By Scott Sleek
Monitor staff

Psychologists, along with consumer groups and other health-care providers, are preparing for a political showdown with the health-insurance lobby over the next several months.

As Congress reconvenes for the new year, health-care providers and patient advocates are buoyed by President Clinton?s call for sweeping new regulations on managed-care companies. The president, following the recommendations of an advisory panel he appointed in early 1997, wants Congress to pass laws that would give consumers:

? Better access to information about their health plans.

? The right to an independent appeal of an insurer?s decision to deny reimbursement or treatment.

? Assurances that medical records are kept private.

Clinton?s proposed patient ?bill of rights? comes in response to a long list of consumer complaints about the overly restrictive or parsimonious coverage they receive under HMOs and other forms of managed care. The standards he calls for mirror a similar ?patient bill of rights? released last February by APA and eight other groups representing mental health professionals.

But supporters of stronger managed-care regulations face a stepped-up attempt by employers, health insurers and Republican congressional leaders to defeat such proposals. In fact, the Republican leadership is reportedly trying to make a partisan battle out of an issue that has transcended party lines. Republicans and Democrats alike have backed legislation to impose quality standards on the industry.

But news reports indicate that GOP bosses, including Senate Majority Leader Trent Lott (R-Miss.), are pressuring other Republican lawmakers to back off their support for reform legislation. And GOP leaders have been meeting with business groups to discuss strategies to defeat managed-care-reform legislation.

APA and other provider and consumer advocates have formed ?Health Umbrella Group? to fight for the type of reforms that Clinton is pushing.

The groups belonging to the umbrella organization include the American Small Business Alliance, the Campaign for Health Security, the Mental Health Liaison Group, the Patient Access to Specialty Care Coalition and the Patient Access to Responsible Care Alliance. APA is an original member organization of each of the latter three groups.

Fighting partisanship

A big piece of the umbrella group?s strategy is to foster grassroots support for lawmakers who support managed-care regulations, but may now be under pressure from their party leaders to back off that stance.

?We want to make it clear that this shouldn?t be a partisan issue,? says Marilyn Richmond, assistant executive director for government relations in APA?s Practice Directorate. ?It?s a debate between people who care about legislating appropriate standards for the health-care system and those who want to ignore the problems.?

GOP leaders are decrying Clinton?s crusade for new reforms as a veiled attempt to revive the health-care reform plan Congress rejected in 1994. They argue that increased regulations will backfire because it will cost health-care insurers more to comply with the standards?costs they?ll have to pass on to consumers in the form of increased premiums or cuts in services.

Signs of the Republican strategy were rampant last fall. Lobbyists for the health-insurance industry say that Lott cautioned Sen. James Jeffords (R-Vt.), chair of the Senate Labor and Human Resources Committee, from working with Sen. Edward Kennedy (D-Mass.) on legislation that would mandate new managed-care standards. (Jeffords is considered one of the GOP?s more progressive figures and has been open to managed-care regulations, political observers note.)

But Lott and other opponents face a tide of complaints about the type of treatment they?re receiving under managed care. The Kaiser Family Foundation and Harvard University, for example, released a survey in November showing that most Americans believe managed-care plans have degraded the quality of care they receive.

The bills

Many of Clinton?s proposed reforms are already contained in various pieces of legislation pending in Congress, and many of those bills are sponsored by Republicans.

Among the most prominent measures is the Patient Access to Responsible Care Act (PARCA), introduced by Rep. Charles Norwood (R-Ga.). That legislation would set specific standards for managed-care companies and hold them legally liable for injuries that patients suffer as a result of the companies? treatment or reimbursement decisions. The bill has more than 200 co-sponsors, including at least 91 Republicans. Sen. Alfonse D?Amato (R-N.Y.) is sponsor of a companion Senate bill.

In response to concerns from employers, Norwood introduced a single-issue bill on managed-care liability, clarifying that PARCA does not propose allowing employers to be sued, except when they make treatment decisions for health plans.

PARCA would eliminate a provision of the 25-year-old Employee Retirement Income Security Act (ERISA), which exempts self-insured plans from liability lawsuits. The ERISA exemption prevents 125 million Americans, covered under self-insured plans, from seeking recourse when they?re harmed because their health plan denied them necessary treatment or directed inappropriate treatment, says Russ Newman, PhD, JD, APA?s executive director for practice.

Democrats and reform-minded Republicans have criticized the Republican leadership?s attempts to derail legislation such as the Norwood bill. Rep. Greg Ganske (R-Iowa) has said the Republican congressional leaders don?t speak for the majority of the party when it comes to health-care legislation. Ganske is sponsor of a bill that would ban so-called ?gag rules??contractual requirements that allegedly prevent providers from telling their patients about treatment options that their health plans won?t cover.

Strategic praise

The umbrella group is trying to show Republicans that their support for stronger managed-care standards has wide appeal with their constituents, if not their party leaders. As part of the strategy, the group plans to host press conferences across the country, especially in the districts of Republican lawmakers, to build constituent demand for managed-care regulations.

Umbrella-group members also plan to meet with members of Congress in their home states and to launch a letter-writing campaign to various lawmakers.

?This process is an attempt to shore up the support we already have,? says Richmond.

The group is even sending letters of commendation to Republicans who are traditional free-market advocates, but have shown support for at least one piece of legislation aimed at regulating managed care. Those lawmakers include Rep. Mike DeWine, (R-Ohio), who supports a bill aimed at restricting health insurers? ability to deny payment for emergency-room care, and Sen. Judd Gregg (R-N.H.), who supports a bill that would require doctors, not insurance companies, to determine the length of hospital stays for women undergoing mastectomies.

The notion behind those complimentary letters is to encourage lawmakers to vote for further patient protections, members of the umbrella group say.