Related Links • Congressional Budget Office Report on "Patients' Bill of Rights" • Text of H.R. 3605

By Amy Goldstein and Helen Dewar
Washington Post Staff Writers
Friday, July 17, 1998; Page A07

The Democratic approach to increasing the government's regulation of managed health care would drive up the cost of the average person's insurance premium by 4 percent, far less than congressional Republicans and the insurance industry have warned, according to a new federal budget analysis.

The study, issued yesterday by the Congressional Budget Office (CBO), provided a useful piece of ammunition to Democrats and their supporters as the two parties wage an increasingly volatile tug-of-war over how best to safeguard "patients' rights."

In particular, the budget estimate predicted that the most divisive facet of the patients' rights debate – a Democratic belief that the government should grant more Americans the ability to sue their health plans for malpractice – would add an average of 1.2 percent to insurance costs. That is less than half the previous estimates produced by several outside research groups.

Elated by the report, Democrats estimated that, overall, their bill would translate into a monthly cost of about $2 per person. The fresh numbers "reiterate what we've been saying all along: the cost of the [patient] guarantees . . . is a real bargain for American families," said House Minority Leader Richard A. Gephardt (D-Mo.).

But the analysis was challenged immediately by Republicans, who favor a more limited approach to regulating HMOs and other managed-care health plans, and by insurance and business groups, which are trying to defeat the patients' rights legislation of both parties.

Brook Simmons, a spokesman for Senate Assistant Majority Leader Don Nickles (R-Okla.), noted that even if the budget analysis were correct, the 4 percent increase could prompt nearly 1.5 million Americans to lose insurance coverage, based on economists' estimates, because some employers and workers would decide they no longer could afford it. Simmons noted that such an increase would occur at a time when insurance prices already have begun to rise far more rapidly than they have over the last few years.

Others disputed the CBO's analysis. "It really does seem like they're low-balling things," said Charles N. Kahn III, president-designate of the Health Insurance Association of America.

The trade-off between the cost and the scope of regulation has significant philosophical and political overtones. Recent polls suggest widespread support for government action to shift power away from managed-care plans, but the surveys also suggest that support diminishes if people believe new regulations would increase insurance costs.

The disagreements over what kinds of costs are tolerable is part of an increasingly noisy and partisan flavor that the patients' rights issue has taken on, as the Senate prepares to begin debating legislation as early as next week. Yesterday, leaders of both parties staged highly visible events to try to pull public sentiment toward their camp.

President Clinton joined congressional Democrats and two maverick Republicans at a midday rally on Capitol Hill in support of a bill sponsored by Senate Majority Leader Thomas A. Daschle (D-S.D.), and Rep. John D. Dingell (D-Mich.). Clinton appealed for bipartisan collaboration to enact legislation this year, saying, "When you show up in an emergency room, or you test positive on a biopsy, nobody asks you what political party you belong to."

But the president also made clear there are limits to his willingness to compromise, emphasizing that he would not sign a bill unless it gave patients the ability to sue their health plan, or other means to make sure that safeguards are enforceable. "You can write all the guarantees you want in Washington," Clinton said, "but if you can't enforce them, the delays in the system will cause people to die."

In one small sign of bipartisanship, Democratic leaders walked into yesterday's hearing with Rep. Greg Ganske (R-Iowa), who supports their bill. But Ganske's public position has infuriated his GOP colleagues so much that he stepped down yesterday from a high-level federal commission exploring the future of Medicare.

House Republicans, for their part, gathered yesterday afternoon on a traffic circle across from George Washington University Hospital's emergency room to mark the introduction of a somewhat narrower GOP leadership bill. House Speaker Newt Gingrich (Ga.) echoed Clinton's call for partisanship, but he, too, drew a line on the issue of suing health plans. "One of the things we're trying to do is improve direct, immediate, practical access," Gingrich said. "Frankly, we would like you to get the care faster than you could get an appointment with a lawyer."