Thanks to the partisan rancor sown by Bill Clinton's impeachment, it has become conventional wisdom in the capital to say nothing much will get done until a new President is sworn in. But health insurers and employers aren't buying that line. Convinced that Congress might come together long enough to enact a patients' bill of rights for enrollees in managed-care plans, industry groups are preparing a furious lobbying blitz to head off any reforms.
Do the lobbyists know something that the pundits don't? Yep. After his trial whimpers to a close, an emboldened President Clinton plans to campaign hard for his bill-of-rights plan, which gives HMO subscribers new leverage against cost-conscious insurers. Republicans, eager to court impeachment-weary voters, are desperate to change the subject. GOP strategists think one way to do that is to pass an HMO bill of their own. What's more, new House Speaker J. Dennis Hastert (R-Ill.), a health-policy expert, hopes to demonstrate his effectiveness by, among other things, making the GOP a player on health care.
REVVING UP. That's why the industry is running scared. Last year, it easily quashed the drive for managed-care reform. This year, lobbyists are revving up the heavy equipment. Employer groups and the managed-care business will unleash a combined $7 million media campaign that includes anti-HMO reform ads in key states. And on Feb. 10, a platoon of execs will head to the Hill to buttonhole lawmakers.
On the surface, the legislation looks relatively benign. Democrats want to guarantee patients' access to emergency care and remove the "gag rule" that bans physicians from discussing more costly treatment alternatives. But Clinton & Co. would give HMO enrollees the right to sue over denial of treatment or inadequate care.
Republican lawmakers adamantly oppose this liability provision, insisting that it would be a boondoggle for trial lawyers and result in frivolous lawsuits. What's more, industry lobbyists fear that once a modest measure is passed, Democrats will be tempted to come back every few years and up the pressure on HMOs. "We will continue to fight against mandates because they increase premiums and reduce coverage," says Johanna Schneider of the Business Roundtable.
Business opponents prefer no bill at all. But they have probably lost that fight already. Speaker Hastert may try to pass some consensus reforms from last year's legislation while holding the line on liability. "It would get the trains moving" and boost odds for a bipartisan deal, says a GOP Hill aide.
But Democrats plan to hang tough on liability. With five more seats in the new 106th Congress, they figure they have less reason to yield. "Democrats should keep the bar high," says party pollster Mark Mellman. "There's no reason to give in to Republicans." That's mostly bravado. If Republicans get behind compromise legislation--sans liability--that gives the White House a chance to claim a rhetorical victory on patients' rights, and Clinton, the Great Compromiser, will be tempted to go along.
With that in mind, insurers are beginning to make preemptive moves. Aetna U.S. Healthcare Inc., the nation's largest managed-care provider, recently agreed to let patients appeal treatment denials to independent review boards. United Healthcare Corp. says it will follow Aetna's lead shortly.
Ultimately, the battle will come down to this: How anxious are impeachment-battered Republicans to curry favor with voters by showing some new-found flexibility on health reform? It's a major unknown, but employers and the insurance lobby aren't waiting to find out. That's why they're waging an uphill fight to snuff out the reform drive before it really gets rolling.