Published in the American Medical News, Vol. 41, No. 14, April 13, 1998, page 1:

Supporters of federal protection said they hope the move will pressure the Republican leadership into backing off its opposition to congressional action.

The AMA, consumer groups and labor unions applauded the measure.

"The bills contain a number of provisions that are consistent with the patient protection principles that the AMA has been advocating for several years," said AMA Chair Thomas R. Reardon, MD.

The legislation - sponsored by such Democratic heavy hitters as Senate Minority Leader Thomas Daschle (S.D.), Sen. Edward M. Kennedy (Mass.), House Minority Leader Richard Gephardt (Mo.) and Rep. John Dingell (Mich.) - brings the count of high-profile managed care bills to three. The other two proposals have Republican sponsors and bipartisan support.

Gephardt accused Republican leaders of blocking a competing bill sponsored by Rep. Charles Norwood, DDS (R, Ga.) and threatened to use a parliamentary procedure called a discharge petition to make sure the Democrats' proposal gets to the House floor.

If signed by 218 House members, a discharge petition would allow the Democrats' bill to bypass the normal committee process and be brought directly to the floor for a vote.

A 'wake-up call' to Republicans -
Dr. Norwood said the Democrats' threat should be a "wake-up call to Republican leaders that substantial managed care reform will pass the House this year in spite of all opposition."

That's a view shared by several groups supporting congressional action.

"We hope it will push the leadership to take this issue as its own, rather than give it to the Democrats," said Judy Waxman, Families USA government affairs director. If GOP leaders don't act, "they're giving the Democrats something to talk about in the (November) elections," she said.

At press time, Republican leaders had not made any statements regarding the Democrats' proposal.

Several groups expressed desire for a bipartisan approach.

"We hope this legislation and other measures will ultimately lead to a bipartisan solution to the concerns expressed by many patients and their physicians," Dr. Reardon said.

Consumers Union Legislative Counsel Adrienne Mitchem said the group hopes that the bipartisanship that allowed for the passage of the Kassebaum - Kennedy health insurance reform law in 1996 will prevail in the managed care consumer protection debate.

Democrats said they are seeking Republican co-sponsors.

'We're working on it," said Sen. Barbara Boxer (D, Calif.). "Part of the whole legislative process is to get this as bipartisan as we can."

A patient bill of rights -
Democrats portrayed their bill as a legislative bill of rights, similar to the package endorsed by President Clinton's quality commission in November.

"It spells out the basic rights of the type already endorsed unanimously by the president's commission," Kennedy said.

The bills protections include:

Clinton sent a letter to Daschle and Gephardt plugging the legislation.

"I am particularly pleased that (the Democrats' bill) includes every protection recommended by the advisory commission," Clinton wrote.

Business, insurance opposition -
The Democrats' bill, however, came under fire from the business and insurance communities for exceeding the presidential commission's recommendations by proposing to allow people with employer-sponsored coverage to sue their plans for malpractice, and by including a 48-hour minimum hospital stay for mastectomies and 24 hours for lymph node dissection.

"Take costly big-government mandates and throw in a bonanza for trial lawyers, and you have the Democrat leadership's recipe for health care reform," said Dan Danner, chairman of the Health Benefits Coalition, a group of business and insurance groups united against federal managed care legislation.

Opponents said the measure would increase costs, thus making coverage unaffordable for millions of working Americans.

Business groups warned that increased costs and liability could force employers to drop coverage.

"It's an elixir that ... could end up killing off the whole notion of voluntary employer-sponsored health care coverage," Danner said.

But Democrats stood by the liability provisions.

"I cannot understand why we should separate one single function in our society to be free from accountability," Kennedy said. "Why should we just say that in this particular area we should completely immunize a group of health care plans?"

The AMA supports the liability provisions.

"As a doctor, I'm held accountable when I make a treatment decision, but if a health plan does, they're not held accountable," Dr. Reardon said. "That's fundamentally wrong. It's a fairness issue for our patients."

Bills share similarities -
The Democratic measure shares several similarities with the Norwood bill and with a measure sponsored by Sens. Jim Jeffords (R, Vt.) and Joseph Lieberman (D, Conn.). For example, the three bills include provisions on comparative health plan information for consumers, external appeals processes, access to emergency care and prohibitions on plan restrictions on physician-patient communications.

But the bills also have significant differences.

Both the Norwood and the Democratic bill include provisions requiring plans to offer a point-of-service option if the only choice an enrollee would have otherwise is a closed-panel HMO. The Jeffords measure has no such provision.

Jeffords' bill also lacks the liability provisions found in the Norwood and the Democratic leadership legislation.

The Democrats' breast cancer hospital-stay provision, its general prohibition against "arbitrary" plan interference in physicians' medical decisions, and its requirement that women be allowed to choose obstetrician-gynecologists as their primary care physicians are unique to their bill.

Dr. Norwood criticized the Democrats' bill as too heavy on mandates.

The managed care lobby has attacked his bill "for the last six months with the 'straw man' argument that (it) would create mandates for coverage, knowing full well that it doesn't," Dr. Norwood said. "But this Democratic proposal has brought the straw man to life by truly mandating coverage for a number of illnesses and specialists."