Measure to regulate HMOs, define patient rights is dead Democrats, Republicans in Senate can't bring bill to floor for debate


WASHINGTON -- Legislation to give patients more power in dealing with health insurance companies died yesterday, a casualty of heavy lobbying by the insurance industry and of the sex scandal dogging President Clinton.

Supporters and opponents said similar legislation would be back in 1999. But this year's struggle shows once again how difficult it is to pass health care legislation affecting doctors, patients, lawyers, insurers and employers of all sizes.

Since the demise of Clinton's plan for universal health insurance in 1994, he and his allies in Congress have tried to achieve the same goal step by step. But even these proposals have set off fierce fights about the proper role of government in regulating one of the nation's biggest industries.

By a vote of 50-47 yesterday in the waning hours of the 105th Congress, the Senate rejected a Democratic move to take up a bill to define patients' rights and to regulate health maintenance organizations.

Democrats said the bill was needed to protect millions of Americans who have problems with HMOs. They said conservative Republican senators such as Trent Lott of Mississippi and Don Nickles of Oklahoma never really wanted a bill and worked with insurers to sidetrack legislation.

Senate Republicans, who introduced their own bill to define patients' rights in July, said yesterday that Democrats had passed up many opportunities for compromise because the Democrats wanted an election issue more than they wanted a new law.

Democratic candidates are, in fact, campaigning on the issue. But some Republican candidates are also promising to pass legislation helping HMO patients.

Democratic Sen. Tom Daschle of South Dakota, the minority leader, said, "Passage of real patient protections should have been the highest priority of this session of Congress," but Republicans "thwarted us at every turn."

The Senate Republican bill was narrower in scope than the Democratic bill. The Democrats said their legislation would have covered three times as many people as the Republican measure.

In an interview, Nickles, the assistant majority leader, said, "The Democrats trashed our proposal and never tried to work with us to come up with common elements that could become law."

Lott, the Senate majority leader, acknowledged that HMO patients had "some legitimate concerns and problems," and he added, "I do believe that we are going to address this next year."

The House passed a bill to define patients' rights and regulate HMOs in July. But in the Senate, Democrats and Republicans had such profound disagreements that they could not even get such legislation to the floor for debate.

The measures considered this year, known as the Patient Protection Act and the Patients' Bill of Rights Act, would have guaranteed access to emergency care and medical specialists and would have permitted patients to appeal the denial of care to an independent panel of medical experts.

The Democratic bills would also have made it easier for patients to sue HMOs and recover damages for improper denial of care.

If Congress sets uniform national standards for health insurance, that would be a major departure from the practice of the past half-century. Such insurance is regulated mainly by the states.

A coalition of HMOs, insurance companies and employers -- the Health Benefits Coalition -- vehemently opposed new federal mandates on health plans, saying such requirements would increase costs and reduce the number of people with coverage.

The coalition began its lobbying and ad campaign Jan. 21, the day of the first news reports about the president's affair with Monica Lewinsky. Clinton gave many speeches about HMO legislation, but his fight for the legislation suffered as he devoted more and more of his energy to fighting for the survival of his presidency.

Pub Date: 10/10/98

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