Senate rejects expanded HMO care

Wider emergency and women's care blocked

July 14, 1999|By Karen Hosler | Karen Hosler,SUN NATIONAL STAFF

WASHINGTON -- The Senate duel over regulating health care got off to an emotional start last night as Republicans blocked a series of Democratic efforts to broaden coverage for managed-care patients.

With only a handful of Republican defections, the Senate rejected proposals to give women greater access to gynecological care and to guarantee overnight hospital stays after a mastectomy.

Proposals to expand the definition of emergency room care and to require insurance companies to pay for treatments that doctors determine are medically necessary were also rejected.

Those tallies -- particularly the 52-48 vote on the women's issues, which Sen. Barbara Boxer, a California Democrat, dubbed a "watershed moment" -- are likely to set the tone for debate this week.

In a highly partisan exercise aimed largely at garnering support in next year's election, the two parties have offered competing bills that seek to protect patients from abuses by managed-care insurance companies.

Led by President Clinton, the Democrats are trying to pressure Republicans into supporting national standards for regulatory controls on health insurance companies.

Differing approaches

"There is no excuse for not passing it," Clinton said at a morning rally. "The Senate has got to lead the way. This is an American issue, not a partisan issue, and it ought to be that way when the votes are counted."

But Republicans are resisting what they called a "one size fits all" approach. They say they favor a more tightly drawn measure that would address the same problems in a more efficient way while avoiding what they call onerous and costly new regulations.

"This is a work in progress," said Sen. Bill Frist of Tennessee, who is the Senate's only physician and is taking the lead on the issue for Republicans. "I'm confident we will pass a bill that would benefit the American people."

Democrats have known from the start that the odds are stacked against their version of the "Patients Bill of Rights." But they are hoping at a minimum to put the Republicans on record against many of their popular proposals so that those votes might be used against Republicans in next year's congressional elections.

"If we win these votes, we'll be able to make major national policy," said Sen. Barbara A. Mikulski, a Maryland Democrat. "If we don't win, we will at least have heightened attention of the voters, giving us a greater chance of reclaiming the majority."

Last night's vote on a proposal to guarantee mastectomy patients an overnight hospital stay if doctors deem it necessary appeared to be the Democrats' best chance of persuading many Republicans to join them.

Offered by Mikulski and other Democratic women, the proposal would also give women the right to designate their obstetrician-gynecologist as their primary doctor. They say this would cut down on paperwork and speed access to doctors in life-threatening situations, such as the discovery of a breast lump.

"I thought this was one place we could come together on," Mikulski said after the vote.

Republicans, who plan to offer their own, more limited version of the mastectomy protection today, contended that the Democratic approach would add so much to the cost of health care that many women would no longer be able to afford insurance premiums.

"Many more women will die because they won't be having breast examinations," said Sen. Rick Santorum, a Pennsylvania Republican.

But some Democrats called that argument preposterous.

"Does the senator actually believe we could be offering something that would reduce coverage for breast exams and for Pap testing and still be able to get the support of the Breast Cancer Coalition?" thundered Sen. Edward M. Kennedy, a Massachusetts Democrat. "Is he suggesting any logic to his position?"

Scope of coverage

A key distinction between the two versions is the scope of their coverage. The Republicans would apply their bill only to the 48 million Americans whose health coverage is regulated by the federal government, not the states. Such coverage is generally offered by large, multistate corporations.

Many states, including Maryland, have patient-protection laws that govern insurance plans used by smaller employers.

Democrats contend that a national standard of care should apply to all 161 million people covered by managed-care insurance plans, whether federally or state-regulated.

In Maryland, where state law allows women to designate their obstetrician-gynecologist as their primary doctor, the Mikulski amendment would have made no difference for those covered by state-regulated plans. But it would have added a protection for mastectomy patients not provided by state law.

The Senate also defeated a Democratic proposal that would have expanded the definition of emergency room care to require coverage of medical problems unrelated to the emergency. Sen. Bob Graham, a Florida Democrat, told his colleagues that they had voted two years ago to give the same protection to Medicare and Medicaid patients.

But Sen. Tim Hutchinson, an Arkansas Republican, called the Graham proposal "a blank check, a gaping loophole."

Playing to the public

Democrats are determined to use the debate this week to refocus public anger on managed-care restrictions. Labor, consumer and medical organizations supporting their bill are running television and radio ads, while senators hold news conferences featuring victims of managed-care abuses.

On the Republican side, a coalition of corporate executives, small-business owners and insurance companies has invested nearly $1 million in ads warning of the extra costs they say the Democratic version would mean.

"We're finding that when people hear individual stories of people who have been abused by their insurance companies, they want something done about it," said Johanna Schneider of the Business Roundtable. "But when they hear how much it would drive up costs, they go real cold, and figure there should be some other way."

Pub Date: 7/14/99

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