WASHINGTON -- Despite four days of impassioned efforts by Democrats, Senate Republicans held their ranks last night to approve their own bill to protect managed care patients, instead of a more sweeping Democratic version.

The bill passed on a vote of 53-47, with two Republican defections: Sens. John H. Chafee of Rhode Island and Peter Fitzgerald of Illinois. The tally was similar to most of the votes on amendments this week.

Republican leaders described their bill as a more efficient, less costly, less burdensome approach than the Democrats' version.

"This is a comprehensive package that will strengthen rights of patients and improve the way HMOs work, without wrecking the American health care system," declared Senate Majority Leader Trent Lott.

Democrats charged that the Republicans were more concerned about insurance company profits than about guaranteeing that Americans can receive the health care they need.

"Under the Republican bill, it is the HMO accountants who are playing doctor, denying the real doctors the ability to implement medically sound decisions," said Senate Democratic leader Tom Daschle.

Vice President Al Gore showed up at the Capitol during yesterday's debate to declare that President Clinton would veto the bill if enacted by Congress in its present form. The House has not yet acted on the measure.

"It has zero chance of going past his desk because it's a fraud" that would in some cases set coverage standards below what some insurance companies are offering voluntarily, Gore contended.

Most of the protections in the Republican bill would apply only to the 48 million Americans whose health plans are regulated by the federal government. The Democrats would have extended new protections to all 161 million Americans covered by managed care policies -- but at a cost that Republicans said would drive prices so high that nearly 2 million Americans could lose their coverage.

Unlike the Democratic version, the Republican bill would not give patients the right to sue their insurance companies if they were harmed by a denial of care.

But Republicans accepted some Democratic ideas -- such as new protections for breast cancer patients and guarantees of direct access to obstetrician-gynecologists, pediatricians, specialists and emergency room care.

Deductions, savings accounts

The Republican measure also includes provisions to expand access to health care for the uninsured, including 100 percent tax deductions for long-term care insurance and health insurance policies purchased by the self-employed. In addition, it would allow all Americans to create medical savings accounts as a health insurance option.

"When our bill takes effect, it's going to mean better health care, it's going to mean greater access to health care, and it's going to mean that when you're sick, you're going to get an opportunity to see a doctor rather than a lawyer," said Sen. Phil Gramm, a Texas Republican.

The Senate vote last night demonstrated that the Republicans were better prepared to resist political pressure to bend to the Democrats on health issues than they were in the gun-control debate two months ago, when Democrats persuaded some Republicans to support their proposals.

Democrats entered the managed care debate this week expecting defeat but hoping to focus attention on an issue of such interest to many Americans that public pressure might ultimately bring at least a minority of Republicans their way.

Despite last night's defeat, they said they have no intention of giving up.

"We will continue bringing [the legislation] up again and again until Congress finally passes a good Patients' Bill of Rights," Daschle declared.

Bipartisan compromise fails

Particularly disappointed last night was a bipartisan group of centrist senators who tried to fashion a last-minute compromise that failed to attract enough support. In the end, neither the Republican nor Democratic leaders in the Senate were enthusiastic about a middle-ground approach.

"It seems to me that we could have done a better job here," said Chafee, a leader of the centrist movement.

Several of the moderates seeking compromise suggested that some members of both parties were more interested in jockeying for position on the issue in the 2000 election campaign than in passing a bill.

"The debate that's going on now is one of the most partisan and the most vacuous, the most devoid of effort to try to reach a solution that I've heard in a long time -- and that's saying something," said Sen. Max Baucus, a Montana Democrat.

At one point yesterday, Sen. Edward M. Kennedy, a Massachusetts Democrat, said he would rather use the remaining time to debate Democratic amendments that were certain to lose, than spend time on the centrist compromise.

"Senator Chafee's bill is good," Kennedy said. "But ours is better."

Patients' right to sue

The most fundamental conflict between the two parties is probably their disagreement on whether to allow managed care patients to sue their insurance companies for damages.

The Senate voted 53-47 yesterday against allowing aggrieved patients to sue for damages in state courts, which Democrats argued would force insurers to place a higher priority on patients' health than on insurers' profits.

"The health insurers won't let them do it," Clinton said at a White House gathering. "It's a sad day for health care in America. But we're not done yet, and this won't die."

Republicans contended that, from a practical standpoint, lawsuits could not ensure speedy treatment for patients who have been unfairly denied care. Instead, the Republicans asserted, lawsuits would drive up the cost of insurance premiums, forcing so many employers out of the market that an estimated 1.8 million Americans would lose coverage.

"While you're waiting for the courts to act, you could wind up crippled in a wheelchair," said Sen. James M. Jeffords, a Vermont Republican. "You might get a big check, but."

Appeals process

As an alternative, the Republicans approved a grievance and appeals process that provides for both an internal appeal and an external appeal to an independent medical expert for cases in which patients believe that insurers have improperly denied them treatment.

The appeals procedure would apply more broadly than other features of the Republican bill to 124 million Americans who have health insurance through private employers. Democrats support that procedure but say access to courts is needed as a last resort.

Most provisions of the Republican bill would apply to the 48 million Americans who receive their health insurance through large companies that underwrite their own policies. Typically, those are multistate corporations subject to federal regulation rather than state regulations.

Republicans argue that the federal government should not overrule health care policy decisions made by the individual states.

Pub Date: 7/16/99