August 1999 Bulletin

Managed care battle to move to U.S. House

The bruising battle in Congress over managed care reform is expected to be repeated in the House of Representatives, where Republicans and Democrats will debate the same issues that rent the air of the Senate last month.

Four days of emotional rhetoric in the Senate ended with Republicans winning all of the battles, mostly along partisan lines, including a defeat of a provision to allow patients to sue their health plans. By a 52 to 47 vote, Republicans won approval of a bill that offered new rights on access to specialists, emergency rooms, obstetricians-gynecologists and external appeals for 48 million Americans not covered by federally regulated plans. The Republican legislation, with more modest features than the broad protections in the Democratic bill, was scorned by President Clinton, indicating he would veto it. However, the House must first pass its version of managed care legislation and differences settled by a conference committee.

In the House, a package of eight bills, said to be favored by the Republican leadership, is tied up in committee because of conflicts among some party members over its scope.

The bills, which would be considered separately, guarantee women direct access to obstetricians and gynecologists, allow pediatricians to be designated primary care physicians, bar "gag" clauses in managed care contracts, require binding external appeals and impose a "prudent layperson" standard for emergency room screening exams. The Republican bills do not allow patients to sue their health insurers; the Democratic bill does.

Similar legislation was approved by the House last year on a narrow margin of 216 to 210. Since then Democrats have won five more seats in the House.

Rep. Charles Norwood, (R-Ga.) and Rep. Greg Ganske, (R-Iowa), are trying to pass tougher provisions than the Republican leadership favors. Meanwhile, the Democrats are trying to force their bill to the floor for debate. The House could also consider the Senate bill. The House is scheduled to go on recess Aug. 7.

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