The Senate is poised to pass a patients' rights bill as soon as today, after frustrated Republicans announced one final push to change legislation that would give millions of Americans far greater leverage in their health plans.
After offering about a dozen amendments, GOP leaders said they plan to call for a vote on a substitute bill that they have crafted and has been endorsed by President Bush. But by late Thursday, it appeared clear the Republicans lacked the votes to significantly alter--let alone stop--a health care measure that newly empowered Senate Democrats made their top legislative priority.
The Democrats on Thursday again thwarted a flurry of GOP amendments, and the Senate passed a key compromise that would protect the vast majority of employers from health care lawsuits by employees.
Republicans said they still hope to impose stricter limits on how much money patients can collect in damages when they sue HMOs. But few in the GOP expected that amendment to prevail. Asked whether there was much chance to change the legislation, Sen. Kay Bailey Hutchison (R-Texas) replied: "We think not much."
As a result, after a day of political brinkmanship, sponsors of the bill were confidently predicting their legislation would sail through final passage either today or Saturday.
"The inevitability of the outcome is increasingly clear," said Sen. Edward M. Kennedy (D-Mass.), who sponsored the bill along with Sens. John McCain (R-Ariz.) and John Edwards (D-N.C.).
The legislation would give patients an array of new rights, including direct access to certain specialists without first having to go through a gatekeeper and guaranteed coverage for emergency room visits. The measure also would greatly expand a patient's ability to sue HMOs over denials or delays of treatment.
Republicans have attacked those liability provisions, arguing that exposing HMOs to unlimited damages will drive up health insurance premiums and perhaps cost millions of Americans their coverage. Citing those concerns, Bush has threatened to veto the legislation.
But Democrats, while making compromises on other fronts, were unbending on provisions that would allow patients to sue for unlimited economic and pain-and-suffering damages, and punitive awards up to $5 million. "Nothing persuades an HMO to do the right thing more than the fear of liability if they do the wrong thing," Kennedy said.
With final passage of the patients' rights bill increasingly seen as a foregone conclusion, the administration has turned its sights to the House, where Republicans are scrambling to gather support for a bill that places strict limits on damage awards.
As part of that GOP effort, Bush and Vice President Dick Cheney huddled with 18 key House Republicans, including Rep. Mary Bono (R-Palm Springs), at the White House on Thursday. The sessions were part of what administration officials have described as a stepped-up lobbying campaign by the president.
But it's not clear that Bush will fare any better in the House, which has voted twice in recent years in favor of a patients' bill virtually identical to the legislation now moving in the Senate.
House Minority Leader Richard A. Gephardt (D-Mo.) said Thursday that he doubts the administration will be able to attract enough votes to derail the Democrat-backed bill.
"I just don't think they're going to get there," Gephardt said.
Confident of the outcome in the House, sponsors of the Senate bill said they hope Bush will reconsider his veto threat after reviewing the compromises they reached this week with Republicans.
Resolving one of the most difficult standoffs, the Senate voted 96 to 4 Thursday to support an amendment offered by Sen. Olympia J. Snowe (R-Maine) and other moderates that would exempt employers from liability under the act, unless they are self-insured and administer their own health plans.
Even employers--or unions--that fall into the latter category would have additional protections. They could be sued only over medical coverage decisions, not contractual or administrative disputes. They also would be shielded from liability if their plans merely process and pay for claims after treatment is rendered and don't require employees to get pre-approval for treatment.
The amendment came in response to continuing GOP complaints that the patients' bill would unnecessarily expose employers to liability.
In another compromise, the Senate voted 64 to 36 to allow state laws covering patients' rights to override the federal statute as long as the state measures are "substantially compliant" with the national standard.
Edwards said he also had reached a deal with Sen. Fred Thompson (R-Tenn.) that would require patients to pursue disputes through an independent review panel--and exhaust that process--before being allowed to sue. The deal creates an exception for patients when the appeals process drags on longer than 31 days. An amendment based on this amendment is to be offered today.
In other disputes, Democrats continued to deflect Republican efforts to change the bill. An amendment offered by Sen. Christopher S. Bond (R-Mo.) that would have capped at 15% attorneys' share of damage awards in HMO suits was defeated, 62 to 38.
An amendment offered by Sen. Arlen Specter (R-Pa.) that would have required all HMO lawsuits to be handled in federal court was defeated, 58 to 42.
Democrats have insisted that the suits should be allowed in state court, where plaintiffs can request jury trials and where judges are more experienced with personal injury claims.
Times staff writer Edwin Chen contributed to this story.