GOP rebels push for tougher managed-care bill

House group hopes for compromise proposal including right to sue


WASHINGTON -- A group of House Republicans, in defiance of their leaders, is trying to pass much tougher regulation of managed-care plans than the Senate adopted last week, and they say they can win if they can force a vote.

House leaders, as in the Republican-controlled Senate, are trying to stand firm against any legislation creating a right to sue health plans offered by most large, multistate employers. But dissidents talk openly of working with Democrats and passing a bill that would allow such suits, while perhaps limiting damages that could be awarded.

The rebels, who call the Senate bill a sham, are pinning their hopes on negotiations between Reps. Tom J. Bliley of Virginia, the chairman of the Commerce Committee, and John D. Dingell of Michigan, its senior Democrat.

"I think the possibility of agreement is pretty good," said Rep. Charlie Norwood, a Georgia Republican.

Bliley and Dingell are expected to meet tomorrow. But the mavericks are wary of the Republican leaders' control of the machinery of the House.

Rep. Greg Ganske, an Iowa Republican who called the Senate bill "not much more than a fig leaf," said he feared the leaders might try to bypass the Commerce Committee and send the Senate bill, or some other weak version, directly to the floor through the Rules Committee, which the leadership controls absolutely.

"What kind of fair debate can we get out of Rules?" Ganske asked. Like Norwood, Ganske made it clear that he would break with his party on a procedural vote to get their proposals considered.

"Beat us if you can," Norwood said, "but don't avoid the fight."

Three factors make the House a different playing field from the Senate.

The Republicans' thin 222-211 majority is one factor. Last year, more for campaign protection than in the expectation of getting a law enacted, Republicans passed a modest patients' bill by only a 216-210 tally, and they lost six seats in the November elections.

The leadership of Ganske, who is a reconstructive surgeon; Norwood, a dentist; and two other Republican physicians, Reps. Tom Coburn of Oklahoma and John Cooksey of Louisiana, is a second factor.

Like many other doctors, and the American Medical Association with whom they appeared last week to denounce the Senate bill, they regard managed care's spending controls as an intrusion and a threat to patients' health.

Third, the issue seems to have a stronger political influence in the House, where contested races can be influenced by a much smaller expenditure of television dollars than it takes to sway a Senate contest in all but the smallest states.

A warning came through clearly in last week's CBS News Poll, showing that 14 percent of Americans regarded health care as the most important problem for government to address, the highest percentage of any issue. Not only is managed care the health issue most intensely fought over in Washington, but it is matched only by the need to insure all Americans -- on which no legislation is contemplated -- as a public concern.

In the poll of 722 adults, taken during the Senate debate, 49 percent said Democrats were more likely to improve the health care system and 27 percent said Republicans were. The poll showed growing hostility to health maintenance organizations and other managed-care plans. The poll had a margin of sampling error of plus or minus four percentage points.

There may be little immediate political impact. Dr. Kathleen Frankovic, director of surveys for CBS News, said, "The public is clearly not paying close attention to the details of the debate in Washington."

But that doesn't mean a free hand for Republicans, because it may signify that the public's sense that Democrats handle health issues better remains in place.

The legislation favored by the dissident doctors in the House would differ from the bill passed by the Senate in many areas beyond the provision for lawsuits when patients claim they have suffered from a denial of proper benefits.

It would cover all health insurance plans, not just the large ones governed by the Employee Retirement Income Security Act, or ERISA. It would guarantee patients a right to appeal insurers' decisions to third parties not chosen by the insurer. It would require health maintenance organizations to offer their customers the right to pay more to use outside doctors. It would prohibit penalties against doctors who seek additional care for patients.

House leaders hope to pass a package of bills offered by Rep. John A. Boehner, an Ohio Republican. That package, basically what the House passed last year, provides for a slightly less independent external review than the doctors' bill and does not cover plans outside of those governed by ERISA or authorize the outside-doctor access in the doctors' measure.

It seeks to expand insurance coverage by provisions to enable small employers to join pools to buy insurance at the lower rates available to large purchasers. While it would not authorize suits, it would subject health plans to prosecution if they disobeyed the finding of an external review panel.

House leaders have said they want to consider patients' legislation during the week beginning July 26. But if they find they do not have the votes, they could postpone action.

Pub Date: 7/18/99

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