Unanimous Senate Approves Health Care Reform Bill

The Senate unanimously adopted sweeping legislation Tuesday to make it easier for millions of Americans to retain their health coverage even after developing a serious illness or leaving a job.

But the bill’s easy passage belies the uphill battle it faces in a Senate-House conference committee that must iron out key differences between it and a similar measure adopted last month by the House.

Both bills, which would ban an array of discriminatory insurance industry practices, are laden with controversial elements that have incited strong opposition from powerful stakeholders in the nation’s $1-trillion-a-year health care industry. These opponents range from trial lawyers and doctors to large employers and insurance companies.

And President Clinton has strongly objected to provisions in the House legislation to limit malpractice damage awards and authorize creation of medical savings accounts.

But proponents of those provisions, including Senate Majority Leader Bob Dole of Kansas, the presumptive GOP presidential nominee, repeated their strong commitment to seeing them enacted.

At the same time, Dole said that a key Senate provision requiring insurers to cover mental health on a par with physical illness should be killed in the Senate-House conference.

The mental health provision, he said, could be “very, very expensive,” adding: “I don’t see how we can keep it in there.”

At a press conference after the bill’s passage, Dole praised the measure’s “incremental” mandates and “common sense” reforms. “The Clinton era of big government health care is over,” he declared.

Senate passage of the bill, by a surprising 100-0 vote, marks a milestone in the nation’s erratic and mostly unsuccessful efforts to improve the nation’s health care system by federal fiat.

The Senate measure could represent the most sweeping health reform legislation enacted by Congress since Medicare and Medicaid were created more than 30 years ago. And its co-author, Sen. Edward M. Kennedy (D-Mass.), said he could recall no bill affecting so many Americans that passed by a 100-0 vote after inspiring so much controversy.

Independent analysts estimate that 25 million Americans a year would benefit from the bill’s provisions to make health insurance “portable” from one job to another. In addition, as many as 80 million with “preexisting” medical conditions could be affected by the bill’s provisions limiting the ability of insurers to exclude them from coverage.

Other Americans would benefit as well. The bill, for instance, increases from 30% to 80% the tax deductibility of health insurance premiums paid by the estimated 17 million self-employed Americans and their dependents. (The House measure increases the percentage to 50%.)

Small businesses would be big winners too. The bill contains technical provisions that, by preempting state laws, enhance the ability of small groups to form private, voluntary purchasing coalitions, thereby increasing their buying power.

The final debate leading up to Tuesday’s roll call was remarkable for the absence of partisan rancor, which eventually destroyed the reform agenda sought by the President and First Lady Hillary Rodham Clinton in 1993-94.

In the final minutes of debate, there were virtually no senators on the floor, save for Kennedy and the bill’s chief author, Sen. Nancy Landon Kassebaum (R-Kan.). Kassebaum is chairwoman of the Labor and Human Resources Committee, which had approved the bill, 16 to 0, in August. Kennedy is the top Democrat on the panel.

“This bill guarantees health care that’s always there,” said Sen. Rod Grams (R-Minn.), a onetime opponent of the bill who, along with many other conservative Republicans, quietly prevented it from being considered earlier this year.

Kassebaum, a popular moderate who is retiring next year after three Senate terms, called the Health Insurance Reform Act “a very modest bill.”

Nevertheless, she acknowledged, it is a significant measure that will be very valuable to many people by providing “peace of mind” and “an important sense of security.”

Both Kassebaum and Kennedy said they will urge the Senate-House conference committee, on which they will serve, to kill the three controversial provisions involving malpractice reform, medical savings accounts and mental health parity.

“The danger is, if we add too much to this, it will fail,” Kassebaum warned.

Advocates of malpractice award limits and tax-exempt medical savings accounts argued that the two features would cut medical inflation, making insurance more affordable to the uninsured.

“If the Republican majority in the House insists on including these controversial provisions,” Kennedy countered, “they will kill this bill and destroy the hopes of millions of Americans for the kind of modest but effective reform that is now well within our grasp.”

He described the legislation as “a modest, responsible, bipartisan solution to many of the most obvious abuses in the health insurance market today.”

“One of the most serious consequences of the current system is ‘job lock.’ Workers who want to change jobs must often give up the opportunity because it means losing their health insurance. A quarter of all American workers say they are forced to stay in a job they otherwise would have left because they are afraid of losing their health insurance,” he added.

Precisely because the bill is so narrowly crafted, some critics have noted that it does nothing to directly help the 41 million Americans who are now uninsured obtain coverage. Kennedy acknowledged as much during a press conference, saying more remains to be done on health care reform.

“The American people want us to keep on keeping on,” he said.

Another apparent shortcoming of the bill is that, despite the new consumer protection provisions, people still must be able to afford insurance premiums. At the same time, insurers are not required to guarantee a minimum level of health benefits.