GOP Cutting Life Support for Health Bill

Legislation that would give patients more rights in dealing with their health plans ran into major roadblocks Wednesday as the House GOP leadership began a drive to drain away support from the measure.

The bill, which has bipartisan support--the entire Democratic caucus is behind it as well as nearly two dozen Republicans--had been the odds-on favorite to win when the House votes today on several proposals that would give patients more leverage when they are denied care by their health plans.

Republican leaders, in a last-minute procedural move, abruptly cut off Democratic proposals to fund the bipartisan bill, throwing into doubt whether fiscally conservative Democrats would be willing to vote for it.

House Speaker J. Dennis Hastert (R-Ill.), who previously had opposed all legislation increasing the liability of health plans, took the surprise step of marshaling his lieutenants around an alternative patients’ rights bill that would give injured patients a new, if far narrower, right to recover damages in the courts than the bipartisan bill.

And GOP leaders pushed through a bundle of tax breaks--worth $48 billion over 10 years--aimed at expanding the availability of health insurance but including no provisions to make up the lost revenue, which makes it anathema to many Democrats. The measure would insure roughly 320,000 people who lack health coverage, according to the nonpartisan Joint Taxation Committee--that is less than 1% of the nearly 44 million people who are uninsured. The measure passed by a 227-205 vote.

Republicans planned to attach the tax break measure to one of four competing patients’ rights bills, further compounding the dilemma for fiscally conservative Democrats.

President Clinton blasted the GOP moves, saying that they amounted to putting “poison pills” into the bill.

“In the dead of the night, last night, the House leaders concocted a process filled with enough poison pills and legislative sleights of hand to practically guarantee the defeat of this bill,” Clinton said in remarks in the White House Rose Garden, adding that the GOP leadership “blatantly puts special interests ahead of the interests of the American people.”

Republicans said that they were outraged by Clinton’s comments, since from their viewpoint they are bringing to the floor patients’ rights legislation long sought by Democrats.

“They are going to kill health care because they want a political issue,” said Hastert spokesman John Feehery. “They don’t want this to go forward. They don’t want us to get credit for anything.”

Rep. Charlie Norwood of Georgia, the Republican sponsor of the bipartisan legislation, said that he was fighting to hold onto Republican supporters as the leadership, backed by a phalanx of health insurance and HMO lobbyists, tries to pull them away.

“This ain’t no small thing, baby,” said Norwood, a dentist who has spearheaded the effort on the GOP side to expand patients’ rights. “The heat is on and they are fighting.”

The leadership has made no secret of its closeness to the health insurance lobby. On Tuesday, Hastert attended a $1,000-a-plate fund-raising breakfast with leaders of the health insurance industry, including the major insurers and HMO operators who have a huge stake in the outcome of the House debate.

Rep. David Dreier (R-San Dimas) defended Hastert’s decision to attend the fund-raiser. Dreier said that the event was scheduled before a date was set for a managed care vote and had no impact on the GOP floor strategy.

The leadership’s current tack is to marshal members behind a version of the patients’ rights bill that the leaders wrote with employer groups over the last few days.

They began to gain traction Tuesday, according to GOP leaders, when Hastert emerged from a GOP conference and said that he would “probably vote for” the new bill, which has a narrow liability provision.

That bill, which is co-sponsored by Rep. Tom A. Coburn (R-Okla.), a family practice physician; Rep. John B. Shadegg (R-Ariz.) and Rep. Bill Thomas (R-Bakersfield) among others, would allow patients to recover damages from health plans in court.

But it contains provisions to insulate businesses from liability and raise the bar for injured patients to have their day in court--especially if independent medical review upholds the decision of a patient’s health plan.

The leadership’s strategy--since it is reluctant to push hard on a bill that opens the courtroom doors at all--is to urge members to vote for any bill other than the bipartisan plan sponsored by Norwood and Rep. John D. Dingell (D-Mich.).

However, vociferous support for the limited liability bill is coming from business groups. Businesses have a huge stake in the debate’s outcome. They fear that, if a broad liability provision becomes law, it is likely to be costly for them. They also worry that even a narrow liability provision that targets health plans would increase the cost of their workers’ health insurance, for which they pay the majority share.

“We’re trying to talk to members as they come on and off the floor between votes and talking to their senior staff,” said Paul Dennett, vice president for health policy at the Assn. for Private Pension and Welfare Plans, which represents medium and large employers.

On the Democratic side, the leaders are struggling to maintain their members’ support for the bipartisan bill, but say that it is an uphill battle.

Fiscal conservatives are philosophically opposed to voting for a measure that is not funded and lawmakers who are in swing-vote districts are worried about a GOP ad campaign that is accusing Democrats of spending the Social Security trust fund.

“Some of our members do not want to invade Social Security,” said House Minority Leader Richard A. Gephardt (D-Mo.), warning that the Republican moves have put the bill in jeopardy.

Passage of the tax break package and other provisions further undermined Democratic support because, like most tax incentives, they would help Americans primarily who are better off. Clinton blasted the package and pledged to veto it.