Preventive Care Vote in Senate Cracks Logjam

Breaking a partisan standoff Tuesday to cast its first vote on health care reform, the Senate adopted a Democratic measure that would require all private insurance plans to begin covering prenatal care and childhood immunizations by next July.

After a week of desultory debate amid a rising chorus of Democratic complaints that Republicans are engaged in delaying tactics, the 55-42 vote provided the first solid indication of the rocky road facing Congress as it attempts to enact comprehensive reform before adjourning early in October.

Only two Republicans voted for the two-page amendment while one Democrat voted against it.

And even as the Senate began voting on amendments to the bill crafted by Senate Majority Leader George J. Mitchell (D-Me.), as many as 20 senators from both parties--billing themselves as centrists--met off and on throughout the day and into the night in an effort to craft an alternative.

“This means we still have a long way to go from doing anything on health care,” said Sen. Patrick J. Leahy (D-Vt.).

From the other side of the aisle, Sen. Pete V. Domenici (R-N.M.) agreed, saying that the vote had “nothing to do with progress” on health reform.

And Sen. J. James Exon (D-Neb.) emphasized after the vote that the 55 votes for the amendment, offered by Sen. Christopher J. Dodd (D-Conn.), “in no way reflected the support” for Mitchell’s bill, meaning that the proposal still lacks the votes it needs for passage.

Dodd’s amendment would require insurers to provide preventive care to pregnant women and children by July with no co-payments. Mitchell’s bill has such a requirement, but it would have taken effect 18 months later.

Domenici and other Republicans characterized Dodd’s amendment as unnecessary government intrusion into medical decisions that are best left to physicians and other health providers.

“It’s just the path I don’t think we want to go,” said Sen. John H. Chafee (R-R.I.). “This was a vote on whether you want the secretary of health and human services to develop a plan or let the marketplace do it,” Domenici added.

Dodd introduced his amendment Friday night, and almost immediately tempers frayed as Republicans continued making often rambling opening statements on health reform, delaying any votes on amendments to Mitchell’s bill. Since Dodd’s amendment was introduced, the Senate has spent nearly all of Saturday, Monday and Tuesday ostensibly debating it.

It was only after Mitchell threatened late Monday to keep the Senate in session round the clock that Republicans, after an hourlong caucus Tuesday afternoon, agreed to allow a vote on Dodd’s amendment.

The two Republicans who voted for the amendment are Sens. James M. Jeffords of Vermont, the sole GOP sponsor of President Clinton’s bill last year, and William V. Roth Jr. of Delaware. Sen. Bob Kerrey of Nebraska was the only Democrat to vote against the proposal. Both California senators, Dianne Feinstein and Barbara Boxer, voted for the amendment.

Adding to the increasingly partisan tone of the health care debate, Sen. John B. Breaux (D-La.), a key moderate, criticized the attendance at the GOP caucus of Haley Barbour, chairman of the Republican National Committee.

Barbour’s presence, Breaux fumed, meant that “health care has become clearly a political, as opposed to a health reform, opportunity.”

When the Senate resumes debate on health care today, the amendment process is expected to continue, with Republicans set to offer the next amendment.

Senate Minority Leader Bob Dole (R-Kan.) said that Republicans are ready “to try to keep this thing moving” but quickly added:

“We think it’s very important that we have an opportunity to tell the American people about the bill. . . . We’re going to continue to make our case. We’re not going to be rushed.”

Democratic leaders, in a press conference, however, professed a rosier outlook.

“We’re off and running. This is the beginning,” said Sen. Tom Daschle of South Dakota.

“It is a breakthrough,” added Sen. Edward M. Kennedy (D-Mass.) “All of us are hopeful we can put away the cots . . . and really get about the business of the Senate.”

Meanwhile, Sen. John C. Danforth (R-Mo.), one of the group of senators who are trying to fashion another reform proposal, said that the group’s emerging plan aims to raise the percentage of Americans with health insurance from the current 85% to “the low 90s.”

Mitchell’s bill aims for 95% coverage by the year 2000, relying on voluntary measures and a variety of insurance reforms and subsidies to the needy. It would trigger an employer mandate by 2002 in states that had not achieved 95% coverage, requiring large businesses to pay at least 50% of a worker’s health insurance premiums.

Several of the senators working on the alternative plan said that cost containment is their priority. But Breaux said that they are also seeking to reduce the benefits package, perhaps by requiring the elderly to join health maintenance organizations or managed care networks to receive coverage for prescription drugs.

Separately, Sens. Sam Nunn (D-Ga.), David L. Boren (D-Okla.), Robert F. Bennett (R-Utah) and Domenici were preparing a bare-bones bill along the lines of one offered in the House last week by Republicans and Southern Democrats.

Also on Tuesday, First Lady Hillary Rodham Clinton spoke at a rain-shortened rally on Capitol Hill, where a pro-White House group, Families USA, unveiled a clock that it said tallied the number of people that have lost insurance since the Senate began its debate.

The count, which does not adjust for those who regain coverage, had run to more than 500,000 and was growing by 51 a minute.

“We can see the numbers ticking away behind us,” Mrs. Clinton said. “It really is a question of security. . . . Millions know what it means to live on the edge of personal security.”