day or what constitutes appropriate care.
Opponents of the Campbell bill said that their intense lobbying efforts over the past month did pay off, despite a considerable number of yes votes.
"This vote was much closer than it would have been a month ago," said Mary Grealy, president of the Healthcare Leadership Council, which lobbied against the measure. "A lot of education went on."
In a failed effort to derail the bill, the AAHP and the Antitrust Coalition released a study earlier in the week that said the cost of private health insurance would rise 8.6% by 2003 if the bill becomes law. The study, performed by former FTC official James Langenfeld, disputes some of the conclusions the Congressional Budget Office made in its May 17 analysis of the bill. The CBO claimed private health insurance costs would rise only 1.5%.
A House vote on the Campbell bill had been scheduled in late May, but was postponed, much to the ire of Campbell and the AMA (May 29, p. 12).
One healthcare lobbyist, who asked not to be named, said many members voted yes because they knew the bill would die in the Senate and not become law.
Senate Majority Leader Trent Lott (R-Miss.) is unlikely to support a physician antitrust exemption because it's the pet project of the AMA, Capitol Hill observers said. Lott is angry that the AMA is attacking several Republican senators who are up for re-election because their positions on managed-care reform don't match the AMA's positions.
A spokesman for Lott confirmed that Lott opposes the Campbell bill and does not favor bringing it to the Senate floor for a vote.
The clock is also working against doctors. No companion bill has been introduced in the Senate, and Congress is adjourned for the entire month of August.
With Elizabeth Thompson