When Corporate America launched a massive lobbying blitz to block sweeping regulation of managed-care plans in late January, it looked like a loser. HMOs and other employer health plans were on the run as consumers, doctors, and pols cast them as the villains in a new world of bare-bones medicine. The public mood was clear down at the cineplex as audiences cheered Helen Hunt's character in As Good As It Gets when she blasted an HMO doctor for limiting her child's treatment.
But in a few short weeks, corporate forces have staged a remarkable comeback. Through skillful politicking, business has stalled the rush to impose new rules on health care. While Congress is still likely to enact a patient's bill of rights this year, the final package will be much more to employers' liking.
That's no mean feat. President Clinton's version of the patient's bill of rights gets plenty of applause for its call for easier access to specialists and treatments. And a physician-friendly Republican alternative that's even tougher on HMOs has 216 House sponsors.
"INTIMIDATED." To stem the tide, business lobbyists argue that the GOP bill, the Patient Access to Responsible Care Act (PARCA), would undermine the managed-care networks that have halted the double-digit medical inflation of the 1980s. PARCA's backers--a coalition of medical and consumer groups--maintain that the measure would raise costs by no more than 2.6%. But actuaries Milliman & Robertson Inc. conclude that the bill would hike premiums by 23%. A boost that large would induce 46% of small companies to drop health insurance, according to a poll released on Feb. 24 by the business-backed Health Benefits Coalition.
Those figures may be self-serving, but companies are using them to chip away at PARCA's support. They've teamed up with Senate GOP Whip Don Nickles (R-Okla.) and House Majority Leader Dick Armey (R-Tex.), who were furious that Senator Alfonse M. D'Amato (R-N.Y.) and 90 Republican House members--all up for reelection this fall--backed the measure. Now, two GOP co-sponsors have dropped out, and "many, many others have told us privately that they wish they hadn't signed on," says small-business lobbyist Dan Danner. Business, laments a Senate Democratic staffer, "has intimidated" Republicans sympathetic to HMO reform.
Corporate America still faces a formidable foe: Bill Clinton. His bill of rights would require health plans to give members detailed information about physicians, hospitals, and claims processing. It would mandate external appeal boards when health plans deny coverage. The package also would make it easier for patients to see specialists and to win payment for emergency-room visits even when they're false alarms. On Feb. 20, Clinton ordered that his rules apply to health plans covering 87 million federal employees, veterans, and Medicare and Medicaid recipients.
But business won't willingly follow suit. It sees the bill of rights as part of a Clinton plan to win what he couldn't get in 1994--sweeping health-care reform--one step at a time. The Business Roundtable wants a purchasers' coalition of large employers--excluding insurance, HMOs, and drug companies--to draft patient-protection rules that companies would pledge to meet voluntarily.
That won't satisfy politicians eager to ride the tide of HMO resentment. The Dems plan to make patient rights a centerpiece of their fall campaigns. And a GOP strategist concedes that such legislation "is a political imperative." With both parties aboard, some version seems bound to pass. Business may have defused the anti-HMO explosion--but it won't escape unscathed.