The increasingly bitter battle between medical providers and managed care plans is expected to move into the congressional arena as lawmakers debate proposals to overhaul the nation's health-care system.
Congress will consider what kind of limits should be placed on health maintenance organizations and other managed care providers, including whom they can hire and fire.A growing number of medical professionals - including doctors, pharmacists and chiropractors - has complained they are being locked out of the health-care networks that are increasingly dominating large urban markets.
These professionals persuaded House Democratic leaders to include a provision in their bill that would force managed care plans to contract with any medical providers in their region who meet their standards.
But the provision, known as "any willing provider," has provoked strong criticism from some lawmakers as well as managed care organizations, who believe it would undermine competition within the health industry.
Sen. Phil Gramm, R-Texas, saying such a provision would be approved "over my dead, cold body," argued that federal limits on personnel decisions would "kill competition."
The "any willing provider" provision is not included in the plan proposed by Senate Democratic Leader George Mitchell of Maine or the Republican Senate plan drafted by Minority Leader Bob Dole of Kansas.
Officials with managed care programs argue that the "willing provider" requirement would substantially raise their costs, because it would require more administrative work and reduce their ability to make cost-cutting deals with medical providers.
Currently, most of these organizations get discounts from doctors and other medical providers by promising to provide them with a minimum amount of business. If they are forced to hire an unlimited number of professionals, they argue, they could no longer guarantee business and would not receive the discounts.
The Group Health Organization of America recently estimated that adding any willing physician or hospital to its plans would increase family health premiums by $1,284 a year.
Rep. Bill Brewster, the Oklahoma Democrat who sponsored the "any willing provider" provision, said he does not believe it would increase costs, because the measure does not dictate to managed care plans what their reimbursement rates should be.
Brewster, a pharmacist, said many consumers are opposed to managed care plans, because organizations often drop doctors or drugstores they have grown accustomed to patronizing. The congressman, who said that no managed care plan serves the 21 counties he represents in southern Oklahoma, said his constituents are wary of HMOs.