Sponsors of sweeping patients' rights legislation spurned concessions from the White House on Friday, dimming prospects for a compromise on the divisive measure before the August congressional break.
Backers of the bill said they found a long list of flaws with a proposal made Thursday by President Bush aimed at producing a compromise on disputed provisions that would greatly expand patients' ability to sue their health plans.
"We didn't reject it," said Rep. John D. Dingell (D-Mich.). "But we most assuredly did not accept it. Frankly, we're still a long way apart."
Indeed, the talks seemed to take a sour turn as White House officials bristled at a two-page critique of their proposal that sponsors of the patients' bill circulated on Capitol Hill.
The document asserted that Bush's offer failed "to address the basic principles" of the effort to reform health care laws.
The White House, which has sought to keep negotiations private, complained that the document amounted to a cheap partisan shot.
White House spokesman Scott McClellan said the critique appeared "to be an effort by some partisan Democrats to score political points rather than working with President Bush and Congressman Norwood to get strong patient protections passed this year."
Rep. Charlie Norwood (R-Ga.), who in a rare break with his party is a co-sponsor of the legislation, has been the point person in the compromise talks with the White House.
Backers of the bill--similar to legislation that already has passed the Senate--said they remain open to continued negotiations. But barring a significant new offer from the administration, neither a deal nor a vote appears imminent on an issue that has become a thorny political problem for Republicans.
Bush and other GOP leaders oppose the Democrat-backed bill, arguing that it will lead to frivolous lawsuits and a surge in health insurance premiums. But they are also seeking to avoid being blamed for the demise of a measure that, at least in general terms, has strong backing from the public.
Adding to the political turmoil is a growing division between House Republicans and the White House on how best to handle the issue and minimize political damage. Bush appears inclined to continue to press for a compromise, no matter how long that takes. But many of the House Republicans would simply like to get the issue behind them, especially as they prepare to return to their districts.
"If it hangs out over the August break, it only gets worse," said a GOP leadership aide, noting that members would likely face a barrage of ads and hostile editorials. "A lot of us don't think the vote situation is ever going to get any better."
For their part, Democrats have shown little inclination to give ground on legislation that they think they have more than enough votes to pass in the House. And if Bush and his allies thwart such passage, the Democrats think they have an effective political issue in the 2002 congressional elections.
"You win, you get the accomplishment. You lose, you get the issue," said Senate Majority Leader Tom Daschle (D-S.D.). "I want the accomplishment, but I want the accomplishment to mean something."
Searching for a way out of that trap, Republicans initially tried to garner support for a rival bill, sponsored by Rep. Ernie Fletcher (R-Ky.). This measure would place far stricter limits on patients' right to sue health maintenance organizations.
But when it became clear this week that Republicans didn't have enough votes for their alternative, party leaders canceled the planned debate on patients' rights and vowed to keep the issue off the House floor until they can defeat the Democrat-backed bill.
Bush, whose threat to veto the legislation carries significant political risk, reopened negotiations on a compromise late this week with Norwood, who has championed the patients' bill for years and holds sway with a key bloc of Republicans.
But those talks faltered Friday, when Norwood and his fellow co-sponsors brushed aside concessions from Bush on a key sticking point: whether patients should be allowed to sue in state court.
GOP leaders have fought to route most lawsuits into federal court, which rarely handles personal injury claims and is considered less likely to allow large damage awards. Bush proposed Thursday that patients be allowed to sue in either state or federal court, as long as there was a single federal statute--not a patchwork of state laws--delineating the cause of action.
House and Senate sponsors of the patients' bill emerged from a meeting Friday saying they regarded the proposal as unworkable. Sen. John Edwards (D-N.C.) said it would set HMOs apart from other industries and professions that can be sued in state court--under state laws--when their products or services cause injuries.
"HMOs ought to be treated the same as doctors," Edwards said. "This treats them differently."
Even some Bush allies in the House expressed doubts about the White House proposal. Rep. William M. Thomas (R-Bakersfield) said many members would be reluctant to create an all-encompassing federal standard that trumps state laws regulating HMOs.
Others complained that the administration's negotiations have complicated efforts to impose party discipline, with many undecided members refusing to commit until the talks are resolved.
"Rank-and-file guys are a little bit worried about what kind of deal might be cut," said the party leadership aide. "We spent all this time building up [the Fletcher alternative] and all of a sudden we could have a bill that looks a lot like Norwood's."
Though the two sides disagree sharply on the liability component of the patients' bill, they are in general agreement on other provisions that would give members of health plans a range of new rights, including guaranteed access to specialists and emergency room care.
Sponsors of the Democrat-backed bill said they would reconvene Monday to consider any new offer from Bush. But there was no indication one was forthcoming.
Some House leaders said they still hope the patients' bill can be brought to the floor for a vote next week. But the measure already has been pushed to the end of a frantic legislative calendar before lawmakers depart for their monthlong summer recess.