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Outlook Bright for HMO Legislation

February 5, 1999

WASHINGTON (AP) _ The debate in Congress over HMOs has shifted from whether to pass ``patient protection″ legislation to what it should include.

The issues have not changed much since last year, but the politics have. A half dozen bills have been introduced, and House and Senate committees already are looking for compromises.

``We want to tackle the managed-care issue in a bipartisan manner,″ Senate Finance Committee Chairman William Roth, R-Del., and the panel’s top Democrat, Sen. Daniel Patrick Moynihan, D-N.Y., said in a joint statement Thursday.

They said their staffs were meeting with interest groups in a ``serious effort″ to find common ground. While Congress has failed to produce legislation thus far, they said, ``it is our hope that with a fresh start and open minds,″ they can reach consensus in 1999.

Even fierce opponents say this year is likely to produce action.

``There is a train going down the track,″ said Chip Khan, who heads the Health Insurance Association of America.

Any law is likely to give patients the right to complain to an outside mediator if an insurance company turns down care and to provide guarantees that a health-insurance plan will pay for reasonable visits to an emergency room and other basic care.

But crucial questions still are debated hotly, including whether patients should be allowed to sue HMOs when care is denied and whether plans must pay for what doctors consider medically necessary care.

Last year, the House narrowly passed a GOP bill along party lines. In the Senate, no legislation was considered because Republicans and Democrats couldn’t even agree on the rules for debate. But this year looks different:

_Both House and Senate leaders have said legislation will be produced through the committee process, which forces the parties to work together. Last year, Democrats backed President Clinton’s plan, and Republicans met in secret to craft their approach.

_In the House, Democrats picked up five seats in the November elections. Last year, the Democratic HMO bill failed by five votes.

_In the Senate, GOP leaders have introduced their own modest legislation. A year ago, they were saying they might not back anything.

_The new House speaker, Rep. Dennis Hastert, R-Ill., has signaled interest in seeing HMO legislation become law. He was chairman of last year’s GOP task force, knows the issues and has promised a vote before year’s end.

Politically, many Republicans would like this issue off the table before the 2000 elections. Last year’s exit polls found HMOs were not a top issue for most voters, although candidates of both parties campaigned on it across the country.

The essential arguments for and against legislation have not changed. Supporters say patients need protection from health maintenance organizations and other managed care plans that deny needed care in order to hold down costs. Opponents say new regulations will increase the cost of insurance, cause employers to drop coverage and leave more people uninsured.

But even opponents, including the HMO trade group, are open to modest regulations, including the right to take disputes over coverage to an independent panel.

It is unclear how hard opponents will lobby against legislation this year. Opponents spent $60 million to lobby on HMO regulation and other subjects in the first half of 1998.

The American Association of Health Plans is looking ahead to 2000, trying to keep HMOs out of the presidential race by releasing polls of GOP voters in New Hampshire and Iowa that show minimal interest in the subject.

Meanwhile, some insurance companies are acting on their own to address complaints. Just Thursday, Sierra Health Services of Nevada became the latest company voluntarily to offer its members external reviews.

``We realize that anti-managed care comments and anecdotes create a concern that HMOs may not provide lifesaving treatment for severely ill patients,″ the company’s chief executive officer, Dr. Anthony M. Marlon, said in a statement. ``Outside independent review should give our members peace of mind.″

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