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Copyright 1999 The National Journal, Inc.  
The National Journal

July 24, 1999

SECTION: CONGRESS; Pg. 2162; Vol. 31, No. 30

LENGTH: 1756 words

HEADLINE: House's Doctors Prescribe Bitter Medicine

BYLINE: Eliza Newlin Carney


     Republican glee over the Senate's recent approval of a
conservative patient protection bill may soon give way to a
headache. As the emotionally charged issue of managed care reform
moves to the House, GOP leaders are struggling to settle both
turf wars and sharp policy differences within their own
Republican Conference.

     In contrast to Senate Republicans, who approved a package
of modest health care changes on July 15 with few defections,
House leaders face open rebellion from a small but influential
group of GOP lawmakers who are doctors. These physician-rebels,
including feisty dentist Charlie Norwood, R-Ga., want far
stronger patient protections than those the Senate approved.
Norwood and his allies, for example, agree with Democrats that
patients should have the right to sue their health insurance
plans for damages--something that GOP leaders strongly oppose.      House Speaker J. Dennis Hastert, R-Ill., has pledged to
bring managed care legislation to the floor before lawmakers
depart for recess on Aug. 6. A vote may take place during the
week of Aug. 2, said a Hastert spokesman. The Speaker also has
told Norwood that he wants the bill to move through the normal
committee process.

     But jurisdictional struggles and intraparty wrangling in
key House committees have stalled GOP managed care proposals for
months. If Republicans can't settle their differences soon,
Hastert may bypass the committees altogether and bring one or
more bills directly to the floor.

     These would most likely include some version of a
stripped-down patient protection bill, comparable to the one
recently approved in the Senate. The Senate bill falls far short
of what Democrats and consumer groups want, but it still may be
enough to give Republicans political cover amid widespread public
anger at the insurance industry.

     Hastert, however, will have a big problem getting an
incremental bill like the Senate measure through the House.
Norwood and other House GOP doctors, including Reps. Tom Coburn
of Oklahoma (a family physician who specializes in obstetrics)
and Greg Ganske of Iowa (a reconstructive surgeon), have vowed to
oppose any bill that doesn't hold health plans legally liable for
medically harmful errors. Their position is less in line with
their party's than it is with that of Democrats, including
President Clinton, who has vowed to veto any managed care bill
that doesn't include tough enough regulations, including the
Senate-passed version.

     ''The Senate bill, unfortunately, is largely window
dressing,'' said Ganske in an interview. ''(It has) great titles,
but substance that doesn't pass muster.'' Ganske maintained that
''half of the (House Republican) Conference would vote for a
strong bill--assuming that they don't have their arms and legs
broken'' by the GOP leadership. As a whole, House Republicans are
more nervous about health care politics than are their Senate
counterparts, only one-third of whom will hit the campaign trail
in 2000. The House Republicans' five-seat majority, moreover,
gives Norwood and his allies huge leverage.

     House Republicans may yet reach a consensus on health
care legislation. Commerce Committee Chairman Tom Bliley, R-Va.,
met on July 20 with ranking member John D. Dingell, D-Mich., to
hash out plans for a bipartisan managed care bill that their
committee could mark up in short order. The Commerce panel's
Republican and Democratic staffs are working on the bill, and
were scheduled to unveil an outline as early as July 26.

     But Bliley has had ongoing problems moving any managed
care legislation through his committee, and there is little
indication that those problems will suddenly vanish. Earlier this
year, the chairman asked panel members Coburn, Ganske, and
Norwood to draft a GOP patient protection bill. In late April,
the doctors presented a draft, the Consensus Managed Care
Improvement Act, which would make insurance companies legally
liable for their decisions. (See NJ 5/1/99, p. 1176.) The bill
also would make it harder for insurers to deny coverage when
doctors can prove that treatments are medically necessary, and
when patients visit emergency rooms.

     ''I think that the consensus bill that we have before the
Commerce Committee is a greatly improved bill over the effort
that the Senate made,'' Norwood said in an interview. ''And I
think that we need to mark that up immediately.''

     But House leaders are none too happy with the doctors'
legislation, which is why it has been stalled in the Commerce
Committee for weeks without a markup. The leaders'
dissatisfaction with that bill also sheds light on why Rep. John
A. Boehner, R-Ohio, this spring unexpectedly proposed his own
package of incremental managed care changes, titled the Health
Care Quality and Access Act. Boehner skillfully took advantage of
his chairmanship of the House Education and the Workforce
Employer-Employee Relations Subcommittee, which has jurisdiction
over employer-sponsored health plans, to insert himself into the
debate. (See NJ, 7/3/99, p. 1955.)

     But Commerce Committee members insist that their panel--
not Boehner's--has final say over managed care legislation. To
complicate matters further, the House Ways and Means Health
Subcommittee also has limited jurisdiction on this issue, but has
been busy with Medicare changes.

     In June, Boehner's subcommittee marked up his patient
protection package, which was broken up into eight separate
bills. That legislation also stalled, however, and the full
Education and the Workforce Committee has yet to mark it up. One
problem is that Norwood, who's also a member of Education and the
Workforce, and other panel Republicans, including moderate GOP
Reps. Jim Greenwood, R-Pa., and Marge Roukema, R-N.J., regard the
Boehner package as too weak. Another problem is that Norwood, in
particular, doesn't want to see the Commerce Committee lose its
jurisdiction over the issue.

     Legislation may still move through the Education and the
Workforce Committee, according to Boehner. It's also possible
that Boehner and Norwood, who along with other key managed care
players have been meeting regularly for several months, could
agree on some sort of middle-ground GOP legislation. But Boehner
acknowledged that the issue remains contentious. In an interview,
Boehner said, ''It's going to be difficult for the Congress to
build a consensus on any piece of legislation, because we have
different views on the policy side, and we have (Minority Leader
Richard A.) Gephardt (D-Mo.), who frankly wants the Congress to
do nothing.''

     Indeed, Democrats are eager to make political hay over
the health care issue, which according to polls is one on which
voters trust Democrats more than Republicans. House Democrats
have gathered 181 signatures, out of a requisite 218, on a
discharge petition that would force a vote on their Patients'
Bill of Rights, which was authored by Dingell. ''I think a good
number of Democrats feel that it's a no-lose situation,'' said
Ronald F. Pollack, executive director of Families USA, a
nonprofit health care consumer group. ''Either they pass good
legislation, or they are going to use this issue in the upcoming
elections to their advantage.''

     For the moment, however, Democrats have no need to play
an obstructionist role, as Republicans have yet to take decisive
action. ''Republicans are welcome to sign our discharge petition,
and/or sponsor our bill,'' said a Gephardt aide. ''And beyond
that, we do think it's time for the Republican leadership to
figure out what it wants to do. And their members are still
waiting for that information from them.''

     Even beyond jurisdictional disputes, House Republicans
remain poles apart on how best to protect patients. Among other
differences, Boehner's package takes a stab at covering the
uninsured, through a provision that would let small employers
pool their resources to purchase insurance through ''health
marts.'' Some Republicans, including Ganske, say the issue of the
uninsured should be dealt with separately.

     The key issue dividing Republican leaders from both
Democrats and GOP doctors is liability. Republican leaders are
dead-set against letting patients sue health plans for damages,
which some critics say might also allow patients to sue their
employers. The Republicans' friends in the business community,
especially insurers, are keeping up the pressure. The insurance
industry has launched a lobbying blitz to block managed care

     In an effort to forge a compromise on the liability
issue, Ganske, Norwood, and other GOP doctors have suggested that
patients be allowed to sue health plans for damages only under
limited circumstances. They propose that patients appeal first to
an external review panel. A health plan that then follows the
review panel's ruling would then be protected from liability for
punitive damages.

     Such attempts to find a middle way, however, may not get
far in what has become an increasingly partisan debate. ''You are
in an area that is intensely controversial, because tremendous
amounts of money ride on it,'' said Dingell in an interview.
''The insurance companies are going to be extremely difficult to
deal with. And I am fearful that to get an agreement with Bliley
is not going to be assisted by the insurance companies.''

     Democrats have their own financial interests at stake.
They are adamant that health plans should not be exempt from
liability--a position shared by trial lawyers, who are among the
most generous campaign contributors to the Democrats.

     Whether or not a patient protection bill makes it through
the House, the issue will not die quietly. If the Republican
doctors don't get their way, they could sign on to the Democrats'
discharge petition. ''There are ways to force this issue,''
Norwood warned. ''And I suspect as frustration is building, and
as time moves on, it's going to be pretty hard for the House not
to produce a bill--or at least it's going to be painful not to
produce a bill.'' Among House Republican leaders, it's aspirin

LOAD-DATE: July 26, 1999

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