(BETHESDA, MD)—"Our goal is to get our message across to Congress and have a meaningful exchange," American College of Cardiology (ACC) Government Relations Committee Chair Lawrence J. Laslett, MD, told participants at the College's annual Legislative Conference.

That's just what the conference participants did. About 100 members of the College's Key Contact program, Board of Governors, and other College leaders came together in Washington, D.C., Sept. 26-27 to share their opinions about patients' bill of rights legislation and other key issues affecting cardiovascular medicine. Led by Dr. Laslett, ACC members from around the nation received issue briefings and nuts-and-bolts lobbying tips and then put their skills to use during visits with legislators on Capitol Hill.

Legislative Landscape
The conference opened with an overview of the current political situation provided by Martin B. Gold of the Legislative Strategies Group, LLC. According to Mr. Gold, the mood in Congress could be summed up in one word: partisanship.

"Even during the Vietnam War and Watergate, we have never seen partisan attitudes like we have now," he told participants. "With few exceptions, the rule is the rule of partisan conflict, both within Congress itself and between Congress and the executive branch."

The bitter rifts formed by the president's impeachment are not the only cause of this bitter partisanship, Mr. Gold explained. In fact, the seeds of today's situation were planted during the 1998 elections. Predicting big wins, the Republicans were stunned when it turned out to be the Democrats who made gains while their own dominance of the House of Representatives shrank to a wafer-thin majority. With control of the House in sight, the Democrats are now sticking together and voting in unison on almost every issue. "The battle for the House is like the Battle of Stalingrad," said Mr. Gold. "Every house, every street, every congressional district is competitive."

Thanks to this new political math, the 106th Congress is unlikely to pass any significant legislation. Instead of action on important issues like health care, said Mr. Gold, there has just been posturing.

Take the patients' bill of rights, for example. Despite great public support and passage of bills in both the House and the Senate, Congress couldn't agree on the details. What's worse, neither party has an incentive to negotiate. For the Democrats, their opponents' failure to act on this popular issue represents a great campaign issue. And Republicans believe they have inoculated themselves from criticism simply by showing interest in the area. A similar dynamic is at work in the debate on prescription drugs.

Top Legislative Priorities
Determined to keep the pressure on despite this gloomy situation, the conference participants headed to Capitol Hill to share the College's message with their legislators. Their visits focused on three priority issues: the patients' bill of rights, Medicare practice expenses, and collective bargaining for physicians.

On patient protections, the College's main goal was to encourage the Senate to pass a revised version of the Norwood-Dingell patient protection bill. Covering all patients in managed care plans, the compromise bill includes the following key provisions:

• A point-of-service option that gives patients access to out-of-network providers;

• Access to specialty care, clinical trials, and emergency room services;

• Fair and timely internal appeals as well as external reviews by professionals with appropriate clinical expertise;

• Information about benefits and procedures, including a checklist for evaluating health plan performance; and

• Prohibitions against so-called "gag clauses" and financial inducements to limit medically necessary services.

"The insurance industry has just launched another aggressive campaign against the patients' bill of rights," said ACC President George A. Beller, MD. "The best way to counter that message is for Congress to hear from patients and physicians."

Conference participants also discussed the Medicare practice expense issue with lawmakers. Halfway through the transition to a reimbursement system based on physicians' actual costs rather than customary fees, the Health Care Financing Administration (HCFA) has still not done what Congress ordered it to do. Of the 36 methodological problems identified in 1999, for instance, HCFA has addressed only two. HCFA's administrator has even said she doesn't believe it is possible to determine actual expenses.

As a result, practice expense payments continue to be seriously distorted. Although practice expense payments for coronary artery bypass surgery will be reduced by more than 30 percent, payments for some office-based procedures will increase by almost 500 percent. If HCFA proceeds with its current plan, cardiology will see overall practice expense payments drop 12 percent.

The College and other members of the Practice Expense Coalition are urging Congress to put the transition process on hold while HCFA refines its methodology. "We're not against a resource-based system," explained Dr. Laslett. "But practice expenses are difficult to stratify. We just want to make sure they are calculated as logically as possible."

Collective bargaining for physicians was another topic of discussion during the congressional visits. In the face of increasing industry consolidation, physicians have been forced into "take-it-or-leave-it" contracts that hinder their ability to provide quality patient care.

To help level the playing field between health plans and health care professionals, the College supported the Quality Health Care Coalition Act of 1999 that passed in the House. The bill would allow physicians to join together to negotiate contracts free from fears of violating antitrust laws. Price-fixing and strikes would be prohibited, and the law would "sunset" after a three-year pilot study. Although the issue is dead for this year, conference participants urged legislators to reintroduce the bill next year.

Challenge of the Uninsured
The conference then zeroed in on another important issue: how to extend health insurance coverage to the millions of Americans who are currently uninsured.

Rep. Gene Green, D-Texas, began by describing his proposal to conference participants. He noted that uninsured individuals are often more expensive to treat because of their inability to afford and, therefore, access early care. Rep. Green explained that his bill would create integrated health care delivery systems to provide better access to services. In addition, the bill would provide incentives for qualified individuals to enroll in programs like Medicaid and the Children's Health Insurance Program.

Rep. Frank Pallone, Jr., D-N.J., also takes an incremental approach to solving the crisis of the uninsured. "We have to talk about what can realistically happen vs. what we want to happen," he explained.

Noting that three-quarters of the uninsured have jobs, he explained that his bill would require companies with 50 or more employees to provide insurance for employees and their dependents. He also described the administration's proposals, such as opening the Children's Health Insurance Program to more children and their parents.

These kinds of incremental approaches won't work, argued Rep. John C. Cooksey, R-Calif. His proposal would give every American—except those enrolled in Medicare, Medicaid, or the government employee health plan—a tax credit to encourage them to buy basic coverage. A sliding scale would provide additional assistance to those with very low incomes or very high medical expenses.

"Politics can be frustrating at times, but politics is this democracy's means of connecting philosophy and policy," said Rep. Cooksey, who is also a practicing physician. "Continue to do what you're doing today. Keep participating in the political process."