June 1998 Bulletin

Outlook clouded for health care bills

Strong economy makes public complacent; business opposition strong, says Rep. Matsui

November elections is clouded by a "don't-rock-the-boat attitude" in Congress, a complacent public and strong lobbying by business groups, says Rep. Robert Matsui (D-Calif.).

He believes that with only a few working days remaining before the November elections, legislators don't want to tackle controversial issues that will affect their votes. There also is little pressure from their constituents, says Rep. Matsui, who spoke at the National Orthopaedic Leadership Conference in Washington, D.C. on April 30. "The economy is strong and when the legislators go home they find the people are happy." Rep. Matsui believes that "not much will get done (in Congress) about health care until unemployment increases and there is pressure from the middle class."

The same complacency isn't being shown by big and small business. Rep. Charles Norwood (R-Ga.) has 230 sponsors for his Patient Access to Responsible Care Act (PARCA), but the Republican leadership won't allow it to get to a vote. The bill is being strongly opposed by business groups, which are dead set against changing the provision of the Employee Retirement Income Security Act (ERISA) that prevents consumers from suing insurers.

The Republican leadership formed a working group which is crafting its own legislation that may espouse voluntary reforms by insurers. Rep. Dennis Hastert (R-Ill.), chairman of the task force, expected to present legislation before Congress left for the Memorial Day recess May 22. Early last month, a group of Republicans in the House devised an alternative plan that would allow small- and medium-sized companies to join in purchasing pools that would offer employees a selection of insurance plans. The participating companies would save money by escaping state health insurance mandates and coming under the umbrella of ERISA.

Patients would have the right to appeal if care is denied, the right to chose any doctor and the right to receive information about any insurance plan. It also would allow individuals who buy health insurance to deduct the cost on their tax returns.

House and Senate Democrats have introduced the Patient Bill of Rights of 1998 legislation which would write into law most of the recommendations of President Clinton's Healthcare Advisory Commission, including requirements that managed care plans provide freer access to specialists, create external grievance procedures, ban "gag clauses" that limit doctor-patient communications and provide for emergency room care that a "prudent layperson" would deem necessary. The bill also permits patients who are injured as a result of being denied care to sue their health plans, if state law allows. The bill was endorsed by the American Medical Association and opposed by small businesses who say it would increase premiums and lower coverage.

Rep. Greg Ganske (R-Iowa), led a group of nine House Republicans to endorse "patients' rights" legislation written by Democratic leaders, saying he is concerned that Congress will end the year without acting on any of the bills.

Sen. Tom Daschle (D-S.D.) is trying to move the Senate version of the Patient Bill of Rights by seeking to append it as an amendment to any appropriate bill.

"The mood in Congress is strange," says Rep. Matsui. "I've never seen anything like it."

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