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Managed Care Improvement Act passes in the House
The Patient Access Coalition (PAC) hung tough with respect to the inclusion of six specific provisions that had to be included in any managed care reform legislation in order to get its support. In October, PAC, which comprises 130 patient advocacy and health care provider groups, had a victory with the passage of the Bipartisan Consensus Managed Care Improvement Act (H.R. 2723) in the House of Representatives with a vote of 275 to 151.
Reps. Charles Norwood, R-Ga., and John Dingell, D-Mich., sponsored the bill, which was supported by the American Society of Cataract and Refractive Surgery (ASCRS) and the American Academy of Ophthalmology (AAO). As leaders of the PAC, ASCRS and AAO played a key role in the bill’s formulation and the House’s passage of it. The AAO, one of the founders of this coalition, and Nancy McCann, director of government relations for ASCRS and co-chair of the coalition, have worked with the bill’s authors Norwood and Dingell, to ensure that the following key principles were included: a point-of-service option at the time of enrollment, a strong appeals mechanism, a ban on financial incentives and “gag clauses,” a full explanation of plan performance prior to enrollment and in-network access to specialists.
Catherine Cohen, vice president of federal affairs at AAO said, in an AAO press release, “Although we feel like passage of this bill is a real victory, we realize that the battle is not yet over. If the bill goes to conference with the Senate, it will likely be next year when members of the Senate and the House actually meet to try to work out a compromise between the House bill and the much narrower version the Senate passed in July.”
If and when
At press time, “if” and “when” were the pivotal questions. John Stone, a Norwood staff member, told Ocular Surgery News, “Speculation right now is what it has been for the last few months. Leadership obviously doesn’t like the bill; they did everything they could to keep it from passing in the House. When it became obvious that it was going to pass in the House and that there was nothing they were going to be able to do to block it, then Congressman Norwood filed a discharge petition that overturned the leadership’s ability to block it. So they decided to jump to their second line of defense, which is to let it pass in the House with the intent of letting it die in conference.”
Why does leadership hate this bill so much? “If this were a fight between providers/patients and the HMO [health maintenance organization] lobby, we would have won 5 years ago when it was first brought up,” Mr. Stone said. “What the HMO lobby is great at doing is going to the entire business community of the nation — the Chamber of Commerce, the National Association of Manufacturers — every major corporation in the country and telling them, ‘If [managed care reform] passes, your premiums are going to go sky high and it’s going to cost you an extra $12 billion in your employee benefit package.’” So, in the simplest form, opposition to managed care reform comes not only from the HMO lobby, but from most every employer in the country, too.
We are not giving up
“The HMO lobby very skillfully plays the business community at large, and they do it that way because that’s the way they have been successfully fighting health insurance reform nationwide at the state level for 20 years,” Mr. Stone said.
Sounds hopeless, but Mr. Stone said that Norwood’s not giving up. “We’re going to continue to fight. If we have to bypass the conference committee altogether, we can do that. What we have to do is arrange a separate vote on the bill in the Senate, and if the House and the Senate pass the exact same legislation, it doesn’t go to conference; it goes directly to the President to be signed. So we may ultimately need to do that, and we’re willing to do that.”
For Your Information:
- Catherine Cohen can be reached at the American Academy of Ophthalmology, Federal Affairs Division, 1101 Vermont Ave. NW, Ste. 700, Washington, DC 20005; (202) 737-6662; fax: (202) 737-7061; e-mail: ccohen@aaodc.org. Ms. Cohen is vice president of federal affairs for the American Academy of Ophthalmology.
- Nancy McCann can be reached at the American Society of Cataract and Refractive Surgery, 4000 Legato Rd., Ste. 850, Fairfax, VA 22033; (703) 591-2220; fax: (703) 591-0614.
- John Stone can be reached at the office of Congressman Charles Norwood; (202) 225-4101; fax: (208) 475-6460; e-mail: John.Stone@mail.house.gov.