Saturday, April 25, 1998

Congress playing it safe on HMOs

By Morton Kondracke

Thankfully, Congress is unlikely to respond to public anger at HMOs with heavily regulatory legislation this year. Unfortunately, it's not likely to give patients more health-care choices and information either.

If members have been bombarded at home with managed-care horror stories, it's possible Republican leaders will decide to pass modest legislation to prevent Democrats from exploiting the health-care issue in November.

Almost certainly, though, nothing like Rep. Charles Norwood's, R-Ga., Patient Access to Responsible Care Act (PARCA) or the Democratic leadership's Patients' Bill of Rights Act is likely to pass.

PARCA is designed to put physicians back in control of medicine -- instead of insurance companies, employers and managed care plans -- by requiring HMOs to pay the fees of any doctor a patient chooses to see.

The Norwood bill has 229 House co-sponsors, but it is anathema to Republican leaders, who regard it as certain to trigger higher health costs and insurance rates and increase the number of people without health insurance.

It is also bitterly opposed by the Health Benefits Coalition, which includes the managed care and insurance industries, the U.S. Chamber of Commerce, the National Federation of Independent Business and other employer groups, all influential with the GOP.

The same groups -- and GOP leaders -- oppose the Democratic bill, which is designed to place consumers in charge of medical care but does so largely through government regulation and recourse to lawsuits.

The bill would authorize three federal agencies to issue regulations on HMO conduct, require HMOs to let patients see specialists without going through a primary care gatekeeper and repeal the federal law that prevents suing HMOs.

Fueled by news accounts exposing deaths and lasting health damage caused by HMOs' denying access to care, even industry lobbyists admit HMOs are barely more popular than tobacco companies.

In January, a poll conducted by the Kaiser Family Foundation and Harvard University reported 48 percent of U.S. adults had personally experienced a problem with an HMO or knew someone who had -- ranging from inability to get adequate information about health plans to denial of access to a specialist or payment for emergency care.

The poll showed overwhelming support for enacting various elements of President Clinton's Patients' Bill of Rights into law, but support dropped precipitously if the steps involved higher insurance premiums, government regulation or employees' being dropped from insurance coverage.

Significantly, support remained highest for health plans' providing more information about their coverage -- suggesting reforms that some pioneering health-care thinkers say Congress and the Clinton administration ought to start planning.

Last year, David Kendall and Robert Levine proposed in a paper published by the Progressive Policy Institute that work start on an Internet-style health information network that would include an individual's coded health records, up-to-date data on the best medical practices for various conditions and performance records of doctors, hospitals and HMOs.

Patients or someone they choose could access the network and electronically match the patient's medical problem to the scientific and performance data. Patients would deposit a report on their treatment and its results into the database -- without identifying themselves and losing privacy -- to add to the information available to others.

Kendall and Levine are in the process of expanding on the idea to reform the entire U.S. health delivery system. They recommend each person have a Health Management Account, paid into by employers and/or the government, and have maximum choice -- as federal employees currently do -- to choose the best health plan for their medical needs and budget.

The one bill this year that contains a start toward a performance- and information-based HMO reform is the Health Care Quality, Education, Security and Trust Act (QUEST) sponsored by Sens. Joe Lieberman, D-Conn., and Jim Jeffords, R-Vt. Unfortunately, it has little backing.

Republican leaders, if they are worried enough about anti-HMO sentiment, are prepared to pass token legislation barring health plans from denying information to patients, protecting patient privacy and imposing minimum hospital stays after mastectomies.

If they thought more creatively, though, they'd launch at least a study of a national health information network. It would be based on the concepts of personal choice and responsibility -- just what Republicans say they believe in.

Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.

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