106th Congress
ANA Strongly Opposes the Quality Health Care Act - H.R. 1304
The U. S. House of Representatives is expected to vote soon on H.R. 1304, the Quality Health-Care Coalition Act of 1999, which would create a broad antitrust exemption to permit doctors and other health care professionals to bargain collectively with health plans.
Several nursing organizations, including ANA, sent the following letter to all members of the U.S. House of Representatives to express our strong opposition to HR 1304. ANA urges all nurses to contact their representatives in Congress to reinforce that message.
May 19, 2000
Dear Representative:
As the House of Representatives prepares for floor consideration of H.R. 1304, the Quality Health-Care Coalition Act of 1999, we are writing to make sure you are aware that associations representing the nursing profession, and especially advanced practice nurses, remain strongly opposed to this legislation. We are concerned that this legislation will raise the cost of health care and give physicians the legal means to limit the services provided by advance practice nurses.
We want to be clear that the Nadler amendment adopted by the Judiciary Committee, which purports to prohibit physicians from reaching agreements to limit the coverage or reimbursement of services provided by non-physician providers, would be ineffective in protecting advanced practice nurses from continuing efforts by physicians to limit their role in the health care delivery system. Although we appreciate the attempt to protect our interests, we do not believe the amendment will preserve for advanced practice nurses the vital protection currently provided by the antitrust laws.
While the amendment suggests that advanced practice nurses may retain some antitrust protection against the most blatant exclusionary practices, it does not ensure them protection against the more subtle practices that, in fact, pose the greatest risk. Thus, the proposed amendment would not prevent physicians from collectively negotiating with health plans for contractual terms that have the effect of placing non-physician providers at a great competitive disadvantage. Consider, for example, contract terms
- that require that a physician be present for certain procedures, even though nurse providers can furnish the procedures independently under state and federal law;
- that impose "quality" standards that forbid or discourage referrals to advanced practice nurses;
- that mandate certain educational or experience requirements that typically can be met by most physicians, but by only few or no non-physician providers; or
- that establish reimbursement rates that are so low for non-physician providers that it is not viable for any of them to participate with health plans as independent providers.
Under existing antitrust laws, physicians can advocate for such terms, even if they disadvantage non-physician providers or are not in the interest of consumers. But the antitrust laws do not allow physicians to engage in collective negotiation and other joint conduct that would allow them to force their views on health plans. H.R. 1304, even with the Nadler amendment, permits such coercion.
Moreover, we do not believe that any amendment can be drafted to assure non-physician providers such as advanced practice nurses that H.R. 1304 does not take from them vital antitrust protection. That is because, by its own terms, H.R. 1304 will give physicians the ability to force health plans to accept the terms that the physicians collectively negotiate, and these terms can be couched in an infinite number of ways in which non-physician providers can be unfairly disadvantaged. Provisos like the Nadler amendment simply will encourage physicians who wish to compete unfairly with non-physician providers to be more resourceful and subtle in their negotiation efforts. The ultimate result -- with or without the Nadler amendment -- will be the same under H.R. 1304. Between physicians and non-physician providers, the playing field will be tilted far in favor of physicians, who will have the unfettered bargaining clout to insist on contractual provisions that place non-physician providers at an unfair disadvantage.
For these reasons, we remain strongly opposed to H.R. 1304. We appreciate your consideration of our views on this important issue for the nursing profession.
American Academy of Nurse Practitioners
American College of Nurse
Midwives
American College of Nurse Practitioners
American Nurses
Association
Association of Women's Health, Obstetric and Neonatal
Nurses
National Association of Hispanic Nurses
National
Association of Nurse Practitioners in Women's Health
National Black
Nurses Association
Return to U.S. Federal
Affairs.
| Sitemap | Home | Feedback | Join ANA |