House GOP version of managed care bill likely to pass today Democrats opposed because it forbids malpractice suits against health insurers


WASHINGTON -- In a last-ditch effort to shore up their shaky coalition, House Republicans refined their managed care legislation yesterday to give consumers more legal power to force their insurers to cover health care costs.

The change will likely ensure that House Republicans will pass their managed care bill today, despite a nearly united Democratic opposition. Democrats largely conceded defeat.

"They don't go to the [House] floor unless they've got the votes," House Democratic leader Richard A. Gephardt of Missouri said of the Republicans.

Republicans and Democrats are divided on whether managed care patients or their survivors should be able to sue insurers for malpractice for denying treatment. Democrats say the threat of a crippling lawsuit is the only way to ensure that managed care companies provide the care that patients deserve.

Republicans say such suits would lead to a rush to the courthouse, raising the cost of insurance and forcing some businesses to drop coverage altogether.

Instead, House Republicans devised an alternative that would allow patients an expedited internal review procedure, followed, if necessary, by an appeal to an outside review board set up by the insurer. If the insurer refused to abide by the reviewers' decision, a patient could appeal to a federal court, which could levy a financial penalty for every day that care is denied.

In a concession to a handful of dissatisfied Republicans, Republican leaders agreed yesterday to increase the size of that daily penalty from $250 to $500, and to give judges the discretion to double it, to $1,000, if they decided the insurer was acting in bad faith. The maximum penalty was increased from $100,000 to $250,000.

"We put in the toolbox of the judge the tools he needs to make sure [insurers] stop screwing with people," said Rep. Lindsey Graham, a conservative South Carolina Republican who flirted with signing on to the Democratic version of managed care legislation.

Republican leaders spent much of yesterday making promises to ensure they would not lose one of the highest-profile votes of the legislative year. A group of conservative lawmakers presented an alternative bill that would forgo mandated protections and instead give employees the option of accepting their employers' health plans or taking a cash equivalent to buy their own insurance.

Rep. Dennis Hastert, the Illinois Republican charged with passing the bill, said he could not give the conservatives a chance to vote on that plan. But he headed off a revolt by promising them a vote next year.

That seemed to be enough.

"I think the [Democratic and Republican] bills are nothing but a prelude to socialized medicine," fumed Rep. Tom Coburn, an Oklahoma doctor who helped write the conservative alternative. But "if they need my vote, I may give it to them. I won't be the one vote that lets [the GOP bill] go down."

Opponents pleaded for a chance to vote on the Democratic alternative. But Republicans were not going to risk handing Democrats a victory on an issue sure to dominate the election season.

Though the managed care bill was being rushed through with little debate and no hearings, rank-and-file members were willing to go along.

"I really honestly do not know what's in this bill," shrugged Rep. Michael N. Castle, a moderate Delaware Republican. "There are others who feel the same way, but they'll probably vote for it anyway."

Pub Date: 7/24/98

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