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One of the top news stories of 1997, the introduction of and reaction to the Patient Access to Responsible Care Act, surely will play out next year.
Benefit lobbyists expect the chief sponsor of the PARCA legislation, Rep. Charlie Norwood, R-Ga., to push for a committee vote on the measure within a month or two of Congress returning to Washington in January after a nearly three-month recess.
The measure, H.R. 1415, which garnered support from nearly half of the House of Representatives, caught employer groups by surprise and they have since been scrambling to lobby Congress to oppose the bill.
The PARCA legislation was presented to lawmakers as an effort to curb managed care plan abuses. Employers, though, contend it would wreak damage on all types of plans.
Already, employer lobbying and protest is having an effect, albeit a limited one, on the legislation.
Rep. Norwood has modified a key provision in the original bill that would have allowed employees to sue their employers in state court and recover applicable damages under state law -- including punitive damages -- for personal injuries incurred in connection to services they received through their health plans.
Those liability provisions in the legislation would have specifically amended the Employee Retirement Income Security Act, which pre-empts state rules and laws that relate to employee benefit plans. Under the federal ERISA statute, employees can only sue for actual damages and, in some cases, legal expenses.
As originally introduced, the legislation, PARCA critics say, would have exposed employers to potentially huge damage awards in state courts for actions over which they had little or no control. For example, an employer that contracted with physicians to set up a health care network could face liability if a physician made a mistake and harmed an employee.
Responding to employer complaints, a bill introduced last month by Rep. Norwood to modify PARCA would preserve the ERISA shield against damages awarded under state law if an employer exercised "discretionary authority to review and make decisions" on claims for plan benefits.
That's an improvement over the original bill, but not by much, benefit experts say. They note the new bill offers only limited liability protection because many employers, in fact, only review decisions made by plan administrators involving large claims.
Even with that change, employers point out that the heart of the PARCA proposal -- an attack on basic health care plan practices -- would remain intact.
For example, while employers now can decide which type of health care-related services they want to cover, the legislation would bar employers and other payers from discriminating in the "participation, reimbursement or indemnification" of health care professionals certified under state law.
In effect, that requirement could force employers to provide coverage for services delivered by naturopaths, homeopaths and even massage therapists -- as long as they are certified by the state -- which are alternative services that many companies never intended to cover under group medical plans.
In addition, the measure would erode employers' ability to establish preferred provider networks. Under the bill, an employer that selects a hospital and its accredited physicians to be in its network could not bar other physicians from being in its network because they were not affiliated with or did not have admitting privileges to the hospital with which it contracted.
That provision, critics say, would cripple employers' ability to selectively contract with physicians on the basis of quality, cost and service.
Indeed, critics say PARCA has far more to do with protecting the incomes of health care professionals than curbing managed care abuses.
While that point will be debated by congressional legislators in the months ahead, health care analysts already are putting a price tag on the legislation.
A study released last month by Milliman & Robertson, an actuarial consulting firm, estimated that employers' annual health care premiums could rise anywhere from between 7% and 39% if PARCA is enacted.