WASHINGTON -- The lines are being drawn for what promises to be among the most divisive battles in Congress this year, the fight over managed-care reform.
On one side: Democrats, consumer groups and medical providers, convinced that patients must have a "bill of rights" to end abuses by cost-cutting managed-care companies.
On the other: Republicans, health-insurance companies and business groups, worried that heavy-handed government restrictions would send premiums through the roof.
It's a prescription for failure, said U.S. Rep. Charlie Norwood, R-Ga., the former dentist who heads a group made up primarily of rank-and-file Republicans willing to defy GOP leaders to pass a reform bill.
Dr. Norwood's Patient Access to Responsible Care Act -- introduced last April -- has 218 sponsors, including more than 120 Democrats and more than 90 Republicans.
"This isn't a Democratic or Republican issue. It's an American issue," he said.
"To get anything done, it has got to be recognized by everybody as a bipartisan agreement," said John Stone, Dr. Norwood's spokesman. "The last thing we need is to come in and start casting the political arrows."
But that's just what was happening in Washington last week. During what amounted to a pep rally at the White House, Democratic leaders vowed to introduce managed-care reform legislation this year that will bear the party's stamp.
"The fight for quality health care has always been a core Democratic issue," Vice President Al Gore told the group of Democratic supporters.
Meanwhile, opponents of reform were starting to gear up a massive lobbying campaign aimed at Republicans.
The National Association of Manufacturers, among other groups, is organizing a fly-in of small business owners from across the country early next month for face-to-face meetings with lawmakers.
"Conservative groups that are the heart and soul of the Republican constituency are against this," said Karen Kerrigan, chairman of the Coalition for Patient Choice, a combination of eight conservative and business organizations opposed to Dr. Norwood's bill. "Republicans need these groups in an election year."
Under Dr. Norwood's bill, health plans must cover emergency room visits that "prudent laypersons" would believe constituted an emergency.
The bill also would give patients the right to choose a doctor outside their health plan, appeal denials of care to an outside panel and sue managed-care companies for harm caused by negligent medical decisions.
An advisory commission formed by President Clinton released a set of recommendations last fall that embraced some of Dr. Norwood's proposals, but stopped short of the choice and liability provisions in his bill.
The bill's opponents argue that it would introduce the level of government regulation into the managed-care system that doomed Mr. Clinton's health-care reform plan several years ago.
"The Norwood bill writes into legislative language many of the most eggregious parts of the Clinton plan," said Kristen Ardizzone, executive director of the conservative Eagle Forum.
The same coalition that succeeded in defeating the Clinton health plan, thanks in part to the "Harry and Louise" ads that blanketed the nation's airwaves in 1994, are coming together now to stop managed-care reform.
Ms. Kerrigan said her coalition is planning a new series of ads to run this year in the districts of lawmakers who opposed the Clinton plan during their 1994 campaigns.
But Dave Hebert, chairman of the Patient Access to Responsible Care Alliance, said it will be more difficult this time for opponents of managed-care reform to get the public on their side.
"It is not `ClintonCare,"' said Mr. Hebert, whose coalition of 60 groups representing medical providers formed to lobby for the Norwood bill. "It is a streamlined effort to try to deal with the shortcomings of managed care. ... (And) people are sick and tired of being mistreated by managed-care plans."
Republican leaders allowed hearings on Dr. Norwood's bill last fall before two House subcommittees. But the measure -- and a Senate counterpart sponsored by Sen. Alfonse D'Amato, R-N.Y. -- face uncertain prospects this year.
David Kendall, senior health policy analyst for the Progressive Policy Institute, is not optimistic.
He said that in the politically charged atmosphere of an election year, Democrats might be tempted to use failure to pass a bill as a campaign weapon against Republicans, while GOP lawmakers might be too worried about offending business supporters to compromise.
"I just see gridlock," said Mr. Kendall, whose Washington think tank is affiliated with the centrist Democratic Leadership Council. "Democrats want to have an issue to take to the voters, and Republicans apparently want to please their ... constituencies with a `Just say no' approach."
But Mr. Stone sees an advantage in this being an election year. He said overwhelming public support will force lawmakers to get behind managed-care reform, if pro-reform Republicans and Democrats can get together on a bill strong enough to avoid being bottled up in committee.
"The way the public is going to see this is who voted for the patient and who voted for the insurance company," Mr. Stone said. "The second it comes to the floor, the battle's over."