HOUSE REPUBLICANS COULD SUPPORT CDF’s "MANAGED COMPETITION" HEALTH PLAN, STAFFERS SAY, BUT MINORITY WILL OPPOSE PRICE CONTROLS AND EMPLOYER MANDATES

House Republicans could join conservative Democrats on a national health care reform plan that features the "managed competition" concept, according to staffers for House Minority Leader Michel (R-Ill.). Republican members could form a potent voting bloc with the Conservative Democratic Forum in the brewing health care debate. Most House Republicans are "not too far" from the CDF in their vision of health care reform, staffers said. If Clinton's plan closely mirrors the CDF's, GOP support is possible. House Republicans will "probably work to defeat" the Clinton plan if it includes price controls or an employer mandate. As currently envisioned, Clinton's plan would include an employer mandate, and global spending caps which are generally interpreted as indirect price controls. House Republicans expect to reintroduce in the 103rd Congress a slightly modified version of their "Action Now" health care plan, first introduced last June. The "Action Now" plan includes small-group market insurance reform, the establishment of "Medisave" health savings accounts as a coverage option, increased funding for community and migrant health centers, malpractice reform and administrative reform. Democratic backers of managed competition are meeting weekly and soliciting input from private sector interests to improve the bill introduced in September for reintroduction early in the 103rd Congress. Participants in the discussions include Rep. Cooper (D- Tenn.), who heads the CDF Health Policy Task Force, Reps. Andrews (D-Tex.) and Stenholm (D-Tex.), who are CDF members, Sen. Breaux (D-La.), chairman of the Democratic Leadership Council and Sen. Boren (D-Okla.). Staffers for Cooper note that the working group is looking at nearly every aspect of the bill, including such considerations as increasing access to health care in rural areas, making health insurance purchasing cooperatives work more effectively, setting additional requirements for accountable health plans and improving the malpractice reform provisions in the bill. Cooper had help in drafting his managed competition proposal from a former aide, Atul Gawande. Gawande, who also worked in Sen. Gore's office, most recently has been a health advisor to the Clinton campaign and was named on Nov. 12 as transition deputy director for health policy (see related story, p. 11). Rep. Stark (D-Calif.) is expected to reintroduce a bill he cosponsored with House Majority Leader Gephardt (Mo.) last year (HR 5502), which would extend Medicare to provide an outpatient prescription drug benefit and control costs through a national health expenditure (global) budget. Although Stark has said he prefers Medicare expansion as a single-payer approach to health care reform, aides say he is eager to work with the incoming Clinton Administration, which has endorsed the concept of "managed competition." House Energy & Commerce Committee Chairman Dingell (D-Mich.) and Health Subcommittee Chairman Waxman (D-Calif.) also introduced a "Health Choice" reform plan (HR 5514) that would expand Medicare to provide universal outpatient prescription drug coverage. At the American Public Health Association annual meeting in Washington, D.C. on Nov. 10, a key Democratic congressional health aide, David Schulke, predicted the return of an outpatient drug benefit. Schulke, who worked on the Medicare outpatient program in the 1988 Catastrophic Care Bill, said "there will be a Medicare prescription drug benefit" for Congress to consider again as part of the health reform effort. Schulke worked for Sen. Heinz (R-Pa.) and Sen. Pryor (D-Ark.) before joining Rep. Wyden's (D-Ore.) staff during the 102nd Congress.