Quality Health-Care Coalition Act of 1999 (Introduced in the House)

HR 1304 IH

106th CONGRESS

1st Session

H. R. 1304

To ensure and foster continued patient safety and quality of care by making the antitrust laws apply
to negotiations between groups of health care professionals and health plans and health insurance
issuers in the same manner as such laws apply to collective bargaining by labor organizations under
the National Labor Relations Act.

IN THE HOUSE OF REPRESENTATIVES

March 25, 1999

Mr. CAMPBELL (for himself, Mr. CONYERS, Mr. MILLER of Florida, Mr. HOEFFEL, Mr.
BAKER, Mr. LAFALCE, Mr. COOKSEY, Mr. PALLONE, Mr. NADLER, Mr. HORN, Mr.
FROST, Mr. FILNER, Mr. BOUCHER, Mr. WEXLER, Mr. SCARBOROUGH, Ms.
SCHAKOWSKY, Mr. SHOWS, Mr. SANDLIN, Mr. TOWNS, Mr. BLAGOJEVICH, Mr.
BROWN of Ohio, Mr. PAUL, Mr. COBURN, Mr. GANSKE, Mr. DELAHUNT, Mr.
ROHRABACHER, Mr. MCCOLLUM, and Mr. KLINK) introduced the following bill; which
was referred to the Committee on the Judiciary

A BILL

To ensure and foster continued patient safety and quality of care by making the antitrust laws apply
to negotiations between groups of health care professionals and health plans and health insurance
issuers in the same manner as such laws apply to collective bargaining by labor organizations under
the National Labor Relations Act.

Be it enacted by the Senate and House of Representatives of the United States of
America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Quality Health-Care Coalition Act of 1999'.

SEC. 2. FINDINGS.

Congress finds the following:

(1) A large number of Americans receive their health care coverage from managed
health care plans. This represents a 10-fold increase over the last 20 years. Serious
questions have been raised about the quality of care patients are receiving under these
plans.

(2) Changes in the health care industry have led to an increased concentration of
health care plans, including more than 162 mergers in the last 10 years.

(3) The McCarran-Ferguson Act has created an enhanced opportunity for market
power of insurance companies in health care and has given such companies significant
leverage over health care providers and patients.

(4) Permitting health care professionals to negotiate collectively with health care plans
will create a more equal balance of negotiating power, will promote competition, and
will enhance the quality of patient care.

(5) Allowing health care professionals to negotiate collectively with health care plans
will not change the professionals' ethical duty to continue to provide medically
necessary care to their patients.

SEC. 3. APPLICATION OF THE ANTITRUST LAWS TO HEALTH CARE
PROFESSIONALS NEGOTIATING WITH HEALTH PLANS.

(a) IN GENERAL- Any health care professionals who are engaged in negotiations with a
health plan regarding the terms of any contract under which the professionals provide health
care items or services for which benefits are provided under such plan shall, in connection
with such negotiations, be entitled to the same treatment under the antitrust laws as the
treatment to which bargaining units which are recognized under the National Labor Relations
Act are entitled in connection with such collective bargaining. Such a professional shall, only
in connection with such negotiations, be treated as an employee engaged in concerted
activities and shall not be regarded as having the status of an employer, independent
contractor, managerial employee, or supervisor.

(b) PROTECTION FOR GOOD FAITH ACTIONS- Actions taken in good faith reliance
on subsection (a) shall not be the subject under the antitrust laws of criminal sanctions nor of
any civil damages, fees, or penalties beyond actual damages incurred.

(c) LIMITATION- The exemption provided in subsection (a) shall not confer any right to
participate in any collective cessation of service to patients not otherwise permitted by law.

(d) DEFINITIONS- For purposes of this section:

(1) ANTITRUST LAWS- The term `antitrust laws'--

(A) has the meaning given it in subsection (a) of the first section of the Clayton
Act (15 U.S.C. 12(a)), except that such term includes section 5 of the Federal
Trade Commission Act (15 U.S.C. 45) to the extent such section 5 applies to
unfair methods of competition, and

(B) includes any State law similar to the laws referred to in subparagraph (A).

(2) HEALTH PLAN AND RELATED TERMS-

(A) IN GENERAL- The term `health plan' means a group health plan, a health
insurance issuer that is offering health insurance coverage, a Medicare+Choice
organization that is offering a Medicare+Choice plan, or a Medicaid managed
care entity offering benefits under title XIX of the Social Security Act.

(B) HEALTH INSURANCE COVERAGE; HEALTH INSURANCE
ISSUER- The terms `health insurance coverage' and `health insurance issuer'
have the meanings given such terms under paragraphs (1) and (2), respectively,
of section 733(b) of the Employee Retirement Income Security Act of 1974
(29 U.S.C. 1191b(b)).

(C) GROUP HEALTH PLAN- The term `group health plan' has the meaning
given that term in section 733(a)(1) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1191b(a)(1)).

(D) MEDICARE+CHOICE ORGANIZATION; MEDICARE+CHOICE
PLAN- The terms `Medicare+Choice organization' and `Medicare+Choice
plan' have the meanings given such terms in subsections (a)(1) and (b)(1) of
section 1859 of the Social Security Act (42 U.S.C. 1395w-28).

(E) MEDICAID MANAGED CARE ENTITY- The term `Medicaid managed
care entity' has the meaning given the term `managed care entity' under section
1932(a)(1)(B) of the Social Security Act (42 U.S.C. 1396u-2(a)(1)(B)).

(3) HEALTH CARE PROFESSIONAL- The term `health care professional' means
an individual who provides health care items or services, treatment, assistance with
activities of daily living, or medications to patients and who, to the extent required by
State or Federal law, possesses specialized training that confers expertise in the
provision of such items or services, treatment, assistance, or medications.