July 1999
Volume 63 |
Number 7
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WASHINGTON REPORT
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| Congressman Stark
Introduces Study Bill; Patient Protection Bills Languish at
Recess |
Michael Scott, Director
Governmental and Legal Affairs
On May 27, Congressman Fortney "Pete" Stark (D-CA), ranking minority
member of the House Ways and Means health subcommittee, introduced
the Anesthesia Outcomes Study Act of 1999 (H.R. 2002). Co-sponsoring
the bill were four Democrats on the Ways and Means Committee -
Congressmen Robert T. Matsui (D-CA), John Lewis (D-GA), Xavier
Becerra (D-CA) and Congresswoman Karen Thurman (D-FL) - with Congressman
John D. Dingell (D-MI), ranking minority member of the House Commerce
Committee.
The Stark bill is identical in its terms to the Safe Seniors
Assurance Study Act of 1999 (S. 818) recently introduced in the
Senate by Senators Mike DeWine (R-OH) and Harry Reid (D-NV). It
differs only slightly from the bipartisan Weldon-Green bill (H.R.
632) introduced last February, which at this writing, is co-sponsored
by 68 House members. All three bills call for the Secretary of
Health and Human Services to conduct a study of mortality and
adverse outcome rates of Medicare patients, analyzing the impact
of physician supervision.
In his floor statement, Mr. Stark said: "I have absolutely no
idea who is right or wrong on the issue or whether there is a
quality difference with or without physician supervision. ...
My colleagues and I advocate that this issue be resolved on a
scientific, rather than a political basis."
Because of his long-time leadership in Democratic circles on
health-related issues, Mr. Stark's decision to introduce a study
bill with his Ways and Means colleagues will likely prove significant
in both the House and Senate. Further, the close similarity of
the bill to the Weldon-Green terms adds even greater credibility
to that effort, which essentially now awaits a GOP House leadership
decision to begin to move a bill (likely a budget reconciliation
bill) containing proposals for change in the Medicare program.
Patient Protection Effort Moves Ahead, If Slowly
News just prior to the Memorial Day recess that talks had broken
down between William V. Roth, Jr., (R-DE) and Daniel Patrick Moynihan
(D-NY), respectively chairman and ranking minority member of the
Senate Finance Committee, placed a real damper on prospects for
bipartisan agreement in the Senate on the outline of patient protection
legislation. Some weeks ago, the Senate Committee on Health, Education,
Labor and Pensions had reported out, on essentially a party line
vote, the relatively ineffective bill favored by the GOP leadership,
and the Roth-Moynihan talks had been regarded as the best hope
for developing a bill that could draw support from both sides
of the aisle. Prospects for consideration of any bill on the Senate
floor were unclear as the recess began.
On the House side, Congressmen Tom Coburn (R-OK), Charles Norwood
(R-GA) and John Shadegg (R-AZ) delivered their "consensus" draft
bill in late May to Commerce Committee Chairman Thomas J. Bliley,
Jr., (R-VA) with the request that it be the basis for a markup
in that committee. The bill is fully consistent with the agenda
of the Patient Access Coalition, of which ASA is a member. It
is also attractive to ASA in that it does not contain the so-called
"antidiscrimination" clause - supported by various nonphysician
provider groups, including the American Association of Nurse Anesthetists.
Its virulent opposition to the consensus bill has already been
made clear by the managed care industry, and some business groups,
fearing higher premiums, have also weighed in against the bill.
The authors have attempted to enhance its chances by coupling
it with an "access to care" bill containing principles favored
in business circles, but it is by no means clear that they will
be able to move the bills in tandem.
At the same time, the House Committee on Education and the Workforce,
through its subcommittee on Employer-Employee Relations, began
markup of the Health Care Quality and Access Act (H.R. 2095).
This bill differs from the draft bill before Commerce in that
it includes an external appeals mechanism for dealing with coverage
decisions, rather than granting the enrollee a right to sue.
Campbell Proposal Gains Broad Bipartisan Support
As Congress recessed, more than 100 members of the House had
signed on to cosponsor "The Quality Health-Care Coalition Act
of 1999" (H.R. 1304), introduced last March by Congressman Tom
Campbell (R-CA). The bill would confer the same treatment under
the antitrust laws to health care professionals engaged in negotiations
with a health plan as given to collective bargaining units recognized
under the National Labor Relations Act. ASA was one of several
medical associations offering formal support for the bill on introduction.
As noted elsewhere in this issue of the NEWSLETTER,
physicians who are not actually employed have been notably unsuccessful
in gaining the right to bargain collectively with managed care
organizations. Although guidelines issued by the Department of
Justice and Federal Trade Commission three years ago offered a
carefully subscribed method for negotiation involving a third-party
"messenger," this method has proven cumbersome and difficult to
follow.
As expected, the managed care industry and the antitrust enforcement
agencies have stated their opposition to the Campbell bill. Also
stating its opposition in late May on several grounds was the
Antitrust Law Section of the American Bar Association.
A hearing on the bill by the House Judiciary Committee is expected
in June. No counterpart bill, as of yet, has been introduced in
the Senate.
ASA members are urged to express their support for the bill
by contacting their Representatives in the House. Any member wishing
to do so should call (888) 812-8824 toll-free.
Senate HELP Committee Plans Markup of Patient Records Bill
Under the terms of the 1995 Health Insurance Portability and
Accountability Act of 1995, Congress has given itself until August
21 to adopt standards governing the disclosure and use of personally
identifiable health information. Failing congressional action,
the responsibility for developing such standards will fall to
the Secretary of Health and Human Services.
For more than a year, significant efforts have been under way,
principally in the Senate, to develop a confidentiality bill.
Comprehensive bills have been introduced in this congressional
session by three Senators, Robert Bennett (R-UT), Jim M. Jeffords
(R-VT) and Patrick J. Leahy (D-VT) - but these bills differed
significantly in approach and content. In late May, Senator Jeffords,
as Chairman of the Senate Committee on Health, Education, Labor
and Pensions (HELP), announced his intention to mark up a "hybrid"
bill in early June.
On May 24, the American Medical Association sent Senator Jeffords
a lengthy letter, expressing concerns about various provisions
of the hybrid draft bill, essentially supporting "the right of
patients to privacy of their own medical information and their
right to control access to their information, with narrowly drawn
exceptions made in the public interest." AMA's principal concern
related to a provision of the bill that would contemplate broad
patient consent upon enrollment in a health plan.
Because of divisions in the Senate and because little action
on this matter has occurred in the House, there is legitimate
concern that Congress will find itself unable to meet its self-imposed
August deadline. Congress could always extend the deadline, but
at least some observers have questioned whether such an extension
would produce consensus.
Senator Nickles to Introduce Pain Relief Promotion Act
In mid-June, Senator Don Nickles (R-OK) announced plans to introduce
the Pain Relief Promotion Act of 1999, which would amend the federal
Controlled Substance Act to expressly legitimize the prescription
of controlled substances to alleviate pain, "even if the use of
such a substance may increase the risk of death." At the same
time, the bill would make clear that use of controlled substances
"for the purpose of causing death or assisting another person
in causing death" is not authorized by the Act - a provision aimed
at Oregon's assisted suicide law. The bill also authorizes $5
million in funds for education and training programs in palliative
care.
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