Healthcare lobbyists shelved summer vacation plans in July, scrambling to spin a variety of key issues.
Lawmakers are wrestling with a patients' bill of rights, proposals from President Bush to reform Medicare and give seniors drug discounts, and a House-approved bill to allow drug imports.
By far, the most focused-upon and fluid issue is patients' rights. After a bill sponsored by Sens. Edward Kennedy (D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.) cleared the Senate on June 29, all eyes turned to the House.
The House was set to debate the Bipartisan Patients' Protection Act, sponsored by Reps. John Dingell (D-Mich.), Greg Ganske, M.D. (R-Iowa), Charles Norwood (R-Ga.) and Marion Berry (D-Ark.). The bill incorporates the essence of legislation sponsored by Norwood and Dingell, which passed the House in the previous session, along with changes to make it conform with the McCain-Kennedy bill.
But that vote was delayed, as Republicans didn't have enough votes to pass their bill, sponsored by Rep. Ernie Fletcher (R-Ky.), which Bush favors. The delay gives Bush time to garner support for the Republican bill.
Among the many physician groups that support the bipartisan House bill is the American Academy of Family Physicians.
"It is time for the House to pass a comprehensive patients' rights bill that protects all patients," says Warren Jones, M.D., the group's president-elect.
"Legislation is long overdue and badly needed."
Yet not every doctor agrees.
"I don't see it addressing quality, access and cost," says George Isham, M.D., medical director and chief health officer of HealthPartners in Minneapolis. "I see it worsening the situation . . . and making more money for a lot of lawyers."
Bush continued to repeat his threat to veto McCain-Kennedy. The key difference between the bipartisan bill and the Fletcher bill is liability.
Under McCain-Kennedy, if a dispute involves medical judgment, the patient will be able to seek redress in state court under applicable state law subject to damage caps (33 states have some level of caps on damage awards). If the dispute is an administrative benefit decision, the patient will be able to seek up to $5 million in federal court. Punitive and exemplary damages are prohibited at the federal level.
By contrast, Fletcher's bill limits pain and suffering to a cap of $500,000 and allows patients to sue only in federal courts.
Bush and other Republicans argue that McCain-Kennedy is a recipe for lawsuits and higher premiums. But Bush may let the bill become law without his signature, says Paul Ginsburg, president of the Center for Studying Health System Change in Washington. Ginsburg points out that Bush initially opposed a patients' bill of rights in the Texas Legislature when he was governor but let it become law without his signature.
"This is an issue that the public has a substantial interest in," says Ginsburg. "If he vetoed the bill, it would be sustained, but he may not want to go there with the public."
But before the House votes, Bush is marshalling his forces to get a bill more conservative than McCain-Kennedy passed so that when the two bills go to a conference committee, Democrats will have to make concessions, Ginsburg says.
Ron Pollack, executive director of Families USA, says a strong patients' rights bill has solid support from the public and, as a result, Norwood-Dingell has a "fairly good chance of passing" with slight modifications to make it conform to the Senate bill. Families USA is a not-for-profit organization based in Washington that seeks affordable healthcare.
"The Senate vote gave a great boost, and it gives us plenty of reason for optimism," Pollack says.
In other areas, Bush set his sights on Medicare reform, releasing a 19-page set of principles he wants to see in any legislation put before him. Bush announced the principles rather than a detailed plan in an attempt to leave the playing field open and thereby choose provisions and bills he likes when they come up in Congress, Ginsburg says. As a result, the Bush principles didn't detail specific costs and benefits.
They call for: enhanced coverage for serious illness, preventive care and new treatments; setting a cap for out-of-pocket expenses for patients with large medical bills; and setting one deductible instead of the separate inpatient and outpatient deductible system.
While continuing to emphasize private-sector solutions to cover elderly patients, Bush also said he would seek to improve traditional fee-for-service Medicare--a concession to Democrats who control the Senate. Bush also referred to an idea of updating and streamlining Medicare regulations, which providers have complained about for years.
In other remarks, Bush indicated he was sympathetic to complaints by doctors and other providers about over-regulation. Cutting red tape is the new strategy of providers who have switched from trying to recoup money lost in the Balanced Budget Amendment of 1997.
Bush used a broad brush in his Medicare reform principles, and that bothers some, including Pollack.
"There were very few specifics in his proposal, and it did not help advance the process," Pollack says. "It was chocked full of vague generalities . . . unlike his proposal on tax cuts."
As for helping seniors out with drug coverage, Bush said HHS will work with pharmacy benefit management (PBM) companies to provide seniors with discount cards. The card program can be implemented without new legislation. PBMs would then use the buying power of Medicare enrollees to extract substantial discounts from drug companies, as they do on behalf of their health plan clients. HHS will promulgate regulations that will require the PBMs to offer discounts in every drug class and to contract with pharmacies across the country so all beneficiaries can take advantage of the discounts, according to Bush's outline.
The plan is scheduled to go into effect sometime next year.
But Democrats and consumer organizations gave the plan a thumbs down. Senate Majority Leader Thomas Daschle (D-S.D.), for example, reportedly said that the idea was a "storefront promise of yet another gimmick." Pollack argues that "the discount card is no substitute for expanding coverage in the Medicare program."
In other news, the House voted in July to allow drug imports, though it failed to pass a proposal to allow drugstores and wholesalers to reimport drugs; presently, only pharmaceutical companies are allowed to do so. Under the bill's provisions, Americans would be able to buy abroad up to a 60-day supply of medicine for personal use only, and the drugs could not be resold.
Isham says he favors the bill.
"I don't know why prices are higher here than in other countries," says Isham. "I think it's another way to put pressure on drugmakers."
What the Senate will do is unclear. If made law, allowing people to import drugs would benefit only people living close to the borders, Ginsburg says.