Hm Os Are Beginning To Look Vulnerable

Even some in the GOP back patients' right to sue

The August recess began like any other for Representative Mark Foley (R-Fla.). He looked forward to a little R&R. But there was no escaping Washington. Shortly after Foley arrived home, powerful Beltway lobbies began pelting the third-termer's district with radio and TV ads denouncing a patients' rights bill that Foley supports. The ads blasted the measure as a "lawyers' right-to-sue bill." Foley shrugs off the campaign. "I'm not going to be dissuaded by any ads," he says.

But the pressure will only intensify when Congress returns on Sept. 8. Foley and 20 other Republicans who support a bipartisan patient-rights proposal, will be the target of an intensifying battle over managed-care reform legislation that the House is expected to vote on later this month. The key provision that insurers are determined to keep out of the law: letting patients sue HMOs and managed-care plans for damages. Before the recess, Foley & Co. split from the GOP leadership on this issue and put their support behind a measure that grants patients the right to sue insurers over treatment. Little wonder that big employers and insurers unleashed a $1 million ad blitzkrieg to force the defectors back into the fold. Their major argument against the measure, sponsored by Representatives John D. Dingell (D-Mich.) and Charlie Norwood (R-Ga.), is that it would raise costs and encourage employers to drop coverage.

Norwood, a dentist who has worked closely with the American Medical Assn., has been a leading voice among House Republicans for a strong patient's bill of rights. Supporters of the "Dingwood" measure have been lobbying, too. In late August, a coalition of doctor and patient groups took out ads in 37 newspapers denouncing HMOs for putting "dollars first and patients last."

SAD STORIES. And when Congress returns to work, 2,000 Families USA activists will lobby lawmakers. For now, the Association of Trial Lawyers of America is keeping a low profile, hoping it can win if the debate doesn't turn into an attack on the plaintiffs' bar. The reform issue clearly resonates with voters. That's what brought 250 people to St. Mary's Catholic Church in Jensen Beach, Fla., on Aug. 30 to talk health care with Foley. For 90 minutes, the lawmaker nodded sympathetically as participants, many elderly, recounted tales of $80 prescriptions for eyedrops and other nightmares. Says Foley: "It gave me more courage to continue my quest for health-care reform."

GOP leaders are scrambling to lure back the renegades. But privately, business lobbyists admit that they may be too late to head off the right-to-sue measure. "Maybe we can limit it," sighs one. Their next step is to rally support for a new proposal, sponsored by Representatives Tom A. Coburn (R-Okla.) and John Shadegg (R-Ariz.), that would allow lawsuits against insurers--but only in federal court and only after an independent panel had certified that an injury was caused by lack of care.

Limited liability, iNsists Coburn, "is the only way to drive a hammer on the bad actors." That's a far cry from the narrow patients' rights bill the Senate passed in July, which does not allow lawsuits, period. House Speaker J. Dennis Hastert (R-Ill.), a self-styled health-care expert who helped push through an HMO bill in the prior session that did not include any right to sue, is now widely expected to endorse the Coburn-Shadegg bill. But head-counters say Hastert lacks the votes to stop the "Dingwood" measure, which has solid Democratic support and 21 GOP co-sponsors. Insurers and other HMO reform foes now vow to fight to kill off any legislation that includes the right to sue. In the end, Coburn-Shadegg may attract pro-reform Republicans such as Foley, who says he's keeping an open mind. That still leaves insurers on the hook. But consumers, who have sat through two years of debate already, will soon be closer to winning the right to take their grievances to court.

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