Members of Congress are looking at a number of mandates on health insurance. Although employers and health care consumers would bear the cost of such mandates, the bureaucratic and regulatory requirements to implement them could also be substantial, says the Heritage Foundation.

One popular proposal would prohibit so-called "gag clauses" -- contractual restrictions by some managed care companies that limit what doctors can say to their patients regarding treatment options. Many physicians and patients consider them an interference with the doctor-patient relationship and thus unethical.

Heritage reports that Multinational Business Services, Inc. (MBS), a Washington-based regulatory consulting firm, studied the regulatory impact of an anti-gag rule contained in H.R. 2976, a bill introduced by Rep. Greg Ganske (R-IA) in the 104th Congress. According to MBS, the measure would require another new bureau within the Health Care Financing Administration (HCFA), the federal agency that runs Medicare and Medicaid.

In 1993, says the MBS report, there were 345,562,800 contracts between physicians and HMOs, and under the proposed mandate a minimum of 0.25 percent to 0.5 percent of those contracts would be investigated for violations -- meaning up to 1,727,814 investigations per year. MBS found that:

• The bureaucracy required to investigate complaints from physicians and patients would consist of five divisions with staffs of 3,640 to 7,142 full-time employees.

• The HCFA would also need a Policy Unit with a staff of 21, a Contract Review Unit with 97 employees, an Investigations Unit of between 2,354 and 4,708, an Administrative Adjudication Unit with 1,148 to 2,296 and an Appellate Review Unit of 20 employees.

• Not counting the cost of these personnel and investigations, the Congressional Budget Office estimates this mandate would cost federal taxpayers $90 million for the period 1997 to 2002.

MBS insists that this is an "extremely conservative" estimate because it is based only on the HMO population, does not include Preferred Provider Organization (PPO) contracts, and assumes a complaint rate of less than 1 percent.