WASHINGTON - In a clash that may doom the issue for this year, Senate Republicans narrowly beat back a House-passed bill that would grant new protections to patients covered by managed-care health insurance plans.
Four Republicans defected on the 51-48 tally against the House measure, strongly favored by Democrats, which sets forth a list of mandated benefits and allows patients to sue their insurance companies if those benefits are denied.
The GOP leadership seemed to be hardening against steps that might be necessary to achieve a bipartisan compromise that could pass Congress and be signed into law by President Clinton.
"It was never going to happen," Texas Republican Sen. Phil Gramm said of attempts over eight months to produce a compromise. "If we really want a bill, the Republicans are going to have to write the bill and pass it ourselves."
Massachusetts Democratic Sen. Edward M. Kennedy, who forced yesterday's vote on the House bill in hopes of advancing the negotiations, took the opposite view. He declared victory.
"We moved the ball closer to the goal line," Kennedy said.
If one more Republican had voted with the Democrats yesterday, and North Dakota Democratic Sen. Kent Conrad had not missed the vote, the bill could have passed on a 50-50 tie broken by Vice President Al Gore.
"We're one vote away," Kennedy said.
Even so, with only a few work weeks left in an election year and huge policy differences separating the opposing sides, prospects of enactment of a bill this year are not good.
Clinton, on returning to the White House from an overseas trip, issued a statement saying he was disappointed in the result, adding that it "means that the American people will continue to wait for the long overdue patient protections that they deserve."
Response to complaints
The measure, which Democrats call the "Patients' Bill of Rights," was developed in response to a national chorus of complaints about managed health care plans, or HMOs, that critics said were denying medical care to save money.
The bill guarantees patients specific rights, such as access to specialists, continued care by the same doctor if insurance changes during treatment, and access by women to an obstetrician or gynecologist without going through their primary care doctor.
The bill also provides for an independent outside review of medical decisions when patients appeal a denial of treatment. As a last resort, the patient could sue the health plan for such denials.
Worries about costs
Republicans say the House measure would add too much to insurance costs, pricing employers and patients out of the market.
"We shouldn't be passing legislation that would increase the number of the uninsured; we shouldn't be passing legislation that's going to make insurance less affordable," said Don Nickles of Oklahoma, the Senate majority whip.
GOP leaders say they have been trying in good faith to develop a compromise version that would be closer to the less sweeping patients' rights bill passed by the Senate last year.
But Democratic and Republican sponsors of the House bill say the effort to find a compromise has dragged on for more than eight months with almost no progress. They say Republican leaders in the Senate are reluctant to enact legislation vigorously opposed by the insurance industry.
'Road to nowhere'
"So far, it has been an endless road to nowhere," Kennedy said of the compromise talks. "The Republican leadership is adopting the practice of delay and denial that HMOs so often use themselves to delay and deny patients the care they need."
The Democrats' tactic of forcing a Senate vote on the House version of the bill was intended mostly to focus the election year spotlight on GOP opposition to what Democrats believe to be an issue popular with voters.
As the Senate debate began yesterday, Democratic Party leaders called on Gov. George W. Bush of Texas, the likely Republican presidential nominee, to "prove his support" for a patients' bill of rights by urging his GOP colleagues to pass the House bill. Bush did not respond, choosing to stay out of the fight.
Maryland Sens. Barbara A. Mikulski and Paul S. Sarbanes voted with their Democratic colleagues in favor of the House bill. The four Republicans who joined them were Sens. John McCain of Arizona, Arlen Specter of Pennsylvania, John H. Chafee of Rhode Island and Peter Fitzgerald of Illinois.
Little effect on Maryland
If yesterday's vote sounded the death knell for prospects of enacting a patient protection bill this year, that may not be bad news for Marylanders, most of whom are protected under state laws that in many cases are stronger than what Congress was considering.
Steven B. Larsen, the Maryland insurance commissioner, has been lobbying for legislation similar to the House bill because it would expand patient protections to the 872,000 Marylanders - about one in five - not covered by similar laws passed at the state level.
But, he says, he would rather see no federal legislation than enactment of the Senate bill, which would override Maryland's stronger state protections for patients when they appeal a decision by their insurance company.
If such a measure were enacted, he said, it would amount to "taking a step backward" for Maryland.
Many states have enacted patient protections, and Maryland's are among the strongest. But states don't have the power to regulate insurance plans for employees of companies that self-insure.
Generally, the Senate has preferred to limit patient protections to the 48 million Americans with insurance who fall outside the reach of state regulation.
The exception has been the appeals process, which the Senate bill would apply to all managed care patients.
But Nickles said yesterday that he would support a provision that allows governors to opt out of the federal law if they choose.
He said Democrats are insisting on a provision he opposes that would empower the federal government to block a state exemption if the state protections are not as strong as federal law.