Health Bill Blocked in Senate

Senate Democrats on Thursday blocked a Republican bill intended to make health insurance more affordable for small businesses, handing President Bush the second defeat in a week for his healthcare agenda.

The 55-43 vote, largely along party lines, was five votes short of the 60 that Republicans needed to overcome a procedural challenge and move the legislation forward.

On Monday, the Senate had blocked Bush’s long-sought caps on jury awards in medical malpractice cases.

The dead-end turn for the small-business bill is another example of the healthcare impasse that persists in Washington as costs and the number of uninsured keep rising.

The debate pitted companies seeking broader access to coverage through lower premiums against patients’ rights advocates trying to protect hard-won current benefits. Election-year mistrust between the political parties shut down most compromise efforts.

“In healthcare, you need people who are absolutely committed to making some major changes and to reaching across the political aisle,” said Robert J. Blendon, a public opinion expert at the Harvard School of Public Health. “The partisan nature of Washington politics has just gotten so extreme that you have a sense people don’t want to move on a problem unless it’s done completely on the terms of their own party.”

Most uninsured are workers and their families, and small companies employ a disproportionate share. Despite widespread agreement on the legislation’s main goal of helping small businesses pool together to save on coverage costs, the specifics of the GOP bill drew broad, well-organized opposition.

In allowing small-employer groups to buy coverage across state lines, the bill would have let them circumvent state consumer protections. These so-called state mandates spell out benefits that insurers must cover and they restrain premium hikes on older and sicker workers.

A majority of state attorneys general and many insurance commissioners said the bill amounted to a federal power grab. The AARP, the American Cancer Society and other nonpartisan groups warned that workers and their families would lose valuable benefits, including some cancer screenings and treatments for osteoporosis.

Supporters of the bill said they were ambushed by a “fear-mongering campaign.” The measure’s author, Sen. Michael B. Enzi (R-Wyo.), said savings from the legislation would come from reduced administrative costs, not bare-bones benefits. He pointed out that large employers were exempt from many state requirements and that most of those companies offered comprehensive health benefits to their workers.

Enzi also rejected complaints by Democrats that Republican leaders had refused to allow amendments to improve the bill.

The modest changes he was willing to make were not substantial enough to attract the support of Democratic moderates, such as Dianne Feinstein of California and Joe Lieberman of Connecticut.

Democratic leaders urged opposition.

“California has one of the most comprehensive sets of required insurance benefits in the country,” Feinstein said. “The reality is that any attempt to ‘harmonize’ state benefit mandates will likely result in harm to Californians.”

Speaking before the vote, Lieberman said the debate -- part of the GOP leadership’s weeklong focus on healthcare -- was mainly an exercise in futility.

“We’re going to spend the whole week banging our heads -- and in the end, nothing is passing,” he said. “That is a failure that ultimately will signify nothing good for millions of Americans who need health insurance. I yearn for a day when we can sit down and reason together.”

After the vote, Enzi said he would work with Democrats to seek compromises that would allow the bill to be brought up again later in the year. However, supporters and opponents agreed that this week represented the best chance in years of passing the legislation.