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Senate presses on with patients' rights legislation

By CNN's Ian Christopher McCaleb

WASHINGTON (CNN) -- Senate Democrats advanced at a deliberate pace Friday through their so-called HMO patients' bill of rights, determined to thwart any Republican attempt to weaken the bill through an amendment process that may take as long as a week or more.

The bill was opened to amendment on Thursday morning, after chamber Republicans, in a show of the power and influence they can wield as the minority under the complicated rules of the Senate, blocked consideration of the legislation through the first days of the week.

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Big Picture: Debate begins on a patients' bill of rights  

Comparison: Patients' Bill of Rights  

The chamber's new majority Democrats were ecstatic when the Senate moved Thursday morning, on a 98-0 vote, to break the Republican-imposed deadlock and begin formal consideration of the bill, but the pace of debate slowed considerably by Friday morning.

Senators spent much of the day Friday discussing how some clinical trials and experimental treatments could be opened to more needful patients, and Republicans looked to insulate employers from lawsuits that might be generated by the liability provisions of the Democrats' underlying bill.

Liability issues are at the heart of the ideological rift between the chamber's Republicans and Democrats. There are two bills under Senate consideration, and they are remarkably similar in many respects - each would provide patients enrolled in health maintenance organizations with expanded access to a variety of specialists and prescription drugs.

But the rival camps are split on the issue of how an HMO or insurance provider should be made to address the consequences of a poor coverage decision. Democrats, supported by a handful of Republicans, have argued for more than five years that a patients' bill of rights is needed to combat the power HMO officials sometimes exercise over doctors.

Democrats in the Senate, led by John Edwards of North Carolina and Ted Kennedy of Massachusetts, with an assist from Arizona Republican John McCain, insist that the HMO industry must be held accountable when it denies or disallows a doctor's recommendation for medical treatment. Patients wronged by such a decision, who can prove through an independent review process that their health was further damaged by an HMO's coverage choice, should be allowed to seek redress in court, they say.

"This debate is about making sure patients get the protections they deserve," Kennedy said. "It's about whether we are going to stop HMOs from making medical decisions."

But most Senate Republicans, who support a rival bill drafted by Republican Bill Frist of Tennessee, Democrat John Breaux of Louisiana and independent James Jeffords of Vermont, oppose the liability sections of the Edwards-Kennedy-McCain bill. Small businesses could be put at great risk, they say, because they too could be held responsible if the insurance company they have contracted is sued by an employee.

The Edwards-Kennedy-McCain bill would allow awards of up to $5 million for pain and suffering, in addition to punitive damages. The Frist-Breaux-Jeffords bill would cap pain and suffering payouts at $500,000 and ban punitive damage awards.

"No other issue has created as much concern in this bill as the issue of whether employers can be sued as a result of a dispute that arises out of the liability sections of this bill," Sen. Phil Gramm, R-Texas, said on the floor Friday.

"We are going to have millions of Americans lose their health insurance," Gramm argued, should the Edwards-Kennedy-McCain bill become law.

"We could wreck the health care system if we don't explicitly protect employers from being sued," said Sen. Kay Bailey Hutchison, also R-Texas.

Both Gramm and Hutchison sought to amend the Democrat-supported bill to include language protecting employers from lawsuits. The language would have been similar to language in Texas' patients' bill of rights, which was vetoed by George W. Bush when he was the Lone Star State's governor, but was enacted by the legislature nonetheless, over his objections.

President Bush issued a veto threat against the Democrat-supported bill Thursday through a statement released by the White House Office of Management and Budget. Like Republicans in the Senate, Bush opposes the liability sections of the Edwards-Kennedy-McCain bill.

• White House
• U.S. Senate

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