Key senators and the Bush administration failed to resolve their differences over the patients' bill of rights legislation during a White House negotiating session Thursday, setting the stage for contentious debate in the Senate next week.
"Everyone will get a vote," and there will be numerous amendments during the floor debate, predicted Sen. John McCain (R-Ariz.), the dissident Republican who is joining forces with liberal Democrats to push a tough bill that is strongly opposed by the White House.
The right of patients to sue their health plans and their employers remains the biggest obstacle to an agreement, according to participants in the meeting. Senators from both parties attended the session, along with Health and Human Services Secretary Tommy G. Thompson, Labor Secretary Elaine Chao and other administration officials.
The Senate is likely to spend two weeks in complex discussions about the best way to offer additional protections to 170 million Americans who have private health insurance.
Thursday's meeting at the White House was the first time that contending senators sat down with each other and Bush administration policymakers to seek a compromise.
Despite the intense arguments over the right to sue, all parties to the debate in Congress have generally agreed on some basic principles in the legislation:
* Patients would have the right to an independent review of decisions by their health plans when treatment is denied. If independent outside experts--a panel of doctors--agree with the patient, the health plan would have to cover the treatments.
* Patients would have the right to see specialists even if the health plan's primary care doctor refuses to make a referral.
* Health plans would be required to cover all emergency medical care and ambulance services on a "prudent layperson" standard. That means if a person thought he might be in danger, the care would be covered even if no serious illness was diagnosed. For example, a visit to the emergency room because of severe abdominal pains that turned out to be indigestion, instead of appendicitis, would be covered by the health plan.
But those noncontroversial ideas have been overshadowed by concern about the circumstances in which patients could sue their health plans or their employers. Business groups are strongly opposed to all versions of the legislation, threatening that some firms might cancel health insurance for their workers rather than run the risk of facing big liability judgments.
"Frivolous lawsuits will result in higher costs, more uninsured and could force many small businesses into bankruptcy," said Dan Danner, chairman of the Health Benefits Coalition, a group representing employers. The coalition is mounting a print and television advertising campaign against the bill sponsored by McCain and two Democrats, Sen. Edward M. Kennedy of Massachusetts and John Edwards of North Carolina.
The bill would allow lawsuits in federal court with unlimited damages for economic losses and punitive damages of up to $5 million.
President Bush has warned he will veto the McCain-Edwards-Kennedy bill if Congress approves it, but the sponsors gave no hints Thursday that they would modify their proposal.
"I welcome the fact that the United States Senate will consider the patients' bill of rights. Every day we fail to act, 50,000 Americans experience suffering," Kennedy told reporters at a news conference on the White House grounds after the hourlong meeting.
But HHS Secretary Thompson said at the news conference that the meeting had not resulted in any changes that would make the McCain-Edwards-Kennedy approach acceptable.
The bill would drive up costs and increase the number of workers without health insurance, he said. And enforcement of the legislation would add a "huge amount of responsibility" that his department would not be able to handle, Thompson said.