July 13, 1999
Web posted at: 9:21 p.m. EDT (0121 GMT)

WASHINGTON (AllPolitics, July 13) -- Senate Democrats lost early skirmishes in the health care fray Tuesday, despite calls from President Clinton to pass Democratic legislation he said would give HMO patients a bill that "protects them, not the insurance companies."

The GOP defeated by a vote of 52-48 a measure that would make insurance companies pay for any treatments that doctors say are medically necessary.

The Democratic legislation would have made health insurance companies pay for care if it is consistent with generally accepted principles of medical practice. HMOs could not deny claims for care that doctors, as a group, recommend.

But Republicans argued that sometimes the most common practices are not the best. They replaced the Democratic medical necessity language with their own system allowing patients to appeal if care is denied.

That amendment also would have made sure that a woman could stay overnight in a hospital after a mastectomy if her doctor recommended it.

The Senate is debating the so-called "patients' bill of rights" but Republicans and Democrats, who each have their own version of the legislation, seem to be in no mood to compromise on a bill that highlights major differences between each party's political approach.

"The American people have waited a long time for this day and we must not let this opportunity slip away. All Americans in all plans must have these basic rights. That's what this is about: Are you for or against all Americans and all plans having these basic rights," Clinton said at the White House Tuesday morning before leaving for a trip to Florida.

President Clinton spoke Tuesday before leaving for Miami

Clinton said the Republican bill offers "toothless, half-hearted protections," and criticized the GOP and the health care industry for saying the Democratic bill would increase health insurance premiums and force people out of health care plans.

Clinton cited figures by the Congressional Budget Office (CBO) that say the Democratic plan would only raise premiums by an average of $2 a month. Republicans have always insisted on using CBO figures since they became the majority in Congress but they are changing their mind now, the president said.

"But now when the health insurance companies say we don't want you to rely on the figures now and we're spending a $100 million to discredit the HMO figures that the same Republican leaders have held up as the gospel truth for four years now," he said.

In the Senate, Republicans continued to argue that the bill will cost health insurance costs to increase. Republicans say the Democratic bill is too expensive and will force employers to drop health insurance coverage.

"Health care already costs too much. Unfortunately, the bill proposed by Senator Kennedy and many of the Democrats would make it worse," said Sen. Don Nickles (R-Oklahoma). "It would make insurance a lot more expensive and therefore less affordable. As a result, millions of Americans would probably lose their health care insurance."

But the president cited his executive order that put in place the protections provided by the Democratic version for all those covered by the federal employee's health insurance plan. He said it cost less than $1 a month to implement.

The president said the issue is a partisan one only in Washington. "This is about political power in Washington trying to shut off something that is manifestly in the best interest of the average citizen in this country," he said.

Earlier on Tuesday Senate Majority Leader Trent Lott cited GOP disagreements with the bill, including the contention that the Democratic bill will raise costs, lead to more lawsuits and duplicate what states have already done.

"We just want to make sure we get a bill that doesn't cost more, add to bureaucracy and cause more lawsuits," Lott said "We want solutions, not problems caused by courts."

Democrats plan to offer as many as 20 amendments -- each targeting a different piece of the legislation -- that they hope will force GOP senators to support their plan or risk looking like they don't want to protect patients.

The Senate also may vote on amendments including emergency room care, how many people are covered by the bill and a GOP proposal to allow the self-employed to take a tax deduction on the cost of health insurance. Republicans also offered an amendment that says whatever bill becomes law, it would be revised if the Health Care Financing Administration can certify that health care costs increase more than 1 percent, or cause a net decrease overall of 100,000 people or more from health insurance rolls.

Senators on Monday began floor debate on the issue and major differences separate the opposing versions. But the debate is as about politics as much it is about policy, and each party has political goals it hopes to achieve.

Republicans, due to their 55-45 majority, are likely to pass the bill they prefer -- one that is more limited than the Democrats' plan but still offers patients some new powers in dealing with their health maintenance organizations (HMO) and other managed care plans.

The GOP leadership arranged for the Democratic bill to be the starting point for this week's debate. But on Monday, Senate Minority Leader Tom Daschle of South Dakota introduced the Republican version of the bill as a substitute to the Democratic bill in a move that, if approved by the chamber, would allow the Republican bill to be amended.

Senate Minority Leader Tom Daschle

A final vote on the entire bill is set for Thursday. Republicans are expected to use the final amendment to substitute the legislation they prefer for whatever remains on the table.

The proposals from both sides address some common complaints about HMOs by expanding access to specialists and allowing patients to appeal when an HMO denies treatment. But there are also significant differences.

For one, the Democrats' bill covers the more than 150 million Americans in managed care. The Republicans' would primarily cover the 48 million currently in employee-funded health plans.

"The insurance companies want freedom from accountability," said Sen. Ted Kennedy. The Massachusetts Democrat who has sponsored the Democratic legislation, said the health insurance bought and paid for the Republican bill but Republicans say trial lawyers support the Democrats because it would allow patients to sue HMOs for punitive damages.

The Democrats also would allow patients to sue HMOs for punitive damages when denied treatment. Republicans would resolve such disputes through outside arbitration.

HMOs can be sued for the cost of denying coverage but not for punitive damages, often a costlier punishment that the actual costs. The 19745 Employment Retirement Income Security Act shields the HMOs from punitive damages but that law was written in 1974 before HMOs became a power in the health care industry.

Republicans say any new lawsuits would lead to higher health insurance costs. "I simply do not believe that you can sue your way to quality health care," said Sen. Susan Collins (R-Maine).

Democrats say the bill would add costs of only about $2 per-covered party, per-month, citing estimates by the CBO. The CBO estimates the Democratic measure would increase premiums by about 4.8 percent -- actually would cost about $9 per month for an individual plan and $22 per month for a family plan -- but Democrats assume employers will pick up a large portion of the cost.

Democrats also want to force health insurance companies to cover care that doctors believe is "medically necessary." Republicans would allow insurers to make those decisions.

"Our bill is a real plan, theirs is a placebo," Daschle said.

Sen. Phil Gramm said the GOP version addresses problems with HMOs without trying to micromanage medical practice.

"We have spent two years putting together a bill that fixes the problems with HMOs that doesn't write medical practice into law. My god, if we'd written medical practice into law a hundred years ago, we'd still be bleeding people for fevers," the Texas Republican said.

Lobbying organizations also have focused the issue. The insurance industry has been running advertising campaigns against both proposals while the American Medical Association has launched a lobbying campaign on behalf of the Democrats' bill.

The Health Benefits Coalition, a group of business and insurance groups that oppose new laws, set up a headquarters of sorts at nearby lobbyists' offices, complete with a phone bank and set of television sets to monitor debate.

Democrats have set up a headquarters named the Intensive Communications Unit, or ICU, where senators could do radio and TV interviews with hometown stations.

CNN's Charles Bierbauer, Jonathan Karl and The Associated Press contributed to this report.

Tuesday, July 13, 1999

• Senate Democrats lose early patients' rights votes
• Differences in Democrat, GOP 'patients' bill of rights'
• Law limits HMO lawsuits
• Bush money machine raised huge money in gubernatorial campaigns
• Smith resigns from GOP
• Sources: Kasich to drop out of GOP nomination race
• Bush campaign acknowledges covenant issue
• Clinton, House GOP tout dueling tax strategies
• Communications manager quits Bush campaign
• GOP blocks House Democrats gun control efforts in spending bill votes
• Thirty women's groups urge senators to oppose bankruptcy overhaul
• House congratulates U.S. women's soccer team
• Prosecutors move to dismiss charges against two Cisneros aides
• Term-limit champion remains mum on re-election plans
• Animated comics, presidential papers get Internet sites
• Analysis: Gore, Bradley, NAACP push tough gun control as GOP stews
• Clinton orders $100 million for heat relief in 17 states

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