GOVERNMENT & MEDICINE

Scope remains patient protection obstacle

Physician legislators tell the AMA's National Leadership Development Conference that the fate of patient protection legislation may also rest on accountability provisions.

By Bonnie Booth, AMNews staff. April 10, 2000.

Miami Beach, Fla. -- The question of how many Americans would be covered by a Patients' Bill of Rights is a formidable stumbling block for House and Senate legislators hoping to draft compromise patient protection legislation by Congress' Easter recess later this month.

But the two physician legislators speaking to participants at the AMA National Leadership Development Conference offered up differing perspectives about whether the issue would sound the death knell for patient protection legislation this year.

Rep. Ernest Fletcher, MD (R, Ky.), who voted against the broad patient protection legislation supported by the AMA and passed by the House last fall, is a member of the conference committee working on the compromise legislation.

"I was appointed to the conference committee because I worked hard during the session to establish relationships and look at both sides," said Dr. Fletcher, who also said he supports most of the provisions of the Patients' Bill of Rights legislation he ultimately voted against. "The conference is an excellent opportunity to get something done, and I am guardedly optimistic. It is important that we get something out of conference that can get out of the House."

He said the group had made progress on some issues but acknowledged it was not making much progress on the major stumbling blocks: who decides medical necessity, liability provisions for managed care organizations and the scope of coverage of the legislation.

The House version of the legislation calls for all of the 161 million Americans with private health insurance to be protected by the legislation, while most provisions in the Senate version would apply only to the 48 million Americans covered by self-insured, employer-sponsored health plans.

"If a bill comes out that doesn't cover everyone, half of the country is going to ask, 'Why were we left out?' " said Dr. Fletcher.

Rep. Greg Ganske, MD (R, Iowa), one of three authors of the House's patient protection legislation, said he held out little hope that the conference committee, chaired by Sen. Don Nickles (R, Okla.), would come to terms on the scope, accountability and medical necessity issues before Easter.

The Senate bill doesn't include a health plan liability provision, while the House measure does. The House bill would give more power to physicians to determine whether a treatment is medically necessary than would the Senate version.

"I suspect the conference committee will not meet its deadline," said Dr. Ganske, who was blocked by his GOP leadership from holding a seat on the negotiating panel. "If it doesn't, Nickles could use that as an excuse to disband the committee. I think they should keep working."

Keep pushing

Dr. Ganske urged physicians attending the AMA's conference to continue to let their elected officials know the legislation is important to them.

"Of the 13 Republican House conferees appointed to the committee, only one voted for the House bill," he said. "There is a bit of a stacked deck, and it is very important for this organization and the 300-plus other professional and patient advocacy groups to keep the heat on. Surveys and polls show this is the No. 2 issue with voters. It is bipartisan, and it cuts across all demographics -- young and old, male and female."

Dr. Ganske said the fact that the issue is so important to voters is likely to mean that the importance of passing some sort of legislation increases as the country edges closer to November's general election.

And AMA President Thomas R. Reardon, MD, said the Association was prepared to use its National House Call advocacy campaign to keep the spotlight on patients' rights, if need be.

"If a real Patients' Bill of Rights, one that guarantees accountability for health plans, one that returns medical decision-making to the hands of physicians, does not become law this spring, we will carry the battle into the fall 2000 elections," Dr. Reardon said. "We will not stop until it is signed into law."

The National House Call, an advocacy campaign that put six health care questions in the spotlight during this year's presidential primary, will be on hand at several events this summer, including meetings of the U.S. Conference of Mayors, the National Governors Assn. and the National Conference of State Legislators.

Dr. Reardon pledged that the AMA would continue to urge voters to use its six health care questions to find out where their candidates stand on issues ranging from health insurance coverage for the nation's 44 million uninsured to reforming Medicare.

"In the course of this election season, we have achieved a great victory," he said. "We have moved medicine's message to the forefront of the national debate. But that is not enough. And that is why the National House Call will continue to push our priorities as the campaign continues, taking our message beyond the primaries to all of the key places where the opinions of this nation -- and its leaders -- are being forged and formed."

Dr. Ganske took the debate up a notch by adding tobacco to the list of items on which physicians and voters should be holding their representatives' feet to the fire.

Dr. Ganske said he agreed with last month's Supreme Court decision that it was not the Food and Drug Administration's place to regulate the tobacco industry. The decision wasn't about tobacco as much as it was about the limits of authority of the court system and the executive branch, he said. But now that the ball is back in Congress' court, Dr. Ganske pledged to push his colleagues to take up the issue.

"I'll use every legislative manner, move and maneuver I can to find a way to bring those FDA regulations back before Congress and get a vote before the November election," he said. And he issued a further challenge to members of the House of Representatives -- many of whom were the beneficiaries of a total of $3 million in tobacco lobby funds since January 1999.

"I'm making a call today to both parties to get off the big tobacco nipple now," Dr. Ganske said.

Antitrust bill vote predicted

The two physician legislators were joined on the podium by Rep. John Conyers Jr. (D, Mich.), who is the ranking Democrat on the House Judiciary Committee. He said he expected proposed federal legislation that would give physicians the right to band together to negotiate with health plans soon to move to the House floor for a vote.

Conyers said two amendments to the bill, authored by Rep. Tom Campbell (R, Calif.), recently had been added. One would restrict physicians from using collective action to gain an unfair competitive advantage over nonphysician competitors, such as nurse practitioners or nurse anesthetists. The second, a sunset provision, calls for the law to expire if it is not reauthorized within three years of its passage.

Conyers said he thought both amendments enhanced the Campbell bill's chances of passage. He added that while he was certain physicians would not abuse an exemption from the antitrust laws, the Federal Trade Commission likely would be monitoring collective physician activity very closely should the bill pass and then reporting its findings to Congress.

Conyers also took the opportunity to encourage physicians to consider universal health care in some form as a solution for the country's health care woes.

"I am working with Rep. Jim McDermott [MD (D, Wash.)] toward a time when health care is a right and not a privilege, when universal health care can correct this rickety system we are working under now."

Conyers' comments met with a smattering of applause, a change in physician opinion about universal health care that wasn't lost on him.

"I want to thank you for the opportunity to be here today, to show that I don't have horns," he said to laughter from the group. "To get even a smattering of applause on universal health care is certainly a change. I can't wait to get back to Washington and write my press release."

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