House Set to OK Broad Reforms in Health Care

The House moved toward approval late Thursday of a broad health care reform bill that would enable tens of millions of Americans to keep their insurance after changing jobs--even if they have an existing illness.

By far the broadest health care legislation approved by either house of Congress in decades, the measure would make insurance portable, generally barring insurers from denying coverage to new employees even if they have “preexisting” medical problems.

The bill, expected to win approval by a comfortable margin, also would place limits on malpractice awards and would provide for tax-exempt medical savings accounts. Its Republican sponsors said that those two features would encourage competition that would cut medical inflation, thus making insurance affordable to some of the 41 million uninsured Americans.

The bill is the latest to emerge from a new burst of legislative activity by the Republican majority in Congress that is becoming increasingly wary of the perception that it has presided over a largely do-nothing Congress--heavy on ideology and partisan rhetoric but light on substance.

That is a message many Democrats are field-testing as the general election campaign nears and one that Senate Minority Leader Tom Daschle (D-S.D.) and House Minority Leader Richard A. Gephardt (D-Mo.) together invoked at a Capitol Hill press conference Thursday.

The health care debate also is focusing a spotlight on the rivals in the November presidential election: President Clinton and Senate Majority Leader Bob Dole (R-Kan.).

Independent analysts say that 25 million Americans a year could benefit from having portable health insurance, while as many as 80 million have medical conditions that could subject them to coverage exclusions based on “preexisting condition” clauses. Consumers would have to pay the premiums, which the bill seeks to keep within prevailing market rates.

Still, the legislation faces a contentious battle in the Senate and the outcome is far from certain. Some critics in that chamber contend that the bill attempts to do too much while others argue that it does not go far enough to cure the ills of the nation’s health insurance financing system.

And lurking on the sidelines are the same array of powerful--and feuding--interest groups that played a large role in killing Clinton’s massive health reform plan two years ago.

The Health Coverage Availability and Affordability Act also faces a probable Clinton veto unless it is stripped of the provisions on malpractice reform and medical savings accounts.

The measure would impose a limit of $250,000 on the amount that can be collected by a victim of malpractice for noneconomic damages, which also is sometimes defined as compensation for pain and suffering. Such limits have long been sought by physicians--but resisted by trial lawyers.

Medical savings accounts are tax-exempt funds that, like individual retirement accounts, anyone may set up and use to pay for out-of-pocket medical expenses. Those using the accounts would have to buy low-premium, high-deductible “catastrophic” illness policies.

Critics of medical savings accounts say that they are likely to be beyond the reach of the poor or even most people who currently have insurance. And the managed care industry believes that these accounts threaten their ability to control costs.

But proponents say that account users would become more cost-conscious in how their money is spent for routine medical services, while enjoying unrestricted choice of physicians.

In the Senate, a similar but less broad health reform bill is to be taken up next month. But conservative Republican senators said this week that they intend to add to the measure malpractice reform and medical savings accounts. Critics of that approach, including Sen. Nancy Landon Kassebaum (R-Kan.), the bill’s chief author, said that those provisions are so controversial that they could cause the bill’s demise.

Across the aisle, Democrats are calling on Dole to persuade his fellow Republicans to abandon the more controversial elements so that Congress can enact a bill that stands a chance of being signed into law.

“This bill is a crucial test for the Republican standard-bearer,” Gephardt said. “Let’s face it: If Bob Dole can’t rein in the radicals of his own party, there is no way President Dole would be able to do so.”

Some Democrats also accused House Republicans of harboring a hidden agenda, saying that majority lawmakers have been adding controversial elements to the bill precisely to kill it.

Referring to Clinton’s gargantuan Health Security Act, Rep. Sam M. Gibbons (D-Fla.) told House Republicans: “Past efforts at reform have failed because they tried to do too much. You are heading down the same road and it makes one wonder if this isn’t a conscious effort to sabotage and sink the modest and relatively noncontroversial reforms.”

Republicans were miffed by the claims. “Totally ludicrous,” snapped Senate Majority Whip Trent Lott (R-Miss.) when asked about the Democratic charges.

“This is likely to be the only significant health care bill that will pass through the Congress,” added Rep. Bill Archer (R-Texas), chairman of the Ways and Means Committee. As a result, he said in an interview, it is the natural and only vehicle for other health care proposals, such as medical savings accounts and malpractice reform.

Indeed many senators also are waiting to add their pet projects to the Senate bill when it comes up for action next month.

One is a proposal by Sen. James M. Jeffords (R-Vt.) to ban lifetime limits on health insurance policies. Another, by Sen. Paul Wellstone (D-Minn.), would include injuries from domestic violence as “preexisting” conditions that no longer would be grounds for denying coverage. The House bill also contains this provision.

House Democrats accused Republicans of paying off big GOP contributors--namely the Golden Rule Insurance Co., an Indiana-based firm that has given more than $1 million to Republican causes and organizations in recent years. The company would be likely to benefit significantly from marketing medical savings accounts.

“Last Friday was political payday for the National Rifle Assn. with a vote to repeal the assault weapons ban,” Rep. Cynthia McKinney (D-Ga.) said Thursday. “Yesterday was political payday for the anti-choice crowd with a vote to ban an extremely rare abortion procedure. And today is political payday for the Golden Rule Insurance Co. and its medical savings account scheme.”

Archer, who closed the debate Thursday night, denied such charges and urged an affirmative vote for the GOP bill. He said that it “will bring help to millions of needy Americans. And it does it by relying on the private sector--not the government.”

“It’s exactly the right dose of medicine,” Archer added. “Too much medicine is bad for the patient but too little medicine won’t help the patient get better. This bill is the right amount of medicine.”

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