July 6, 2000 (Washington, D.C.) -- Seeking to keep the nation's focus on a "patients' bill of rights" while Congress is on recess, President Clinton on Thursday pressured Senate Republicans to vote for the bipartisan House legislation.
The House and Senate have both passed bills regulating managed care practices, but official negotiations have broken down over a final bill to send to the White House.
The cores of the two bills are significantly different. The Clinton-endorsed House bill, which passed last year with a broad bipartisan majority, would allow patients to sue health plans and would apply to the 161 million Americans in a private health plan. By contrast, the Senate bill, approved only with Republican votes, offers no right to sue and applies only to those 48 million Americans who are in group health plans that are not regulated by state authorities.
Both plans offer varying provisions to expand coverage of emergency room visits, and access to pediatricans, ob/gyns, and other specialists.
A broad coalition of doctor and patient groups endorse only the House provisions, which they claim are stronger. But last week, Senate GOP leaders shepherded a partisan 51 to 47 victory for a new measure that offers a limited right to sue.
Clinton on Thursday in turn escalated the battle by highlighting an analysis that claims that this Senate plan would actually undo current legal protections for HMO patients. "Congressional passage of the Senate bill would be far worse than were Congress to enact no measure at all," said scholars from Rutgers and George Washington University in a letter to Rep. John Dingell (D, Mich.).
Sen. Don Nickles (R, Okla.), the Senate Republican point man on patient's rights, countered Thursday that last week's Republican vote "put progress over politics" by holding HMOs accountable and empowering doctors.
Backed by most Senate Republicans, health insurers and employers have claimed that the House bill would bring a rush of frivolous lawsuits, sharply raising the cost of health care and forcing companies to drop coverage and contribute to the ranks of the uninsured.
But Clinton on Thursday claimed that the House bill would increase premiums by less than $2 per month. Four of the Senate's 55 Republicans have broken ranks to support the House measure, drawing the president to emphasize that just one additional GOP vote will give victory to the House plan.
One possible Republican vote is Sen. John Ashcroft (R, Mo.), who is feeling increasing pressure on the issue; Clinton made his remarks Thursday at an event with Missouri Gov. Mel Carnahan (D), who is challenging Ashcroft this November for his Senate seat.
John Stone, spokesman for Rep. Charlie Norwood (R, Ga.), a key author of the House bill, tells WebMD, "With no compromise whatsoever, we almost passed the House bill in the Senate. So with any kind of legitimate, reasonable compromise, we ought to have the majority over in the Senate."
Stone says that behind-the-scenes negotiations are ongoing. "Within the next two weeks, you're going to see a true compromise bill come out," he says. "Hopefully, it will be one that the leaders of both parties and the president can all say they can work with."
Others are betting on a successful compromise. Norman Ornstein, PhD, a political scholar at the American Enterprise Institute, tells WebMD, "The odds are better than 50-50 that we'll see something pass," he says, but adds, "these are still preliminary negotiations, and it's quite possible that you won't get any kind of a break until the fall."
Congress returns to work next Monday from its Fourth of July holiday. Lawmakers will work through the month, but depart again for the month of August before returning for a final month of legislating.
Ornstein notes, however, that Democratic presidential candidate Al Gore has chosen so far to focus his health care campaigning on a Medicare prescription drug benefit. "He's not making much of an effort on patient's rights," Ornstein tells WebMD. "That takes a bit of the public focus off of this, and may take some of the pressure away from doing things."