Legislation '98:

From Patient Rights to Medicare Reform Fights.

"With the 105th Congress back in session, major health care issues again are appearing on the docket. As many legislators focus one eye on legislation and the other on their re-election campaigns, it is vital that medicine remain focused on some of the major health care issues that will receive attention in the months ahead.

It's likely that the most widely publicized legislation will deal with patient protection and quality issues. The President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry got the ball rolling when it released its "Consumer's Bill of Rights" last November. President Clinton and congressional Democrats are expected to use this document as a basis for legislation introduced during 1998.

Meanwhile, the "Patient Access to Responsible Care Act" has been introduced by Rep. Charlie Norwood (R, Ga.) and Sen. Alfonse D'Amato (R, N.Y.) and has garnered 211 co-sponsors, despite continued opposition from the GOP congressional leadership. At the same time, congressional Democrats have vowed to fight for "meaningful" reforms.

One significant element of the legislation would preempt language in the Employee Retirement Income Security Act (ERISA) that protects managed care companies from malpractice suits. The AMA, while applauding the many patient protections, has withheld its support for this legislation while working with sponsors to modify other provisions that are less physician-friendly. However, the AMA has expressed support for another bill introduced by Rep. Norwood that would hold health plans liable for medical treatment decisions.

The AMA also has pledged its support for passage of the "Patient Right to Know Act" (HR 586 and S 449), sponsored by Rep. Greg Ganske, MD (R, Iowa) and Sen. Jon Kyl (R, Ariz.). This legislation also is opposed by the Republican leadership, although the House version has 296 co-sponsors. The bill would protect the confidentiality of patient-physician communications and prohibit managed care companies from including gag clauses in their contracts with physicians.

A key feature of President Clinton's State of the Union message was his proposal to expand Medicare coverage to individuals older than 55 by allowing them to buy into the program. The AMA and Clinton are in agreement that the problem of providing coverage for the rapidly growing pool of under-65 retirees must be addressed.

However, medicine has no intention of moving away from its primary legislative target of assuring the long-term fiscal solvency of the Medicare program in a way that will not impose onerous financial burdens on today's younger generations. The AMA will continue to insist that Medicare must meet the needs of current beneficiaries before any expansion should be considered. The upcoming report of the National Bipartisan Commission on the Future of Medicare also will play a bearing on the future of this legislation

Also related to Medicare reform is legislation targeting Medicare fraud and abuse, a topic embraced by both parties and by President Clinton. The AMA is firmly committed to setting the highest ethical standards for the profession and working with the federal government to rein in the small number of providers intent on defrauding Medicare. However, legislative attempts to stretch the traditional definition of fraud and abuse are a cause for concern, and the AMA will continue to emphasize that a physician's inadvertent billing errors should not trigger fraud charges.

Another Medicare issue deals with the ban on physicians' private contracting with Medicare patients. Reforming this ill-advised 1997 legislation has been identified as a top priority by House Ways and Means Committee Chair Bill Archer (R, Texas). Legislation (HR 2497 and S 1194) already has been introduced, but faces opposition from the White House and Congress.

Also hovering over Congress is the settlement with the tobacco industry. At the December 1997 Interim Meeting, the AMA House of Delegates reaffirmed its opposition to the provision of liability protection for tobacco companies -- a provision included in the settlement agreed to by the industry and state attorneys general last year.

President Clinton's budget proposal, meanwhile, relies heavily on the assumption that Congress will approve a settlement that provides billions of dollars to the federal treasury. A key step likely will come on March 16, when Sen. Don Nickles (R, Okla.), the Republican point person on tobacco legislation, holds a summit with the chairs of the seven congressional committees that have jurisdiction over the tobacco issue.

It should be kept in mind that 1998 is an election year, with every seat in the House of Representatives and one-third of the Senate seats up for grabs. As the Republicans seek to maintain and expand their congressional majority, and as the Democrats attempt to make inroads into that majority, the nation is in for a heavy dose of politics in the coming months.

For medicine, as always, the challenge is clear: to make sure that any legislation enacted works to the benefit of the patient. The AMA, its allies, and individual physicians around the country will continue to speak forcefully toward this goal."