Democrats inching toward goal of health care reform

Incremental changes gained with help of GOP

April 18, 1999|By David Folkenflik | David Folkenflik,SUN NATIONAL STAFF

WASHINGTON -- Congressional Democrats are becoming increasingly aggressive in their efforts to achieve by piecemeal legislation much of what President Clinton failed spectacularly to accomplish with his health care initiative in 1993 and 1994.

Over the past three years, Democrats, who remain in the minority in both houses of Congress, have gained support from enough Republicans to secure passage of incremental changes -- sometimes on a disease-by-disease basis. And the young session of the 106th Congress has already yielded a flurry of bills seeking more change on two fronts: an extension of insurance to those who lack it and required coverage by health insurers for people who do have insurance.

"You can get incremental progress, but you also move forward toward the universal coverage goal," said Rep. Benjamin L. Cardin of Baltimore County, a leading Democratic voice on health care policy. "As time's going on, more and more Republicans are getting interested in this approach. We have been on the offensive, and we've made significant progress."

While some Democrats who favor guaranteed health coverage for every American say the smaller steps fall far short of what is necessary, some conservative critics are wary of what they say is a stealth campaign for a government takeover of the health care industry.

`A back-door approach'

"We think it's a back-door approach to universal care," said Kelly Loussedes, a spokeswoman for the Council for Affordable Health Care, a coalition that represents businesses opposed to many Democratic proposals.

"Who could be against kids?" she said. "Who could be against seniors getting the care they need? They're trying to create access. But they can't create access if the cost is too high."

Buoyed by successful 1997 legislation that authorized $24 billion over five years to pay for the medical care of about 5 million uninsured children, Democrats are seeking to allow 300,000 of the 3 million Americans ages 55 to 64 who lack insurance to buy into those Medicare programs now reserved for senior citizens. The measure would cost $1.4 billion over five years.

There are other proposals as well, with varying prospects for passage:

Medicare would pay for prescription drugs for specific long-term ailments, under legislation drafted by several Democrats.

Medicaid would pay for the treatment of low-income women who are eligible for federally sponsored screening for breast cancer and cervical cancer but who are not covered by the federal plan for low-income Americans, under a bill sponsored by Sen. Barbara A. Mikulski, a Maryland Democrat. During the 1990s, 4,000 women nationwide and 500 Marylanders tested positive for one of the two cancers in the program.

HMOs would have to pay for the emergency-room care of patients who "reasonably" sought immediate care for conditions that did not prove life-threatening, under a bill sponsored by Cardin and two moderate Republicans, Rep. Marge Roukema of New Jersey and Sen. John H. Chafee of Rhode Island.

Health care plans could not force women to leave hospitals after they undergo mastectomies or lymph-node dissections for breast cancer until an attending physician and the patient agreed, under legislation promoted by Rep. Rosa DeLauro, a Connecticut Democrat, and Sen. Olympia J. Snowe, a Maine Republican.

And, most prominently, Republicans and Democrats are vying over competing bills that spell out the ability to challenge rejections of coverage from managed-care plans. House Speaker Dennis Hastert helped design his party's plan, but a similar measure may have trouble passing the Senate. The Senate Republican leadership appears cool to a managed-care reform bill approved by the Health, Education, Labor and Pensions Committee.

Rep. Nancy L. Johnson, a Connecticut Republican, chided Democrats for embracing initiatives that impose new requirements on employers and health insurers, instead of offering incentives for consumers to buy insurance. But she acknowledged that many voters are highly concerned about the scope of their health care coverage and that Republicans are more willing now to help Democrats pass modest reforms than they were a few years ago.

GOP `helped them do it'

"We've helped them do it," said Rep. Bill Thomas, a California Republican who heads a House subcommittee on health care issues. "The Democrats have been able to use the failure to get [guaranteed] health care as a device to get government into that process."

Thomas said he supported a 1996 bill that allowed workers to maintain health insurance after they leave jobs. That law, written by Sens. Edward M. Kennedy, a Massachusetts Democrat, and Nancy Kassebaum Baker, a Kansas Republican, was hailed at the time as a significant reform to protect those who lost their jobs.

But now, Thomas complained, Democrats seek to extend how long workers can retain their policies after leaving a company, a step Thomas said would saddle employers with an unreasonable burden.

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