The House will get little time to recover from its bruising battle over campaign finance reform before facing a similarly searing partisan struggle over patients' rights.
Both issues center on measures that passed the House in previous years but confront major new obstacles in the chamber this time around. Both hinge on the readiness of GOP moderates to flout the will of their party's leaders. And both are reform causes that have become crusades for Sen. John McCain (R-Ariz.).
A key difference on the patients' bill is the more direct involvement of President Bush, who has threatened to veto the Democratic-backed measure that passed the Senate last month and could be debated in the House as soon as this week.
Bush has attacked the Senate bill as a measure that would trigger an avalanche of lawsuits against health insurers and drive up premiums because of provisions that would dramatically broaden the legal rights of patients. Bush reiterated that critique in his weekly radio address Saturday.
He stressed that he supports a bill "that provides immediate access to specialists and an immediate appeal to a panel of doctors when an HMO denies care." But he added: "I hope to sign a bill that gets people help when they need it, not a bill adding hundreds of dollars to the high premiums they already pay."
Still, Bush may be hard-pressed to follow through on his veto threat, if it comes to that, because of another key difference between campaign finance reform and patients' rights: The health care bill seems to be a much higher priority for the public.
Overhauling the nation's campaign finance laws rarely registers in polls as a top concern of voters, although McCain says that voters do bemoan the influence of big money in politics. But polls repeatedly show a great deal of public support for patients' rights legislation--at least in general terms. And approval ratings for HMOs are typically lower than for almost every other public institution.
The patients' rights bill the Senate approved would carve out an array of new protections for the 190 million Americans in private health plans. It would guarantee access to specialists, leave it up to patients to determine when they need emergency room care and where to seek it and require independent reviews by physicians of some disputes over treatment decisions.
But the bill's most controversial component would greatly expand patients' ability to sue HMOs over denials or delays of treatment. Patients could sue in both state and federal courts, with the ability to collect unlimited damages for pain and suffering, and punitive damages of up to $5 million.
A nearly identical bill is sponsored in the House by Reps. John D. Dingell (D-Mich.), Greg Ganske (R-Iowa) and Charlie Norwood (R-Ga.).
But, taking a page from their strategy in campaign finance reform, House GOP leaders have constructed a competing patients' bill designed to crack the coalition supporting the more sweeping measure.
Bill Curbs State Suits
The GOP measure, sponsored by Rep. Ernie Fletcher (R-Ky.), would ban punitive damages and cap pain-and-suffering awards at $500,000. It would also prohibit suits in state court except in cases where an HMO refuses to abide by the decision of an independent review panel.
But Fletcher acknowledged he wasn't sure he had the votes to defeat the Democratic-backed bill or pass his own, saying, "It's going to be close."
Both sides acknowledged the similarities between the politics of patients' rights and campaign finance reform. For starters, the stakes of both issues are higher than in previous years because the Senate has already passed legislation, raising the likelihood that whatever emerges from the House will become law or face a Bush veto.
"These are real bullets now," Fletcher said.
And both sides said the patients' rights debate is likely to be colored by the bitter fight in the House on Thursday over campaign finance reform. A planned vote on that issue went by the boards after leaders from both parties failed to agree on the terms of floor debate.
All but one House Democrat and 19 Republicans voted down the procedural rules drafted by GOP leaders that reform supporters charged would have put their legislation at a major disadvantage. The defection of so many Republicans was a rebuke to House Speaker J. Dennis Hastert (R-Ill.), and Democrats saw that as an encouraging sign for their patients' rights bill.
"A bunch of Republican members stood up to the Republican leadership," Dingell said. "That is useful independence . . . from my standpoint."
But House GOP leaders said they remain confident that their patients' bill will prevail. "I think campaign finance is a peculiarly troublesome issue," said John Feehery, Hastert's press secretary. "I don't think it will have any spillover into patients' bill of rights."
Dingell said he and other sponsors of the Democratic-backed bill plan to unveil a new version Monday or Tuesday, reflecting adjustments made to reflect amendments to the Senate version that added liability protections for employers who provide health insurance. The House debate could begin by the end of the week.
Bush also used his radio address to focus on another health care issue, calling on Congress to support his proposal to add new prescription drug benefits to Medicare, the federal health insurance program for senior citizens.
Bush Backs Discounts
The plan, announced by Bush on Thursday, would create discount cards entitling Medicare recipients to price reductions ranging from 10% to 50% at participating pharmacies.
"This program will provide immediate help to seniors without destabilizing Medicare's finances," Bush said.
In response, Sen. Tim Johnson (D-S.D.) said in his party's radio address that Bush's plan does far too little to help seniors afford rising prescription prices.
"Modest discounts may be a start," he said. "But this year, Senate Democrats hope to accomplish a meaningful, universal, voluntary system that seniors can count on to provide access to drug coverage they simply don't have today."