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Beneath the sound and fury of partisan campaign rhetoric about a “Patients Bill of Rights” lies another significant health care legislative battle. Not only does this second fight have the potential to alter the relationships between health maintenance organizations, doctors, and patients, but also the House is expected to vote on it this week — and may hand the health maintenance organizations and insurance industry a painful loss. The Quality Health-Care Coalition Act, sponsored by Rep. Tom Campbell, R-Calif., would amend antitrust laws to give doctors new rights to collectively bargain with HMOs. While essentially allowing doctors to unionize, the bill prohibits strikes or any other labor disturbance. “This legislation is the best way to let the market deal with the complaints so many health care professionals have raised with HMOs,” Campbell said when he introduced the legislation in March 1999. “First on the list of contractual terms that health care professionals will demand is a greater right to prescribe and care for patients in the proper medical terms.” Up until the last minute, the lobbying continues to be fierce. Doctors see the legislation as a way to return their authority to make decisions with their patients, while insurance companies and HMOs fear it would raise doctors’ fees and escalate costs. The effort in support of the bill is led by the American Medical Association and the American Dental Association, with an assist from other medical associations and unions. The opposition is organized through The Antitrust Coalition for Consumer Choice in Health Care, made up of major insurers, including Blue Cross and Blue Shield, and the U.S. Chamber of Commerce. Hogan & Hartson’s Robert Liebenluft and Melinda Hatton have been the coalition’s lead organizers. Many other top-tier lobby shops are also working on the issue for their regular business clients, including Washington Counsel, O’Brien Calio, the Duberstein Group, and Fierce and Isakowitz. “This bill creates freedom for cartels that are totally unregulated and free to fix prices,” says Jim Edwards of the Health Care Leadership Council, which represents 50 pharmaceutical companies, health care providers, and insurers. “We see it as a money transfer from consumers’ pockets to doctors’ bank accounts.” The Federal Trade Commission and Department of Justice also oppose the bill, claiming it gives doctors unfair leverage. Campbell’s bill has unusually strong bipartisan support, including 220 co-sponsors. House leadership was expected to move the legislation to the floor in May, but unexpectedly postponed it. Opponents have been lobbying members of the House Rules Committee, hoping an unfavorable sequence of amendments will give co-sponsors some cover to vote no. The delay prompted the AMA to step up its efforts. “Giant health insurers … present physicians with ultimatums — take it or leave it contracts that contain terms that threaten quality patient care,” AMA Executive Vice President Ratcliffe Anderson wrote to members of Congress this month. “H.R. 1304 is the solution. It would provide limited relief from antitrust laws that currently prevent health care professionals from joining forces to negotiate better contracts with health plans.” Currently, there is no companion bill in the Senate.

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