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Copyright 1999 The National Journal, Inc.  
The National Journal

May 1, 1999

SECTION: HEALTH; Pg. 1176; Vol. 31, No. 18

LENGTH: 929 words

HEADLINE: Sour Medicine on Managed Care?

BYLINE: Marilyn Werber Serafini


     In early February, when Rep. Michael Bilirakis, R-Fla.,
chairman of the House Commerce Health and Environment
Subcommittee, intro-duced the House Republicans' legislation
imposing new restrictions on managed health care plans, he openly
acknowledged that the bill was merely a ''placeholder'' that
needed work. Now, nearly three months later, the Commerce
Committee is just beginning to fill in the details of its managed
care bill--and there are early indications that the end result
may have difficulty passing the House.

     Rep. Tom Bliley, R-Va., chairman of the Commerce
Committee, asked the panel's two doctors and one dentist, all
Republicans, to draft a consensus managed care bill that can win
committee support. The trio--Reps. Greg Ganske of Iowa, Tom A.
Coburn of Oklahoma, and Charlie Norwood of Georgia--unveiled a
draft of the bill on Wednesday.      Bliley needs the support of Ganske, Coburn, and Norwood
(the dentist) to report a bill out of his committee, which has 29
Republicans and 24 Democrats. The trouble is that both Ganske and
Norwood have sought comprehensive managed care reforms that go
beyond the comfort level of many of their fellow House

     For instance, the draft legislation would allow patients
who are denied medical care to sue their health plans--something
most Republicans have opposed--although the bill sponsors did
make some concessions in this area in the hope of gaining more
GOP support. The sponsors also removed language that would have
allowed physicians to have the final word on what services are
''medically necessary,'' and instead would allow a third-party
appeals panel to have the final word.

     Such concessions may not be enough. In recent months, GOP
congressional leaders have resisted the idea of moving a sweeping
managed care bill. They have embraced a strategy of passing
limited regulations on the health insurance industry piece by
piece. ''Constituents are not beating down the doors of their
members asking for change, much less massive change,'' said a
Senate Republican aide.

     In fact, House Majority Leader Richard K. Armey, R-Texas,
recently indicated that he continues to be much more interested
in pursuing legislation aimed at decreasing the number of
uninsured Americans by giving them a tax break when they purchase
health insurance on their own. ''If my boss could legislate by
magic wand, we wouldn't do a managed care bill, but we would do
tax equity,'' said Dean Clancy, an Armey aide, at an April 22

     Clancy said legislation that helps individuals get health
insurance would also satisfy some complaints about managed care.
Armey's tax equity bill, Clancy noted, would ''remedy injustice
and, at the same time, cover more people and reduce frustrations
with managed care, because people can take their business

     Opponents of managed care legislation are making similar
arguments. For instance, Charles N. ''Chip'' Kahn III, president
of the Health Insurance Association of America, contends that the
issue of uninsured Americans is more pressing than the issue of
managed care reform. ''Providing affordable health coverage to
the millions of Americans who desperately need it should be 'job
one' for Congress and the Administration,'' Kahn said in a recent
statement. ''Backers of so-called patient protection legislation,
instead, are pushing bills that would raise the number of
uninsured by raising the cost of health insurance.''

     Ganske in an interview said he had hoped that Bliley's
request for the doctors on his committee to produce a consensus
bill was an indication that GOP leaders were warming to the idea
of comprehensive managed care legislation. But Ganske speeded up
the release of his draft bill after hearing that the leaders were
not planning to bring managed care legislation to the House floor
until October. ''It would benefit my (House Republican)
Conference to deal with this sooner rather than later,'' Ganske
said. ''If it doesn't come until later this year or next, it will
be a campaign issue.''

     The Senate has had a head start: The Health, Education,
Labor, and Pensions (HELP) Committee passed a managed care bill
on March 18 with all 10 Republicans in support, and all 8
Democrats in opposition. That bill, however, doesn't go as far as
Ganske would like. The committee rejected Democratic amendments
that would have made health care plans and employers liable for
medical services that they deny or delay, and would have allowed
physicians the final word on what services are ''medically

     Even if a sweeping managed care bill crafted by Ganske,
Norwood, and Coburn passes the House, it would have to be
reconciled with the measure approved by the Senate HELP
Committee--a bill that doesn't have important provisions that
Democrats and a few Republicans, such as Ganske, claim are
necessary for their support. Moreover, Senate GOP leaders won't
bring the bill to the floor until the Senate Finance Committee in
May considers provisions to expand the use of medical savings
accounts and to enhance the health care tax credit that goes to
the self-employed. (The committee hasn't made much progress on a
bipartisan bill.)

     In the end, predicted one Senate GOP aide, Congress may
pass nothing more this year than a moderate managed care bill.

LOAD-DATE: May 04, 1999

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