WASHINGTON -- After a contentious debate, the House yesterday passed by a razor-thin majority a bill to allow patients and doctors more leeway in obtaining medical treatment and to strip managed care companies of some protection against lawsuits from those who are denied care.

The 216-210 vote came after Republicans defeated an alternative, written by Reps. John D. Dingell, a Michigan Democrat, and Greg Ganske, an Iowa Republican, that would have allowed swifter legal challenges to health maintenance organizations and insurers that refused to pay for reasonable care.

Among Maryland members, Republicans Roscoe G. Bartlett, Robert L. Ehrlich Jr. and Wayne T. Gilchrest voted for the GOP plan. Republican Constance A. Morella and Democrats Benjamin Cardin, Elijah E. Cummings, Steny H. Hoyer and Albert R. Wynn voted against it.

"I'm guaranteeing you that the Republican bill has excellent patient protections in it," said Rep. Charlie Norwood, a Georgia Republican and a dentist who exasperated his party's leaders this year by prodding them to address HMO reform.

Democrats asserted that the Republican bill was a political cover designed to protect lawmakers hostile to reform. Among Democratic complaints: The measure would not compel insurers give patients access to specialists outside their network or to pediatricians and gynecologists as primary care providers.

"It's a sham, it's subterfuge, it's cosmetic, it's ineffective and it won't solve the real problems," House Minority Leader Richard A. Gephardt, a Missouri Democrat, said to a packed House. "This is a bill with rhetoric but without a remedy."

The White House has said President Clinton would veto the bill in its current form. The Senate is likely to pass a version that avoids some provisions that Democratic opponents find objectionable.

Issue on voters' minds

Still, the HMO measure represented a sharp philosophical turn-around by the Republican leadership, which usually leads the charge against regulations on industry and held no public hearings on the bill.

But a public outcry against the excesses of cost-conscious HMOs forced the Republicans to take more seriously an issue it had expected to consign to task-force oblivion. Clinton made the issue a central component of his State of the Union address in January.

"There is no member of Congress that goes anywhere in their district who isn't hearing about it," said Rep. John A. Boehner of Ohio, chairman of the House Republican Conference. "It shouldn't surprise anybody that we're dealing with this issue."

The Republican bill would guarantee that health plans pay for needed emergency care. It would bar "gag rules" that prevent doctors from informing patients of the availability of costlier procedures. Additionally, women and children would need no approval for visits to obstetricians, gynecologists and pediatricians.

While Republicans strengthened the rights of patients to appeal an insurer's denial of treatment, the bill would require patients to pay for doing so. The bill allows insurers to define what constitutes "necessary care."

The Republican bill does create ways for individuals, associations and small businesses to set up insurance purchasing pools. But any member of such a pool would be protected only by the measures in the House Republican bill, not by existing state regulations.

"It is terribly drafted -- it doesn't do what they say it will do," said Cardin, a Baltimore Democrat who is closely involved in health care policy. "It won't give you protection, it won't cover access to specialists. They've left out numerous issues."

The bill would afford vulnerable House Republicans a measure of protection against Democratic challengers, who have complained that Republicans favor insurers against the will of the voters.

"Obviously, our opponents have decided this is the No. 1 issue in the fall campaign," Boehner said. "I'm very confident our bill really does empower patients without empowering lawyers."

Insurers opposed

Republican leaders, who were drafting revisions on the bill well into Thursday night to appease the party's moderate flank, allowed a vote on the Democratic alternative yesterday after it became clear that it could not pass.

While many physician and care-provider associations had rejected the Republican measure in favor of the Democratic proposals, the nation's largest health care insurance group -- the Health Insurers Association of America -- opposed both bills.

"We're disappointed that the House should have been fast-tracking this legislation, which is inherently flawed," said Chip Kahn, president-designate of the association. But, Kahn said, he preferred the Republican approach to that of the Democrats, which would have opened up his industry to more lawsuits.

"This is an issue of the trial lawyers seeking to enrich themselves at the expense of everybody else in the country," House Speaker Newt Gingrich said. "We have a proposal which says more patients have more rights by appealing against the HMO."

In the House, both parties sought to lift the federal law that prevents people on employer-based health care plans from winning compensatory damages. Under current law, a person whose insurer refused to grant an MRI and who then died from an undetected brain tumor could win the cost of the brain scan only in a lawsuit against that insurer.

The Democratic bill would have allowed lawsuits in state courts against insurers; the Republicans offer slower access to the courts, after a series of administrative appeals had been exhausted. The patients would have to pay a fee to make an appeal outside their insurance company, but an arbitrator's ruling would not be binding, under the House bill passed yesterday. Instead, a company would have to pay a fine of up to $500 per day for noncompliance with an arbitrator's ruling if a court ultimately found against it.

"The House GOP proposal shortchanges patient protection," said Kathy Pontzer, a lobbyist with the American Occupational Therapy Association.

Pub Date: 7/25/98