Democrats Fail to Force GOP to Move on Patients’ Bill

Though narrowly losing a vote on a patients’ bill of rights amendment Thursday, Senate Democrats signaled the start of a guerrilla war that is likely to bring increasing pressure on the GOP leadership to compromise on the measure before November’s elections.

Seeking to advance discussions that have been stalled in a House-Senate conference committee for months, the Democrats offered their version of a managed care bill as an amendment to unrelated legislation authorizing Department of Defense programs for 2001.

While the amendment was tabled, the Democrats picked up two more Republican votes than they had last year, leaving them just one vote shy of a tie.

All 51 votes against the measure were cast by Republicans. Forty-four of the 45 Senate Democrats and four Republicans voted for the measure. The four Republicans were Sens. Peter Fitzgerald of Illinois, Lincoln Chafee of Rhode Island, John McCain of Arizona and Arlen Specter of Pennsylvania. Sen. Kent Conrad, a Democrat from North Dakota, did not vote.

“It’s very important to the American people to know where senators stand,” said Sen. Edward M. Kennedy (D-Mass.), one of the bill’s leading proponents.

The aim of the vote, he said, was to jump-start conference committee negotiations that so far have been “an endless road to nowhere.”

Republicans charged Democrats and the White House, which backed Thursday’s maneuvers by the Democrats, with undermining the GOP’s effort to reach a compromise and suggested that it will be even more difficult now for negotiations to go forward.

“Everything the White House has done, everything the Democrats have done is very detrimental to getting a bill enacted,” said Senate Majority Whip Don Nickles (R-Okla.). “It’s hurtful to the process.”

Sen. Phil Gramm (R-Texas) went further, saying that the Democrats’ move was motivated by election-year politics and accusing Kennedy of a “cynical political act.”

“This is an election year, we are proving here on the floor of the Senate,” Gramm said.

Allowing the conference committee on the managed care bill to drag on for months has been a high-stakes gamble for Senate Republicans who chair the House-Senate conference. They have been betting that voters care less about patients’ rights than other health care issues, and, in general, the polls have borne them out.

Now, however, with Democrats willing to force votes on the floor, they are putting Republican senators running for reelection in the position of being tagged by opponents as among those who held up action on a patients’ bill of rights. That is a far more potent political weapon and could raise the issue’s importance in voters’ minds.

Adding pressure on the Senate GOP is growing frustration among House Republicans, who are at risk of losing their majority. Nearly a third of GOP House members supported the Democratic version of the legislation last year.

Speaker J. Dennis Hastert (R-Ill.) has steadily pushed Senate leaders to come up with a compromise that will pass both chambers and that President Clinton will sign, in hopes of giving his troops a popular, consumer-oriented legislative accomplishment to tout when they campaign this fall.

Hastert spoke with Nickles just before the Memorial Day recess to urge that the two chambers and both parties keep working together. “The speaker’s goal all along has been to craft a bill that provided needed patient protections so that patients could get care--not necessarily in court--and to get the bill signed into law,” said Peter Jeffries, Hastert’s communications director.

At the heart of the debate are deep philosophical differences between the Senate Republican bill and the Democratic one, as well as serious tension between the two leading negotiators: Nickles and Kennedy. The two men have starkly different views on the role of government in the health care system. Nickles wants to let the private market govern and leave most decisions up to the states. Kennedy argues that consumers should have the same rights regardless of what state they live in.

Two big issues have made reaching a compromise particularly difficult. Democrats and a bipartisan group of House members always have supported versions of the legislation that ensured that the full array of patient protections covered roughly 170 million Americans--everyone in a private health plan. They have also supported making managed care companies liable when a patient is injured as a result of a plan’s medical decisions.

In contrast, Senate Republicans have sought to limit much of the legislation’s scope to the roughly 50 million Americans whose health plans are regulated by the federal government. A broader group--125 million Americans--would be covered by the legislation’s provision allowing patients to appeal a health plan’s denial of coverage of a treatment or visit to a specialist.

Until recently, GOP senators have steadfastly refused to consider opening up HMOs to new liability. Indeed that position has been a near-mantra for the party, which views trial lawyers largely as a destructive force for the private health care market. They say that lawyers would bring frivolous suits, driving up health care costs for everyone.

Democrats, even some who are usually supportive of the insurance industry, argued strenuously against that position.

“I believe that when an insurance company makes a medical decision or a business makes a medical decision they ought to be held accountable, just as doctors are held accountable,” said Sen. Christopher J. Dodd (D-Conn.), whose state is headquarters for a number of the nation’s largest insurers, including Aetna/US Healthcare. “This is not a groundbreaking idea.”

Nickles said that he had not completely given up on the conference negotiations. But it is also possible that Clinton and top leaders from both parties might try to break the impasse.