Copyright 1999 The Washington Post
July 27, 1999, Tuesday, Final Edition
SECTION: A SECTION; Pg. A01
LENGTH: 1692 words
GOP Doctors in the House Put Patients Before Party; Push for 'Bill of Rights'
BYLINE: Michael Grunwald, Washington
Post Staff Writer
Rep. Tom Coburn
(R-Okla.) was telling an HMO horror story, one of those infuriating tales about
greed-driven care that have dominated the patients' rights debate in Congress.
Just last Monday, Coburn said, a pregnant woman visited her obstetrician
in Muskogee after she was exposed to the chicken pox virus. The doctor
prescribed a routine $ 700 injection of antiserum. But her insurance company
refused to pay, even though she had obstetric coverage.
"This was a
no-brainer," Coburn said the next day. "She needed that injection to protect her
baby. I know that what they did was wrong."
If that medical opinion
sounds a bit presumptuous for a member of Congress, well, Coburn was also the
obstetrician on the case. In fact, there are nine doctors in the House, as well
as four dentists. And a few of the Republican doctors are taking a lead role in
pushing new protections for managed-care patients, giving their House leaders
migraines in the process.
Coburn, usually one of the most conservative
members of the House, Rep. Charles Whitlow Norwood Jr. (R-Ga.), a dentist, and
Rep. Greg Ganske (R-Iowa), a plastic surgeon, have denounced the narrower
Republican HMO bill that recently passed the Senate as bad medicine, and they
have stymied their leaders' efforts to write a similar prescription in the
With most House Democrats united behind a sweeping
"patients' bill of rights," and with House Republicans holding
a mere five-vote majority, the GOP doctors are the latest nightmare for House
Speaker J. Dennis Hastert (R-Ill.), who had to beg his caucus to unite behind a
$ 792 billion tax cut last week. And with polls pointing to managed care as a
potent political issue for 2000, the stalemate could become a nightmare for the
entire Republican Party.
"The doctors obviously play an important role.
And they obviously have strong opinions on this issue," said John Feehery, a
spokesman for Hastert. "It's not an easy situation."
On July 15, the
GOP-controlled Senate agreed in a largely party-line vote to provide limited
protections for about 48 million Americans, assuring them easier access to
emergency rooms and specialists, while expanding their ability to appeal payment
decisions by HMOs. The Senate rejected the Democratic alternative, which would
extend much stronger protections to all 161 million Americans with private
health insurance, including a right to sue their HMOs and a guarantee that only
their physicians can decide what care is "medically necessary."
general, Republicans have argued that tight restrictions on HMOs will fatten the
wallets of trial lawyers, drive up health insurance costs for all Americans and
increase the growing ranks of the uninsured. Democrats have responded that when
HMOs are allowed to consider profits before patients, health insurance is almost
meaningless. The GOP doctors are the wild card in the debate, fired up by their
personal experiences, taking on some of their supporters in the business
community as well as their own House leaders.
"I know I'm fighting my
friends on this one," Norwood said. "But they understand that I'm not backing
down. If I'm driving them nuts, well, that's the way it goes."
past, the physicians have tried to work with their leadership on managed care,
to no avail. On a flight home to Atlanta, Norwood once asked then-Speaker Newt
Gingrich what it would take to get an HMO bill to the floor. Gingrich grinned
and told him to find 200 co-sponsors. Norwood signed up 238, but the bill went
nowhere. Similarly, Ganske rounded up 285 co-sponsors for a bill to end "gag
rules" that prevent doctors from telling their patients about expensive options,
more than enough to pass it. Nothing happened.
Hastert favors limited
HMO reforms along the lines of the Senate bill, and he had hoped to pass
something quickly to defuse the issue. But the doctors are no longer playing
nice. The day the Senate bill passed, Coburn, Norwood, Ganske and Rep. John
Cooksey (R-La.), an eye surgeon, appeared at an American Medical Association
news conference to blast it as an "HMO Bill of Rights." Coburn and Norwood have
drafted legislation in the Commerce Committee with many elements of the
Democrats' patients' bill of rights. Ganske tried to work with
them, but he broke off to write his own bill, which is even closer to the
"Our leadership has delayed and delayed and
delayed," Ganske said. "They've been twisting people's arms off, and so have the
business lobbyists. But this issue isn't going away."
For now, it
doesn't seem to be going anywhere. In May, after Commerce Chairman Thomas J.
Bliley Jr. (R-Va.) suggested he liked the Coburn-Norwood bill, Hastert abruptly
decided to shift the focus of the managed care issue to the Education and
Workforce Committee. But Norwood is on that committee, too, and when a
subcommittee chairman, John A. Boehner (R-Ohio), tried to bring up a
leadership-approved package of limited patient protections, Norwood rounded up
enough GOP moderates to freeze the process. Hastert is still trying to sort out
the whole situation.
"The doctors are bringing reality to the House,"
said AMA president Thomas Reardon. "They understand the issues. They understand
what's happening to patients with managed care."
Of course, HMO
lobbyists believe the opposite is true. They don't say so directly, but they
imply that the doctors' personal experiences have given them skewed views of the
industry. For example, Karen Ignagni, president of the American Association of
Health Plans, said that while the HMO who refused to pay for the injection for
Coburn's patient may seem heartless, the problem was probably created by an
employer's decision not to purchase that benefit.
understandable that the doctors feel that way, being on the front lines, but we
don't agree with them on the substance," Ignagni said. "Unfortunately, they're
playing a very large role in this debate."
Coburn, Norwood and Ganske
all arrived in Congress in the conservative Republican uprising of 1994, and
none of them named health care as their top priority. But all of them say their
experiences with managed care made them staunch advocates for reform, relating
anecdotes about HMO bureaucrats who valued the bottom line over their own
Coburn says he once sent a 26-year-old patient to the
hospital because he feared she had bacteria in her blood; her HMO refused to
pay, so she left against medical advice and ended up on a respirator. Norwood
growls about clerks who told him to cap cavities instead of doing expensive root
canals. And Ganske recalls an HMO official denying a breast cancer survivor's
appeal for reconstructive surgery by asking: "What good is a woman's breast
"It ain't like I made this stuff up or read it somewhere,"
Norwood drawled. "I keep hearing that we're overreacting to anecdotes, but this
is real life. I've seen it."
A medical degree is no guarantee of
rebelliousness on the issue. Sen. Bill Frist (R-Tenn.), a heart surgeon, helped
lead the GOP fight for the more modest protections in the Senate, but
managed-care critics (and some of the House doctors) point out that his brother
runs the nation's largest for-profit hospital chain, Columbia-HCA, and that
Frist himself owns at least $ 5 million in Columbia-HCA stock. Rep. Ernie
Fletcher (R-Ky.), a family doctor from Lexington, is backing the GOP leadership
on HMO reform as well.
Fletcher says his health care ideas were formed
by his experience as a doctor, but also by his experience as a state legislator.
In Kentucky, he said, a massive reform plan ended up increasing the cost of
coverage and swelling the ranks of the uninsured by 25 percent.
lesson I took out of that is like the Hippocratic Oath: First, do no harm," said
Fletcher, a freshman who sits on the Education and Workforce Committee. "I
respect what the other doctors are trying to do. But I'm afraid their plans
would just make things worse."
So like a patient in a waiting room, HMO
reform is on hold for now. Ganske warns that if nothing happens once again,
Democrats will run campaign ads in 2000 featuring victims like Jimmy Adams, an
adorable Georgia infant who lost both hands and legs from gangrene after his HMO
told his mother to drive him to an emergency room 42 miles away. The boy had a
104-degree fever and his heart stopped on the way to the hospital. In his latest
newsletter, Ganske noted that Jimmy "will never play basketball or caress the
cheek of the woman he loves with his hand."
That's right, GOP leaders
grumble. The Democrats probably will run ads like that if Republicans fail to
pass an HMO bill. So why won't the doctors help pass our HMO bill?
Democrats want nothing to happen for political reasons, and the doctors are
playing into their desires for policy reasons," Boehner said. "It's a very
Medical Backgrounds on the Hill
Lois Capps (D-Calif.) Nurse
Tom Coburn (R-Okla.) Doctor
John Cooksey (R-La.) Doctor
Ernie Fletcher (R-Ky.) Doctor
Greg Ganske (R-Iowa) Doctor
Eddie Bernice Johnson (D-Tex.) Nurse
Sue W. Kelly (R-N.Y.) MA in
John Linder (R-Ga.) Dentist
Jim McDermott (D-Wash.) Doctor
Charles W. Norwood
Jr. (R-Ga.) Dentist
Ron Packard (R-Calif.) Dentist
Mike Simpson (R-Idaho) Dentist
Slaughter (D-N.Y.) MA in public health
Victor F. Snyder (D-Ark.) Doctor
David Weldon (R-Fla.) Doctor
Allard (R-Colo.) Veterinarian
Bill Frist (R-Tenn.) Surgeon
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