Politics or patients: Senate to vote on health 'bill of rights'

July 14, 1999
Web posted at: 10:21 p.m. EDT (0221 GMT)

WASHINGTON (AllPolitics, July 14) -- A Senate vote on the entire patients' bill of rights is set for Thursday after a final round of debate and amendment votes. Republicans are expected to use the final amendment to substitute the legislation they prefer for whatever remains on the table.

Senate Republicans defeated all Democratic amendments to the patients' bill of rights Wednesday, opting instead for their own measures, which Democrats said are riddled with loopholes.

In a second day of voting virtually along party lines, Republicans killed a key Democratic measure that would have expanded the scope of the bill as well as amendments for greater access to specialists and clinical trials.

In this story:

Clinton likely to veto
Defining 'medically necessary'

Senators rejected 52-48 a proposal by Sen. Edward Kennedy that would have extended protections to three times the number of people the GOP plan now covers.

"Nothing more clearly demonstrates that the Republican bill is an industry protection act, not a patient protection act," the Massachusetts Democrat said.

On Tuesday, Republicans voted to limit many of the new rights it has proposed to the 48 million Americans now exempt from state regulations. Democrats wanted to cover the 161 million Americans in private health care plans.

Republicans also defeated, 53-47, a Democratic plan to give patients access to needed specialists even if the specialists are outside a health plan's network. Republicans promised their own version, which would require "timely" specialist care, but would not give patients the right to go outside a network.

Also, the Senate voted 55-45 on Wednesday to approve an amendment offered by Sen Olympia Snowe (R-Maine) that requires health insurers to pay for extended hospital stays for women who have undergone mastectomies.

Snowe said her plan would ensure that "appropriate medical care" dictates how long a woman remains hospitalized after breast surgery and "not an insurer's bottom line." A similar Democratic amendment with broader language was defeated Tuesday by the Republicans.

But the Snowe amendment goes farther than other GOP proposals, covering everyone with private health insurance except state and local workers, or about 140 million people.

Democrats also were upset by Snowe's amendment because it replaced an amendment by Sen. Christopher Dodd (D-Connecticut) that would have allowed patients -- under certain conditions -- to have access to clinical trials.


Sen. Christopher Dodd

Dodd said many health care plans are refusing to cover routine costs for patients participating in clinical health studies. The amendment would require coverage of the costs under certain conditions.

"This ought not to be a controversial proposal," Dodd said.

Republicans said the Dodd amendment would lead to increased costs. They said they would introduce their own amendment dealing with the issue, although the current GOP proposal calls only for a study of the issue.

"If we put this new mandate on ... somebody's got to pay for it," said Sen. Bill Frist, (R-Tennessee). "The federal government's not going to pay for it."

Frist is the only physician in the Senate. His brother, Thomas Frist, is chairman/CEO of Columbia/HCA, one of the nation's leading owners of hospitals.

First promised that the GOP will develop its own amendment on experimental treatments by Thursday and will include "very good" Democratic ideas into the final GOP bill.

Meanwhile, Sen. John Chafee, R-Rhode Island, was working with a handful of Democrats to fashion a compromise that incorporates much of what Democrats want. His spokesman, Nicholas Graham, said Chafee had four Republicans on board and would need just one more to reach 50 votes if all 45 Democrats went along.

Clinton likely to veto

Republicans also introduced an amendment that would allow individuals to purchase long-term care insurance to deduct 100 percent of the cost of that insurance from their taxes. Other issues that were debated Wednesday includes emergency room treatments and access to specialists.

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.

Democrats are arguing that their legislation would do more to expand and protect patient's rights against health maintenance organizations (HMO) than the Republican bill.

"I think most people in America will understand that our colleagues on the other side of the aisle have spent more time and energy protecting the right to bear arms than the right for citizens to be able to get decent medical care," said Sen. John Kerry (D-Massachusetts).


Sen. Phil Gramm

"What will happen in this legislation if the Republican charade passes -- and they have the votes - is that once again the American people will be left behind and business and business only, the bottom line, will be the victor."

Republicans have countered that the Democratic bill is too expensive and will force employers to drop health insurance coverage.

"If the best they can do in telling us what is right with them and what is wrong with us is that they want higher taxes and they want every state in the Union how to run health care, they are going to be in the minority for a very, very long time," said Sen. Phil Gramm (R-Texas).

But despite their defeats, Democrats believe they have the upper hand in the political debate as it is likely to remain a political issue into the 2000 election. President Bill Clinton likely will veto the GOP bill.

Vice President Al Gore, campaigning in Iowa Wednesday, said the administration would not roll over if the GOP prevails. "We won't be done with it. We're going to keep fighting for the bill of rights -- the real bill of rights -- until it becomes law," he said.

Republicans have been offering competing amendments in hopes of offsetting the political damage of defeating the Democratic proposals. So far, only a few Republicans have sided with the Democrats defected in a series of votes this week, due in part to the GOP having its own amendments or promising to answer Democratic proposals on emergency room care, women's health and clinical trials.

No Democrat has voted with Republicans during this week's debate. Those GOP senators with Democrats at least once were GOP Sens. Spencer Abraham of Michigan, John Chafee of Rhode Island, Peter Fitzgerald of Illinois, John McCain of Arizona, Arlen Specter of Pennsylvania and John Warner of Virginia.

On Tuesday, in mainly party-line votes, Senate Republicans turned back five Democratic amendments that would have extended new patient protections to Americans under managed care health plans.

Senators voted 53-47 opted to restrict many of the provisions only to 48 million Americans in health plans that are currently exempt from state laws or regulations.

Democrats wanted to cover another 113 million Americans living in states that may or may not have approved their own protections for patients.


Sen. Don Nickles

Republicans, because of 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 and other managed care plans.

Defining 'medically necessary'

The Senate also 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 required 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 and replaced the Democratic medical necessity language with their own system allowing patients to appeal if care is denied.


Sen. Chuck Robb

Earlier in the day, the Senate defeated 52-48 an amendment proposed by Sen. Chuck Robb (D-Virginia) that would have allowed women to select a gynecologist or obstetrician as their primary care doctor. That amendment also would have assured a woman could stay overnight in a hospital after a mastectomy if her doctor recommended it.

Republicans won adoption of a measure that would allow self- employed to deduct the full cost of their health insurance from their taxes.

The GOP also passed, by a 52-48 vote, an amendment would nullify the final version of the patients' bill of rights if it resulted in an increase of health care costs by 1 percent or more. The GOP claims the Democratic will cause health care costs to rise, resulting in people losing their health insurance.

The Congressional Budget Office has estimated that the Democratic plan would raise insurance premiums 4.8 percent over the next five years. But Democrats also cite figures by the CBO that say the Democratic plan would only raise premiums by an average of $2 a month.

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

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