Managed Care Reform Outlook Gloomy Despite New Proposal

House Republicans on Nov. 2 declared the "fight" for a patients' bill of rights "not yet over" although they have not won the support of Senate GOP leaders, CongressDaily reports. Reps. John Shadegg (R-Ariz.) and Tom Coburn (R-Okla.) on Nov. 2 said they planned to introduce a "compromise bill" that would give patients the right to sue their HMOs over benefit denials in federal court after exhausting an "external appeals" process. The proposal would "cover all Americans with private insurance, although states would be able to retain authority over certain health plans" (Rovner et al., CongressDaily, 11/2). Passage of such a bill in the 106th Congress seems unlikely for several reasons, however. First, House Minority Leader Richard Gephardt (D-Mo.) on Nov. 2 "declared the Congress over" and said he was willing to send members home, while keeping the government open through one-day continuing resolutions. While this announcement follows the Senate's Nov. 1 decision to recess until after Election Day, House Republicans said yesterday they were prepared to stay in session through the weekend. Gephardt said, "We are finished here ... and it's time to admit failure" (Earle et al., CongressDaily, 11/2). Second, the Shadegg-Coburn bill has been criticized by supporters of the House-passed Norwood-Dingell patients' rights bill (H.R. 2723). On Nov. 2, an aide to Rep. Charles Norwood (R-Ga.), who co-wrote Norwood-Dingell, called Shadegg and Coburn's proposal "political grandstanding." Shadegg and Coburn's plan calls for the right to sue in state courts for "quality of care issues." Norwood's aide said this provision would merely reinforce the right to sue for medical malpractice -- "which is already regulated at the state level" -- and not for inappropriate denial of care as provided for in Norwood-Dingell. Shadegg responded that Norwood-Dingell "would lead to more litigation," while his proposal "would preclude employers from being sued and cap both punitive and pain and suffering damages." Coburn added, "This will give (HMOs) the incentive to do the right thing." The third obstacle, and perhaps the "biggest challenge" to passing managed care reform, is Senate Majority Whip Don Nickles (R-Okla.), who has so far refused to get "on board" for any of the existing HMO reform proposals. Nickles, who is chairing the "stalled" House-Senate managed care conference, has proposed "a narrower version of the House bill that has not generated much interest in the House" (Fulton, CongressDaily/A.M., 11/3). A Senate Republican aide said that once the Senate reconvenes after the election the focus will be on the "big three:" passing the FY 2001 Labor-HHS appropriations bill, the GOP-backed tax-relief bill, which includes $30 million in Medicare "givebacks," and the bankruptcy reform bill (Rovner et al., CongressDaily, 11/2). Still, a Norwood aide "vowed" that managed care reform "would remain an issue next year" and that "Nickles would have to address it head on." He added, "They're going to have to dig real deep to go toe to toe with us for next year" (CongressDaily/A.M., 11/3).