Insurance Proposals Bring Out Lobbyists
By Donald P. Baker
RICHMOND—When a bill was proposed in the Virginia General Assembly this year to allow managed-care subscribers to sue their health insurers for malpractice, the state's largest health insurer wasted little time going on the attack.
Trigon Healthcare Inc. hired 33 lobbyists, including some of the best known names in the Richmond influence community and a few lesser-known people with ties to legislators, to prowl the halls and buttonhole lawmakers.
The massive assault appears to be succeeding. Although most of a 14-point "patients bill of rights" is intact, the plan to allow patients to sue Trigon and other managed-care providers is dead.
"There was a great deal of lobbying, as much as I've seen" in 35 years as a legislator, said Sen. Stanley C. Walker (D-Norfolk), who sponsored the primary bill, a response to complaints that health insurers are denying services to policyholders to hold down costs.
Other bills in the package include provisions that create a binding appeals process, ease access to specialists, require that insurers can be reached 24 hours a day for preauthorization of services and increase mental illness benefits.
They also broaden coverage for drugs in some cases, allow patients to see any doctor willing to limit charges to those covered by the plan and ban incentives to doctors or hospitals to deny medically necessary services to high-risk patients.
The General Assembly plans to consider the remaining bills Monday.
Although Trigon, the Blue Cross Blue Shield giant based in Richmond, fielded the most lobbyists, it wasn't alone.
As of Wednesday, 170 persons had registered with the secretary of the commonwealth on behalf of insurance companies, hospitals, drug manufacturers, doctors, pharmacists and other health care interests.
At a crowded hearing before the Senate Education and Health Committee, Walker Meslang, chief legislative aide to Walker, said he "counted 50 individuals lobbying against managed-care reforms."
Against that array, patients' advocates at times seemed overwhelmed, even though they have the support of the 6,800-member Medical Society of Virginia.
The industry's lobbyists "certainly did a very efficient job," said Nancy Davenport-Ennis, of the Newport News-based National Patient Advocate Foundation.
Asked about the extraordinary effort, Brooke Taylor, Trigon's public relations director, said: "That's what lobbying is. It is politics, providing information to political people."
She said Trigon lobbyists are "trying to influence everyone in the General Assembly to take a more reasonable approach to managed-care reform. We provided a lot of information to as many people as we could."
Taylor said the "vast majority" of Trigon lobbyists are not working the General Assembly. They were put on the payroll, she said, to help with seminars around the state last fall, to which lawmakers and business leaders were invited.
"We register anyone who in any way might be considered a lobbyist," Taylor said.
Trigon's lead attorney, James C. Roberts, widely viewed as the capital's leading insurance expert, plays down the numbers, too.
"Let's see," he said, counting on his fingers, "I think there's about seven of us," including two or three employees of Trigon.
Trigon's stable also includes some names more associated with politics than policy.
It includes Republican Gov. James S. Gilmore III's chief fund-raiser, a former business partner of his chief of staff, the chairman of his Blue Ribbon Commission on Higher Education, the wife of the executive director of the state Republican Party and a Republican former acting state attorney general and U.S. attorney.
Others include a top adviser to former Republican governor George Allen; the son of a former Democratic delegate, a relative of a leading Democratic delegate, a former executive director of the state Democratic Party and two Democratic Party campaign consultants.
No figures are yet available for how much money Trigon's lobbyists are spending this year. In 1997-98, the most recent period for which records are available, 13 Trigon lobbyists spent $98,682, according to records from the secretary of the commonwealth. That placed Trigon sixth overall in spending. Another health care provider, Norfolk-based Sentara Health System, was fifth, at $100,529.
Trigon is the state's largest health insurer, with 1.8 million customers. It sells policies everywhere in the state except in that portion of Northern Virginia inside Route 123, which is the province of the Washington area Blue Cross company, now called Care First.
Care First has a couple lobbyists here, as does Inova Health Systems, the corporate parent of Inova Fairfax Hospital.
Taylor said Trigon provides its customers "with what they want, and they tell us they don't want to pay more" for health insurance.
The health insurance industry says premiums could rise as much as 20 percent if all provisions in the proposed legislation were enacted.
Patient advocate Davenport-Ennis doesn't believe that. She said that the Congressional Budget Office reported last year that if the entire patients bill-of-rights plan proposed by President Clinton had been enacted, a typical family's health insurance would have gone up $7 a month.
Trigon's Taylor said that "if you listen to the rhetoric, you'd believe we were making money hand over fist." But she said more than 99 percent of premium money goes for claims or in claims processing.
Trigon last week reported that its net income in 1998 was $123.6 million, on revenues of $2.24 billion, up from $95.1 million in profits in 1997 on revenues of $2.06 billion. Since it became a for-profit stock corporation in January 1997, Trigon's stock has nearly tripled, from $13 a share to $35-plus at Friday's market close.
Democrats surprised both the industry and Republicans when they unveiled their health care package three days before the session began. Since then, Republicans have killed nearly all of the Democrat-sponsored measures and replaced them with their own.
Sen. Emily Couric (D-Charlottesville) said a relieved insurance industry, which "was against almost everything" at the start of the session, "fell back quickly" after defeating the liability proposals, which died on virtually straight party-line votes.
Sen. Jane H. Woods (R-Fairfax) said "we're not at the point yet" where patients need the right to sue their insurers for malpractice.
The idea of allowing subscribers to sue the plans is modeled after a Texas law that took effect two years ago and whose supporters say has not greatly affected rates. More common is an external review process adopted by 18 states.
The D.C. Council approved such a review in December, and a Maryland law takes effect this year. In Maryland, Gov. Parris N. Glendening also has proposed a patient's bill of rights that among other things would require HMOs to allow specialists to serve as primary providers and would mandate a minimum 48-hour hospital stay following a mastectomy or testicular cancer surgery.
Woods said the most important component of Virginia's remaining legislative package is the binding appeals process, which she said will resolve all but a small percentage of disputes between patients and their insurance companies.
Republicans say that despite the changes, the rights of patients are likely to be significantly improved if remaining parts of the package are approved before the session ends Saturday. Gilmore has not taken a position on the bills.
Staff writer Robert Pierre contributed to this report.
© Copyright 1999 The Washington Post Company