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LEGISLATIVE ALERT BULLETIN PLEASE READ CAREFULLY -- GRASSROOTS ACTION NEEDED FOR SENATE BATTLE ON MANAGED CARE LEGISLATION

From: ACA Department of Government Relations
Subject: Amend the federal Employee Retirement Income Security Act (ERISA) statute
FOR IMMEDIATE RELEASE: August 14, 1998

This is an URGENT LEGISLATIVE ALERT BULLETIN regarding efforts to amend the federal Employee Retirement Income Security Act (ERISA) statute and pass national managed care reform legislation containing important patient and provider protection standards. Please read this bulletin carefully and take IMMEDIATE ACTION as requested.

BACKGROUND IN THE U.S. HOUSE:

As a result of continuing pressure to act on the managed care issue, and fearing the growing election-year support for substantive managed care reform provisions embodied in the ACA-supported PARCA Bill, the GOP leadership in the U.S. House of Representatives engineered the passage of H.R.4250 through the U.S. House in late July. This parliamentary maneuver effectively blocked a vote on the full PARCA bill in the U.S. House.

While containing some patient protections, H.R.4250 is largely a watered-down reform bill and is too weak to be supported by the ACA. Additionally, H.R.4250 contains some provisions which we and our allies in the PARCA Coalition oppose. The next step in the legislative process is consideration of managed care reform legislation in the U.S. Senate. The White House has already indicated the likelihood of a veto should H.R.4250 pass Congress in its current form.

BACKGROUND IN THE U.S. SENATE:

After concluding a month-long August recess period, Congress will reconvene in early September. At that time, it is anticipated that the U.S. Senate will debate and vote on managed care reform legislation. In the Senate, the parliamentary situation is such, that major action there is expected to center around a battle between two competing managed care reform bills, S.2230 and S.1890, along with various amendments to them. S.2230, known as the Nickles Bill, is authored and supported by the GOP Senate leadership. S.1890, known as the Daschle-Kennedy Bill, is authored and supported by the Democratic Senate leadership.

While neither Senate bill is ideal, both represent improvements over H.R.4250, the House passed bill. Of the two Senate bills, the Democratic bill, S.1890, is far more substantive, although it's non-discrimination and point of service provisions are not as strong as the PARCA language. It remains, of course, the goal of the ACA and PARCA Coalition to pass the strongest bill possible. As a full PARCA bill is not expected to be voted on in the Senate, the ACA and PARCA Coalition have elected to voice support for the Democratic Bill, S.1890. In exchange for the support of the Democratic bill by the ACA and the PARCA coalition, we have received assurances from Senators Kennedy and Daschle that they will offer and support non-discrimination and strengthened point of service amendments to the final bill (likely the Nickles bill) that will be voted on by the Senate. Accordingly, please take action as requested below which will help strengthen our position in the U.S. Senate.

SPECIFIC GRASSROOTS ACTION NEEDED NOW:

1.Write/call your two U.S. Senators at United States Senate, Washington, D.C. 20510/202-224-3121 and urge that they vote for S.1890, the Daschle-Kennedy Bill. Indicate your support for S.1890 is based on the fact that of the two major managed care bills likely to be considered in the Senate, it is the one which most closely resembles the substantive provisions found in the PARCA bill.

2.VERY IMPORTANT: Urge your two Senators to support specific amendments to any final bill to be voted on which would:

A.Include and\or strengthen the bill's provider non-discrimination provisions aimed at preventing health plans from discriminating against providers solely on the basis of their licenses; so that providers receive fair reimbursement for their services, non-discrimination regarding reimbursement should also be included; non-discrimination will create more competition among providers, thus promoting more efficiency in the health care market-place and assure patients a greater choice of providers.

B.Strengthen the point-of-service (POS) provisions, making it easier and more practical for enrollees to go "out of network" to see a provider of their choice. A choice of two closed-panel HMOs does not meet the criteria of a strong point of service, nor do exemptions for small employers.

IMPORTANT NOTE:

If you have any questions about this URGENT LEGISLATIVE ALERT BULLETIN, please call the ACA Department of Government Relations at (703)276-8800. Thank you for your IMMEDIATE RESPONSE to this URGENT BULLETIN.