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Senate OKs GOP Health Care Bill Amid Veto Threat

Reform: Modest measure to broaden patients' rights passes, 53-47, mainly along partisan lines. But Democrats say the plan excludes more than 100 million Americans.

July 16, 1999|ALISSA J. RUBIN | TIMES STAFF WRITER

WASHINGTON — The Senate's emotional weeklong debate on managed health care ended late Thursday with the approval of a Republican measure that would take modest steps to broaden the rights of some patients.

Republicans said the bill, which passed 53-47, largely along party lines, makes important strides to protect patients without risking an increase in the price of health care or leaving insurance companies and employers vulnerable to frivolous lawsuits from patients.

But Democrats blasted the measure, saying it leaves out more than 100 million Americans, including many people in HMOs, and offers only weak protections to those it purports to help.

President Clinton also strongly criticized the Republican bill, threatening a veto if it comes to his desk.

"It has zero chance of going through his desk because it's a fraud," Vice President Al Gore said at a Capitol Hill news conference. Gore and the Democrats pledged to keep bringing the issue back until a version they can support becomes law.

The House has not yet considered managed care legislation this year but plans to take up the issue later this month.

Most of the patients' rights in the Senate-approved bill would somewhat broaden access to emergency care, obstetrician-gynecologists and clinical trials for the 48 million people who work for companies that self-insure their employees--in other words, where the employer, rather than an outside insurer, assumes the risk. Many states, including California, have similar laws, but they do not apply to companies that self-insure. There are about 2 million Californians in self-insured plans.

Under the measure, both the self-insured and an additional 75 million people whose employers purchase health insurance plans would gain access to an independent appeal process if they want to dispute a denial of coverage by their managed health-care plans.

To win over wavering Republican members, a $13.4-billion package of tax breaks over five years was added to the bill, including a deduction for the purchase of long-term care insurance, giving the self-employed a 100% tax deduction for their health insurance premiums and expanding the availability of medical savings accounts.

Also added to the legislation, at the behest of Sen. Olympia J. Snowe (R-Maine), was a provision to ensure that a woman and her doctor--not her insurance plan--decide how long she can stay in the hospital after a mastectomy.

Two Republicans voted against the bill: Sens. John H. Chafee of Rhode Island and Peter G. Fitzgerald of Illinois.

The Republican legislation "will strengthen the rights of patients and change the way HMOs work without wrecking the health care system," said Senate Majority Leader Trent Lott of Mississippi.

Democrats sharply disagreed, saying the bill would do nothing to improve the quality of health care. "You can put lipstick on a pig and it's still a pig," said Sen. Edward M. Kennedy (D-Mass.). "That is what the Republican proposal is all about."

The debate allowed both parties to win political points.

Republicans were able to say that they passed a bill protecting patients' rights--a boast that could prove especially useful for senators who are facing reelection in 2000. And Democrats can point out that Republicans rejected broader patients' rights.

Overall, however, Republicans carried the day, blunting many of the Democratic charges by offering their own versions of most provisions.

A Democratic version of the measure was supported by many doctors, nurses and consumer groups. Fighting the Democratic measure was the health insurance industry, HMOs and employer groups, who spent millions of dollars on a lobbying and advertising campaign to defeat it.

"I am disgusted and frustrated by the fact that a very strong special interest can have such a grip on our Congress," said Jack Lewin, executive director of the California Medical Assn.

"The result, in my view, actually strengthens the hand of the investor-owned HMOs over patients . . . . It's disheartening and frustrating. This should be a bipartisan issue," Lewin said.

Lott hailed the Senate action. "It is the right thing to do, and this is the right time to do it."

"This is a victory for patients, with improved access to health care for Americans," declared Sen. Bill Frist (R-Tenn.), the Senate's only physician, who helped put together the GOP plan. "It achieves a balance [for] doctors and patients . . . with a cost that does not hurt access to care."

The Republicans received tacit support from the business community and insurers, who were on hand throughout the debate in a marble-floored room a few feet from the Senate chamber to help review amendments and buttonhole lawmakers.

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