October 1999 Bulletin

House doctors buck party

Force GOP leadership to consider right to sue

A group of doctors and a dentist in the House of Representative have put patients before their party on managed care reform legislation.

Rep. Tom Coburn (R-Okla.), an obstetrician; Rep. Gregg Ganske, (R-Iowa), a plastic surgeon; and Rep. Charles Norwood (R-Ga.) a dentist, forced the Republican House leadership to take notice of their prescriptions for patient protections in health care. Their medicine is stronger than the remedies approved by the Senate in mid-July.

Senate Republicans streamrolled Democrats in four days of emotional debate and pushed through a bill that gives some people easier access to emergency rooms and medical specialists, helps women stay in hospitals longer after breast cancer surgery and expsands patients' ability to appeal if health plans won't pay for medical care. Most provisions apply only to 48 million Americans whose companies self-insure and can't be regulated by the states.

The last day of partisan warfare featured the defeat of the most contentious issue-patients' right to sue HMOs for malpractice. Sen. Bill Frist (R-Tenn.), the Senate's only physician and a key player in the Republican strategy, hailed the final legislation as achieving balance for doctors and patients.

But in the House, some physicians had a different view. Rep. Norwood scoffed that the Senate bill "didn't fool anybody" with protections that apply to only 48 million people. Rep. Ganske called it "not much more than a fig leaf." They, plus Rep. Coburn and Rep. John Cooksey (R-La.) an ophthalmologist, appeared at an American Medical Association (AMA) press conference to blast the bill.

With only a five-vote majority, the House Republican leadership had to pay attention to the doctors. They would not support a bill similar to the one approved by the House the previous year, nor a bill similar to the one approved by the Senate this year.

At first, the Republican leadership's strategy was to move piecemeal bills, based on the most popular protections that have bipartisan support. In April, this strategy gave way to asking Rep. Norwood, Rep. Ganske and Rep. Coburn to write a consensus managed care reform bill. Drafts of two consensus bills were given to House Speaker J. Dennis Hastert (R-Ill.) in May. Other bills were introduced, but by August no bill had gone to the House floor for debate and vote.

Rep. Norwood and Rep. Ganske began negotiating with Rep. John Dingell (D-Mich.), sponsor of the Democrat-backed "Patients' Bill of Rights," which includes the patient's right to sue a managed care plan in state court. Rep. Coburn and John Shadegg (R-Ariz.) developed a bill that includes third-party negotiation on disputes with health plans and the patient's right to sue a managed care plan in federal court after having gone through the appeals process.

In early , Rep. Hastert promised a vote on the Coburn-Shadegg bill, the first time a Republican congressional leader has backed an expanded right to sue. In late August, the AMA backed the Norwood-Dingell bill, while commending Rep. Coburn and Rep. Shaddeg for their legislative efforts.

After Rep. Coburn and Rep. Shaddeg warned that they would join with Rep. Norwood unless there was a strong Republican alternative, the Coburn-Shaddeg bill was introduced early last month. Although Rep. Hastert promised a vote in the bill in September, he did not endorse it when it was introduced.

As this is written, the House has not voted on managed care legislation.

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