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  •   Health Care Reform Hits the Campaign Trail

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  • Key Stories: The Presidential Race

  • By Terry M. Neal
    Washington Post Staff Writer
    Tuesday, April 6, 1999; Page A7

    The fight over health care reform is likely to play a big role on the presidential campaign trail this year because Democrats believe it is a slam dunk issue for them. But Republican candidates don't plan to ignore the subject, even though polls suggest voters favor Democrats on the issue.

    For the past several years, the effort to reform managed health care has bedeviled both parties and has mired Congress in a seemingly endless partisan debate. Early last year, health care reform loomed as a major issue in congressional elections but was drowned out, along with most other subjects, amid the furor over the White House sex and perjury scandal.

    The quality and availability of care offered by health maintenance organizations and other forms of managed care have become issues of increasing concern to voters. And even though the presidential primaries don't begin for another 10 months, candidates already are signaling how important they consider the issue.

    Both Vice President Gore and former senator Bill Bradley (D-N.J.) have vowed to make health care reform a central issue in their campaigns.

    Gore has been an outspoken advocate of the Patients' Bill of Rights -- legislation that proponents say would ensure that companies put quality health care decisions ahead of profit-making decisions. Critics say such government regulations would drive up the cost of health care and make it unaffordable to more families.

    Gore mentions health care reform, as well as the need to ensure long-term care of the aging population, in nearly every speech and thinks it "is right up there with Social Security and preserving Medicare," said spokesman Roger Salazar.

    Bradley plans to focus on how to expand coverage to the more than 40 million Americans without health insurance. "He has talked about trying to focus on how to get as many people covered as possible," spokesman Eric Hauser said. "He'll be moving toward a more comprehensive notion of what that entails in the fall."

    Several GOP candidates, including Malcolm S. "Steve" Forbes, Dan Quayle and Lamar Alexander, are promoting versions of a popular conservative alternative -- medical savings accounts that give individuals a tax advantage if they set aside money for medical expenses. Many Republicans say that would empower individuals to make health care choices without increasing government regulation.

    In a speech last week before hundreds of managed care administrators in Atlanta, Forbes derided what he called the regulatory approach favored by most Democrats and some Republicans in Congress. "Why does it take an act of Congress for patients to have flexibility and choice in what doctors they see?" said Forbes, who has offered the most specific proposal of any GOP candidate.

    In Texas, Gov. George W. Bush (R) has signed into law a broad HMO reform bill that, among other things, makes it easier for patients to see out-of-network doctors.

    Special interest groups already are making their views known to politicians. The American Association of Health Plans, which represents hundreds of health care companies, has aired television ads in Iowa and New Hampshire -- the first caucus and primary states -- essentially urging Republican candidates to ignore the issue.

    AAHP officials released a poll that suggests that the vast majority of GOP primary voters in those states are satisfied with the quality of service of their HMOs and oppose government regulation that would increase costs. "Bashing managed care isn't going to get you anywhere," Mark Merritt of the AAHP said in an interview. "We want to impact the debate early."

    But New Hampshire GOP Chairman Steve Duprey said Republican candidates who ignore health care will do so at their own risk. Last year, Gov. Jeanne Shaheen (D) made managed care reform a central theme of her successful reelection campaign, Duprey noted. And state lawmakers from both parties are supporting legislation similar to the Patients' Bill of Rights in the legislature this year.

    "The typical New Hampshire voter is going to ask [candidates], 'Look, my HMO didn't cover this or didn't cover that, and I had no way to appeal,' " Duprey said. " 'What's your approach compared to Al Gore's approach?' I think because it's a state issue, it will be an issue this year."

    The extent to which reform of HMOs and other managed care groups is a factor in the campaign could depend on what happens in Congress, which is again considering the Patients' Bill of Rights. Democratic and GOP leaders on Capitol Hill are promising to pass some version of it, but there remains a broad partisan gulf over exactly what should be done to improve the way tens of millions of Americans receive their health care.

    The legislation being considered would, among other things, make it easier for patients to be reimbursed for emergency room visits, visit doctors outside of HMO networks and appeal denials for medical treatments patients believe they need. But Democrats support and most Republicans oppose the right of patients to sue managed care companies for the medical care decisions they make -- an issue that could spill over to the election campaign.

    "If Congress fails to adopt or adopts a really watered down bill of rights, I think it'll be a very significant issue in the race," said Ron Pollack, executive director of Families USA, a consumer group that supports broad HMO reform.

    Andrew Kohut, director of the Pew Research Center, said 69 percent of the respondents in a recent national poll listed health care as a top issue -- behind education and Social Security -- compared with 62 percent and 56 percent last year and the year before, respectively. Poll respondents also said they trusted Democrats over Republicans by 46 percent to 25 percent on health care issues. But voters are wary of reforms that could increase costs, a potential complication for Democrats.

    Thelma Erickson, an Atlanta resident who listened to Forbes's remarks, said she had doubts about his plan to broaden access to medical savings accounts. "I just don't think that's the solution that's going to reach the needs of people who traditionally have not been able to afford health insurance," she said.

    Staff researcher Ben White contributed to this report.

    © Copyright 1999 The Washington Post Company

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