By Amy Goldstein and Terry M. Neal
Washington Post Staff Writers
Thursday, June 25 1998; Page A01

House Republicans responded yesterday to the growing chorus of public unrest over health care in America, unveiling their own version of a federal plan to expand the rights of patients in a system increasingly dominated by managed care.

By devising a set of GOP principles for protecting patients, Republican leaders are trying to wrest control from Democrats over a new generation of health care reform, unifying the party and fortifying its members on an election-year issue that is proving to have visceral appeal among voters.

The legislative outlines, produced by a group of key Republicans and backed by House Speaker Newt Gingrich (R-Ga.) and most of the party leadership, represent a significant turnaround in much of the GOP's attitude toward regulating health care. Eight months ago, when President Clinton called on Congress to adopt a "bill of rights" for patients in health maintenance organizations and other kinds of managed-care arrangements, many GOP leaders denounced the idea as big-government meddling. Now, confronted by divisions within their party and the enormous popularity of such protections among consumers, they have embraced the idea as their own.

Although the issue has been gathering momentum for several months on Capitol Hill -- as several other bills have attracted hundreds of co-sponsors -- the legislation announced yesterday means "patients' rights" has attained center stage as the dominant social issue remaining this term. Legislation on other central domestic matters -- including tobacco regulation, education, and child care -- has been defeated or is languishing.

And though many details of the Republican bill will not be finalized until Congress returns from a recess next month, the legislation is likely to become the main GOP vehicle for the upcoming "patients' rights" debate.

In broad terms, the legislation will incorporate many themes of the White House plan, such as giving patients more information to help them select a health insurer, requiring insurers to pay more emergency room bills, and creating more effective avenues for patients to protest if they are denied services they think they deserve.

But at Gingrich's direction, the group, led by Rep. J. Dennis Hastert (R-Ill.), has given its proposal a more conservative flavor, including several elements that are certain to trigger a fierce debate with Democrats. They include an expansion of "medical savings accounts," two controversial methods of helping small businesses afford coverage for their workers, and a revived effort to tighten limits on the amount of money patients can receive in medical malpractice cases.

The Republicans' work drew swift criticism from congressional Democrats, the White House and advocacy organizations from opposing camps in the patients' rights debate.

The Health Insurance Association of America, the powerful trade group instrumental in the defeat of Clinton's large-scale attempt to reform the nation's health care system four years ago, called the Republican proposal a "mishmash of cobbled-together ideas that are guaranteed to raise consumers' costs, reduce choice and generate more federal bureaucracy." Organizations representing large businesses sounded similar themes.

From a different vantage point, Ron Pollack, president of the patient-advocacy group Families USA, said the proposal "has the foul odor of election-year positioning. . . . They've loaded this thing down with poison pills that are designed to make this legislation ultimately fail."

White House officials praised the Republicans for deciding that federal legislation is needed, and said they would work together to enact a bill this year. But they said the leadership's approach contains several unacceptable aspects and omitted a few elements they endorse, such as guarantees that patients may visit medical specialists with fewer restrictions and may in certain circumstances keep the same doctor temporarily if they are forced to switch health plans. "Without these important protections, the Republicans' patients' bill of rights is nothing more than a bill of goods," Vice President Gore said at a White House ceremony.

In a sense, the Republicans' bill reconfigures the politics of patients' rights. On the one hand, it serves to unify the party, which had splintered badly on the issue, with 88 GOP House members signing on to a bill, sponsored by Rep. Charles Whitlow Norwood Jr. (R-Ga.), that party leaders had opposed. Yesterday, Norwood announced he would abandon his bill and support the new legislation. On the other hand, the debate could also grow more partisan. Norwood's bill had attracted enough support from Republicans and Democrats alike that it could have passed. Upon its withdrawal, members of both parties began scurrying yesterday to line up behind their leaders' measures, setting the course for intense feuding over whose approach is better and who gets the credit.

In a foreshadowing of that more partisan cast, the Democrats called their own news conference. Senate Minority Leader Thomas A. Daschle (D-S.D.), sponsor of the bill that incorporates the White House proposal, branded the Republican version as "recycled rhetoric intended to do one thing: Give them political coverage."

The GOP approach would require health plans to allow many patients to bypass their insurers' approved physician lists and select their own doctors, an idea vigorously opposed by the insurance industry. It would allow obstetrician-gynecologists and pediatricians to be designated as primary doctors for women and children. And it would require health plans to create and pay for relatively speedy grievance systems, in which patients could first protest to an in-house appeals board, composed of doctors. If still dissatisfied, they could continue their protest to an independent panel of physicians.

Many details, however, remain unresolved. Patients in large, self-insured health plans would, for example, have somewhat greater ability to go to court to collect penalties if their plans deny them care, but the specifics have not been worked out. And Hastert said that his group would defer to the Ways and Means committee on several tax strategies to reduce the nation's cadre of 42 million people who are uninsured.

Staff writer Judith Havemann contributed to this report.