WASHINGTON -- Republican leaders, facing a party revolt driven by an outcry against managed health care, are rushing to win agreement this week on legislation that provides new protections for patients while making health insurance more affordable.
Working against them is a united business community and a long GOP tradition of resistance to regulation of private industry. But many rank-and-file Republicans are anxious to set philosophy aside to answer their constituents' anxieties about managed-care insurance plans, which cover 80 percent of the American work force.
"The water is building up behind the dam. I think everybody knows that," said Republican Rep. Greg Ganske, an Iowa physician and co-sponsor of a largely Democratic managed care bill.
If GOP leaders don't act soon to produce their own version of a bill that checks what appear to be the worst abuses of the managed care system, they fear their members will desert party ranks to vote with Democrats on legislation that Republican allies in the business community bitterly oppose.
If no bill passes, Democrats will snatch the issue and club Republican candidates with it during the fall elections.
"We see it as a win-win," said Senate Democratic Leader Tom Daschle of South Dakota: "We'd love the bill, but we'll take the issue."
Congress resisted President Clinton's attempt four years ago to overhaul the private health care system, but the industry has reshaped it on its own -- prompted by a demand to become more efficient to control costs. In the process, though, patients claim health care has suffered mightily.
Many legislators are demanding action on two bills -- both with bipartisan backing -- that would address these problems in three main ways: by protecting the patient's ability to see the doctor of his choice; by easing access to emergency care; and by allowing patients to sue their managed care company for the denial of care.
But Republican leaders are resisting those bills because the bills are vigorously opposed by the health insurance industry as well as the larger business community that provides the central financial base of the GOP.
So far, though, a GOP task force charged in January by House Speaker Newt Gingrich with producing a less sweeping measure has failed to come through.
Heading off attack
Rank-and-file Republicans worry they will have no answer to Democratic charges that they are putting business interests above the life-and-death concerns of their constituents.
"Even if their constituents aren't raising [the issue] generally, the ones who do have powerful, emotional stories," said one health care lobbyist, who spoke on the condition of anonymity. "Members [of Congress] are picturing the fall and saying, 'I don't know how I can get out of this.' "
Republican Rep. Charlie Norwood, a folksy Georgia dentist, has threatened to launch a petition drive in the House next month to force a vote on his managed care legislation, which already has 230 co-sponsors -- more than enough to pass. He said he owes it to his GOP allies to give them a chance to vote for a bill they have already been attacked for supporting.
Failure may cost seats
What makes the Republican leaders so nervous is that they hold only a 20-seat majority in the House, and the Democrats are making an all-out push to regain control.
In that climate, the GOP anti-regulatory philosophy is no match for stories like that of Carol Anderson, a Gambrills hospital worker who had to change insurance providers in the middle of breast cancer treatment. When she called Prudential's health maintenance organization to ask if her doctors were on its network of physicians, she was told they were not, but because her breast reconstruction was already under way, she could stay with them.
That was in January 1995. The next month, her new HMO refused to cover her reconstructive surgery, claiming she had been misinformed about Prudential's policy. After months of fighting, the insurance company agreed to pay, but only if Anderson went to one of its doctors. That April, she tried to comply, but the new doctor refused to finish surgery that another doctor had begun. She finally paid $1,400 to get back on her old insurance policy.
"A common, everyday person goes to a job, gets insurance, gets a card, and thinks this insurance card is going to get you the health care you need," Anderson said. "I'm going to say 70 percent of the time it's not."
The health care industry strongly disputes that. Industry spokesmen note polls that suggest Americans may gripe about managed care in the abstract, but they are widely satisfied with their own situation.
"There is little evidence of widespread dissatisfaction," said Karlyn Bowman, an American Enterprise Institute expert on public opinion.
Stories have had effect
But even some health care industry lobbyists admit that the many anecdotes of HMO horrors have taken a toll in the political realm.
"People are trying to exploit these issues, to tattoo their opponents and force them on their heels," said Bruce Josten, the U.S. Chamber of Commerce's chief lobbyist.
When the task force finally produces its bill -- expected within a week or two -- the legislation is likely to extend the same protections already guaranteed for Medicare recipients: the right seek emergency care for ailments or accidents a "prudent layperson" would deem an emergency, to seek the care of medical specialists, to appeal coverage to an independent panel, to receive information on treatment options not favored by the insurer, and to maintain the confidentiality of medical histories.
By executive order, Clinton has already extended such protections to the nearly 90 million Americans enrolled in federal health plans.
The bill is also expected to nod to Republican priorities. It may include a provision to allow the self-employed to deduct all medical costs from their taxes. And it may expand the availability of medical savings accounts that would be at least partly tax-deductible and which could be used by individuals who wish to pay for much of their own medical costs.
House Commerce Committee Chairman Thomas J. Bliley Jr., a Virginia Republican, is pushing "Health Marts," which would allow employers, insurers, health care providers and workers to develop nonprofit purchasing pools that would bring down the cost of insurance by creating economies of scale. Rep. Bill Thomas, a California Republican, would like some kind of tax deduction for people who choose to buy their own insurance.
"We're trying to deal with the 40 million [uninsured] that everybody seems to have forgotten," said task force member Harris W. Fawell of Illinois. "If you don't reach out to people who don't have access to the system, what have you really done?"
What bill will lack
What the bill is not likely to include are two provisions demanded by Norwood, Ganske and the Democrats. One would allow patients to sue their managed care companies for denial of service. The other would order that companies offer an option to allow employees to choose doctors outside managed care's prescribed network.
Businesses are wary of any mandated patient protections, especially the so-called "prudent layperson" standard on reimbursement for emergency care. But they cannot accept either an expansion of legal liability or a mandatory choice of doctors, Josten said. Either would increase the cost of health care and undermine all the cost controls instituted by managed care companies.
Sensing their political advantage, Democrats are showing little sympathy.
Clinton, who is presiding over the strongest economy in a generation, said, "If we have to endure a smidgen more inflation, bring it on."
Pub Date: 6/15/98