HEALTH - Sour Medicine on Managed Care?

By Marilyn Werber Serafini, National Journal
© National Journal Group Inc.
Saturday, May 01, 1999

	      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 
Republicans. 
	     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 
conference. 
	     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 th
eir business 
elsewhere.'' 
	     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 
necessary.'' 
	     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.