For U.S. Rep. Charlie Norwood to pass what he sees as a true patient protection bill, he might first have to defeat a rival bill backed by the House leadership and President Bush.
In a preview of a heavyweight legislative battle next week, Mr. Norwood, R-Ga., said the bill dubbed the Fletcher Alternative would promote "federalization of health care" and pre-empt patients from suing managed care plans in state court.
But the bill's principal sponsor, Rep. Ernie Fletcher, a Republican family practice doctor from Kentucky, said it holds HMOs accountable without subjecting them to unlimited lawsuits that would drive up costs to unaffordable heights for employers.
Mr. Norwood, a retired dentist, is hoping that by first defeating that bill, more Republicans will flock to his bill, which is similar to what the U.S. Senate passed earlier. But though he is a nationally recognized leader on the issue, he faces a strong lobbying effort on the other side from Mr. Bush and his own party's leadership.
"They're twisting arms up here about as much as I've ever seen it," Mr. Norwood said.
For his part, Dr. Fletcher decried the "demagoguery" from the opposing side and said next week would likely see things come to a head.
"This is for real now," Dr. Fletcher said. "This is not political posturing."
Despite the rhetoric from both sides, there is substantial agreement on many issues, such as ensuring reimbursement for reasonable emergency room visits and requiring access to gynecologists and other specialties without a referral. Dr. Fletcher estimated the bills are 90 to 95 percent in agreement.
"But that 5 to 10 percent is where the rubber meets the road," Dr. Fletcher said. While both have provisions that would allow patients injured by denied treatment to sue in state court, Mr. Norwood argues the Fletcher bill allows it only if a review panel agrees and the company still refuses the treatment, a series of hoops that renders the redress worthless.
"What that does is it gives a nonjudicial body - they're doctors, they're not judges - it gives them the ability to make a decision that will limit a patient's due process rights to court, and we think that's unconstitutional," Mr. Norwood said.
But Dr. Fletcher said the right to sue in state court is still intact and there must be some way for managed care companies to still make sound coverage decisions and not allow poor care out of fear of lawsuits.
"Charlie's bill is going to increase litigation and worse than that, it will promote a lot of defensive medicine," Dr. Fletcher said. "You take away the ability of managed care to reduce the cost of health care and provide quality care."
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.