Gingrich to GOP Task Force: Better Managed Care Without Over-Regulation
By Mary Agnes Carey, CQ Staff Writer
(CQ, May 23) -- A House GOP task force charged with developing an election- year answer to consumers' concerns about managed care has been struggling with a problem that is almost as difficult as the issue itself: finding an approach that pleases House Speaker Newt Gingrich, R-Ga.
Gingrich has urged the task force, which has spent months developing its legislative proposal, to come up with a plan that focuses more on giving individuals greater options for their health care rather than expanding government bureaucracy. The Speaker, for example, has been promoting changes to the tax code to let more people deduct the cost of their health insurance.
The task force's deliberations gained intensity the week of May 18, as the group tried to produce a list of recommendations by its self-imposed deadline of the Memorial Day recess. On May 22, the group, led by Dennis Hastert, R-Ill., produced an outline of "concepts" that he will present to Gingrich.
Hastert, who will travel with Gingrich to Israel over the recess, said he will discuss the ideas "point by point so he understands what we're doing and where we're headed."
The proposal, Hastert said, includes many items that the task force has discussed for months, such as expanding patients' access to specialty care, creating a process by which patients could appeal insurers' coverage decisions and forcing insurers to pay for emergency care when a "prudent layperson" deems it necessary.
The document also includes broader concepts such as allowing small businesses to pool resources to get the same discounts on premiums that larger business receive.
After days of tense meetings in which task force members tried to regroup after a strong rebuke from Gingrich, Hastert on May 22 said the task force's deliberations were "pretty much on track."
Earlier in the week, Gingrich had made clear to the task force that he was unhappy with the direction it seemed to be taking. One House aide said that at a May 19 leadership meeting, the Speaker "hit the roof" because the task force's package was overly regulatory and would lead to unnecessary expansion of the government's role in health care.
"I believe in empowering citizens, not empowering bureaucrats," Gingrich told reporters after the two-hour meeting with the task force May 20. The Speaker said he urged the task force to "be positive, be bolder and embrace 21st century thinking." Another meeting is planned for early June.
Gingrich's remarks left many participants scratching their heads. Some task force members viewed his comments as guidelines rather than specific marching orders. Some, such as Charlie Norwood, R-Ga., said the Speaker was thinking like the academic he once was.
"Newt is a college professor; it's impossible for him not to have the big vision," Norwood said.
A Dilemma for Republicans
The managed care issue presents Republicans with a difficult dilemma of balancing their philosophy of reducing government against pressure from constituents to respond immediately to problems with their insurers.
The task force also faces pressure from other, competing legislative proposals, including bills sponsored by Norwood and by House and Senate Democrats. Those measures propose specific fixes to the health care system such as expanded access to specialty care, external appeals and changes in current law to allow patients to sue their health plans under state laws.
Some Democrats have accused Gingrich of intentionally stalling deliberations in order to kill legislation that would produce substantive patients' rights reforms.
"What the Speaker is after here is a cosmetic fix," said Frank Pallone Jr., D-N.J., a member of the House Commerce Health and Environment Subcommitee. "He wants to come up with a bill that purports to provide patients' protections without really providing any."
While task force leaders said they were back on track, the deliberations indicated that the group still has not resolved one of the most fundamental questions on managed care legislation: whether to take a broad approach or settle for a narrow one.
Jim McCrery, R-La., said Gingrich encouraged the panel to consider how health legislation could address structural problems, such as the inability of small businesses to buy insurance for their employees at the same rates available to larger companies, and inequities in the tax code that prevent individuals from having the same full deductibility for health benefits as many businesses do.
Many Republicans feel that the party must articulate how it wants to achieve those broad goals in order take the issue back from Democrats, who have consistently made the issue their own.
"Sooner or later, Republicans will have to describe to the American public what our vision is for health care in this country," McCrery said.
The pressure of the shortened election-year calendar may mean, however, that backers of the GOP proposal cannot think too big. Dramatic changes to the tax code, for example, "may not be in this package," Hastert said. "You don't turn that around on its head in 30 days."
Norwood, whose patient-rights bill (HR1415) has 232 cosponsors, including nearly 90 Republicans, said Gingrich's remarks reflect how difficult it is to develop a legislative proposal that satisfies those who want a focused measure as well as others who want a more comprehensive bill.
Norwood's persistence in pushing his bill has been an irritant to the task force as it tries to develop its own measure.
Norwood said his legislation is "about fixing the system today because of what Congress has done," insisting that action must be taken this year. "There's just no way you can justify not doing this."
Liability Concerns
The task force's final package may sidestep any changes to current law that would make health plans more liable for their decisions, although Norwood is pushing them to take that step.
Gingrich also sees liability as an issue for the task force. And at a fundraiser May 19, Gingrich told the audience, which included representatives from the managed care industry, that health maintenance organizations need to be held responsible for their decisions.
"We cannot be known as the pro-HMO party," one participant quoted Gingrich as saying.
Then on May 21, Gingrich told reporters he wanted to "make sure whoever makes the medical decision is held legally liable."
Bills sponsored by Norwood and by Democrats would change provisions in the Employee Retirement Income Security Act (ERISA) that in many cases limit patients' ability to sue their health plans for damages.
But the business community -- a key political ally for Republicans -- is vehemently opposed to any changes to ERISA and has promised to fight them vigorously.
"Expanded liability is a serious threat to our employer-sponsored health care system and could result in millions more uninsured," said Dan Danner, chairman of the Health Benefits Coalition, a lobbying group of employers and insurers battling legislation they say will drive up premiums and possibly reduce coverage.
McCrery, however, urged caution in interpreting what Gingrich wants to see in a bill.
"I don't think [the business community] should be overly alarmed about the Speaker's comments on liability," he said. "I know he does not want to expand litigation."
Expanding Choices
Gingrich also offered clues that he believes patients ought to have more choices when selecting a health plan. After the May 20 meeting with the task force, the Speaker told reporters that "people ought to have the right if they don't like their HMO to have some other choice." But he did not elaborate on how that should be accomplished.
Gingrich and other Republicans also are struggling with the fact that producing a measure with patient protections would likely expand the federal government's reach. While many GOP members back proposals to give consumers more power with their health plans, just how to structure enforcement of such provisions is a problem. They are reluctant to create new federal bureaucracies or expand existing ones, such as the Labor Department, as part of an oversight structure. But without proper enforcement, such proposals may prove ineffective in real-world applications.
D'Amato's Quest
As members of the GOP task force worked on their legislative proposal, in the Senate Alfonse M. D'Amato, R-N.Y., continued his quest to force a vote on his breast cancer legislation (S249).
Despite D'Amato's pledge to "hold this assembly hostage" in order to get a floor vote on his bill, prolonged debate over several elements of a high-profile tobacco bill (S1415) captured most of the chamber's attention. D'Amato's measure is now part of the larger tobacco bill. (Tobacco, p. 1360)
D'Amato got an unexpected boost when Geraldine A. Ferraro, who is vying for the Democratic nomination to challenge D'Amato in the fall, accused him of "doing the insurance companies' work instead of the people's work" because his legislation does not provide for a minimum 48-hour hospital stay after a mastectomy.
D'Amato used the criticism, however, to bring attention to his efforts to move the bill. He is also the Senate's chief sponsor of a companion bill to Norwood's patient's rights measure (S644), but he has not pushed it as actively as he has the mastectomy bill.
D'Amato's mastectomy bill would allow physicians, rather than insurers, to decide when a breast cancer patient should be sent home from the hospital and require insurers to pay for reconstructive surgery. (CQ Weekly, p. 823)
D'Amato said Ferraro made "tawdry charges" that were "shocking and unacceptable. And she owes not just me, but all the people working in this important area an apology."
Ferraro's remarks aside, prospects for passage of D'Amato's measure are good, according to Assistant Majority Leader Don Nickles, R-Okla. Although Nickles has opposed so-called body part legislation that addresses specific coverage issues, Nickles said D'Amato's was likely to survive.
"I think it will stay in [the tobacco bill]," Nickles said. "We can only fight so many fights."
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