I

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.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Quality Health-Care

3 Coalition Act of 1999’’.

4 SEC. 2. FINDINGS.

5 Congress finds the following:

6 (1) A large number of Americans receive their

7 health care coverage from managed health care

8 plans. This represents a 10-fold increase over the

9 last 20 years. Serious questions have been raised

10 about the quality of care patients are receiving

11 under these plans.

12 (2) Changes in the health care industry have

13 led to an increased concentration of health care

14 plans, including more than 162 mergers in the last

15 10 years.

16 (3) The McCarran-Ferguson Act has created an

17 enhanced opportunity for market power of insurance

18 companies in health care and has given such compa19 nies significant leverage over health care providers

20 and patients.

21 (4) Permitting health care professionals to ne22 gotiate collectively with health care plans will create

23 a more equal balance of negotiating power, will pro24 mote competition, and will enhance the quality of

25 patient care.
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1 (5) Allowing health care professionals to nego2 tiate collectively with health care plans will not

3 change the professionals’ ethical duty to continue to

4 provide medically necessary care to their patients.

5 SEC. 3. APPLICATION OF THE ANTITRUST LAWS TO HEALTH

6 CARE PROFESSIONALS NEGOTIATING WITH

7 HEALTH PLANS.

8 (a) IN GENERAL.—Any health care professionals who

9 are engaged in negotiations with a health plan regarding

10 the terms of any contract under which the professionals

11 provide health care items or services for which benefits

12 are provided under such plan shall, in connection with

13 such negotiations, be entitled to the same treatment under

14 the antitrust laws as the treatment to which bargaining

15 units which are recognized under the National Labor Rela16 tions Act are entitled in connection with such collective

17 bargaining. Such a professional shall, only in connection

18 with such negotiations, be treated as an employee engaged

19 in concerted activities and shall not be regarded as having

20 the status of an employer, independent contractor, mana21 gerial employee, or supervisor.

22 (b) PROTECTION FOR GOOD FAITH ACTIONS.—Ac23 tions taken in good faith reliance on subsection (a) shall

24 not be the subject under the antitrust laws of criminal
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1 sanctions nor of any civil damages, fees, or penalties be2 yond actual damages incurred.

3 (c) LIMITATION.—The exemption provided in sub4 section (a) shall not confer any right to participate in any

5 collective cessation of service to patients not otherwise per6 mitted by law.

7 (d) DEFINITIONS.—For purposes of this section:

8 (1) ANTITRUST LAWS.—The term ‘‘antitrust

9 laws’’—

10 (A) has the meaning given it in subsection

11 (a) of the first section of the Clayton Act (15

12 U.S.C. 12(a)), except that such term includes

13 section 5 of the Federal Trade Commission Act

14 (15 U.S.C. 45) to the extent such section 5 ap15 plies to unfair methods of competition, and

16 (B) includes any State law similar to the

17 laws referred to in subparagraph (A).

18 (2) HEALTH PLAN AND RELATED TERMS.—

19 (A) IN GENERAL.—The term ‘‘health plan’’

20 means a group health plan, a health insurance

21 issuer that is offering health insurance cov22 erage, a Medicare+Choice organization that is

23 offering a Medicare+Choice plan, or a Medicaid

24 managed care entity offering benefits under

25 title XIX of the Social Security Act.
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1 (B) HEALTH INSURANCE COVERAGE;

2 HEALTH INSURANCE ISSUER.—The terms

3 ‘‘health insurance coverage’’ and ‘‘health insur4 ance issuer’’ have the meanings given such

5 terms under paragraphs (1) and (2), respec6 tively, of section 733(b) of the Employee Retire7 ment Income Security Act of 1974 (29 U.S.C.

8 1191b(b)).

9 (C) GROUP HEALTH PLAN.—The term

10 ‘‘group health plan’’ has the meaning given that

11 term in section 733(a)(1) of the Employee Re12 tirement Income Security Act of 1974 (29

13 U.S.C. 1191b(a)(1)).

14 (D) MEDICARE+CHOICE ORGANIZATION;

15 MEDICARE+CHOICE PLAN.—The terms

16 ‘‘Medicare+Choice organization’’ and

17 ‘‘Medicare+Choice plan’’ have the meanings

18 given such terms in subsections (a)(1) and

19 (b)(1) of section 1859 of the Social Security

20 Act (42 U.S.C. 1395w–28).

21 (E) MEDICAID MANAGED CARE ENTITY.—

22 The term ‘‘Medicaid managed care entity’’ has

23 the meaning given the term ‘‘managed care en24 tity’’ under section 1932(a)(1)(B) of the Social

25 Security Act (42 U.S.C. 1396u–2(a)(1)(B)).
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1 (3) HEALTH CARE PROFESSIONAL.—The term

2 ‘‘health care professional’’ means an individual who

3 provides health care items or services, treatment, as4 sistance with activities of daily living, or medications

5 to patients and who, to the extent required by State

6 or Federal law, possesses specialized training that

7 confers expertise in the provision of such items or

8 services, treatment, assistance, or medications.

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