Congress set for a battle over managed-care restrictions

This stage is set for a major showdown over restrictions on managed care when Congress returns this month from its month-long recess.

On July 15 the Senate passed legislation with limited reforms. But it seems possible the House will support far more extensive reforms, including the right of patients' to sue health plans in state courts, coverage of a far larger population and several other provisions APA has pushed for. Most of the Republican majority in the House supports limited reforms similar to those in the Senate bill. But much of the control over the issue has come down to several House Republicans, led by Charlie Norwood (R-Ga.), who happen to be health professionals. Having chafed under managed-care denials, they are working with Democrats to pass a broader bill. Because Republicans control the House by only five votes, that coalition may have enough votes to pass a more comprehensive bill.

Just as Congress was leaving for recess, the bipartisan group introduced a compromise bill to be considered in the September.

And in quick response to the apparently growing support for that proposal, Republican House Speaker J. Dennis Hastert (R-Ill.) signaled general support for an alternative that includes a more limited right for patients to sue, put together by Reps. Tom Coburn (R-Okla.) and John Shadegg (R-Ariz.).

However, the bipartisan group indicated it would continue with its strategy of getting a vote on the bill it introduced.

Among the many questions remaining, however, were whether the month recess would change things politically. For example, House Republican leaders have urged employers and insurers to increase their efforts to oppose the bipartisan legislation.

There is also the question of whether Hastert will allow the bipartisan bill to come to the floor for a vote. A bill could be forced to the floor without the speaker's approval by a "discharge petition" signed by a majority in the House, but that act would be considered an even more serious rebellion by the dissident Republicans.

And even if the bill passed the House, it would then go to a conference committee to settle differences with the Senate bill.

Among the provisions that are in the bipartisan House proposal and that APA supports are: