Partisan standoff keeps Senate from agreement on managed care

Disputes over scope of coverage, patients' grievances hinder efforts

July 15, 1999|By Karen Hosler | Karen Hosler,SUN NATIONAL STAFF

WASHINGTON -- A majority of senators favor easing restrictions on managed care patients, but a partisan standoff continued yesterday to prevent them from reaching a broad agreement.

Republicans scrambled yesterday to offer proposals on women's health issues and emergency room care similar to Democratic measures they had defeated Tuesday. But they rejected a Democratic effort to expand the legislation to cover all managed care patients.

"It's an evolving product," said Sen. Bill Frist, a Tennessee Republican, who promised that the final bill would best serve the interests of the American people.

But Democrats charged that the Republicans were going through the motions of offering attractive-sounding proposals that would have little practical effect.

"This is going to be `cover yourself day' for Republicans," said Senate Democratic Leader Tom Daschle.

Rhode Island Republican Sen. John H. Chafee was working last night on a compromise that his spokesman said would embrace most of the Democratic proposal.

The outcome of Chafee's efforts remained uncertain, however. A spokeswoman for Daschle said last night it appeared unlikely Chafee would be able to win enough Republican support for a proposal that would keep all 45 Democrats on board.

In an example of the conflict, Republicans approved yesterday a measure to protect mastectomy patients from being ousted from a hospital too soon. The plan was similar to a Democratic proposal they rejected earlier. Democrats praised the Republicans' proposal but refused to vote for it because it omitted a provision allowing managed care patients to take part in clinical trials.

The tortured debate illustrated how partisan disputes over fundamental issues such as the scope of coverage and the cost and recourse for patients' grievances threaten legislation to protect managed care patients, even though most senators support the concept in principle.

Unless Chafee's compromise succeeds, the Republican version of the "Patients Bill of Rights" is likely to be approved tonight, only to face a veto from President Clinton.

The sharpest difference between the two parties concerns disputes when insurers refuse to pay for specific treatments.

A top Democratic priority is to give managed care patients the right to sue their insurance companies for damages if they are harmed by denial of care.

Republicans contend that the cost of lawsuits would drive up premiums to the point that small businesses could no longer afford them. They propose instead to set up a process for appealing a denial of coverage to medical experts outside the insurance company.

Republicans charge that Democrats are in the pocket of trial lawyers, who would benefit financially from lawsuits against managed care companies. Democrats counter that the Republicans are doing the bidding of the insurers.

Despite the squabbling this week, Democrats have won Republican support for at least the idea of protecting managed care patients from insurance company abuses, which had been mostly a Democratic initiative.

The most sweeping Republican measure adopted yesterday would require insurers to pay for overnight hospital stays for mastectomy patients whose doctors deem it necessary.

The proposal, by Sen. Olympia J. Snowe, a Maine Republican, was nearly identical to a measure proposed yesterday by Maryland Sen. Barbara A. Mikulski and others that the Republicans voted down.

Snowe complained that she had been forced by Senate parliamentary procedures to oppose the Democratic proposal despite her long-term advocacy on the issue.

As a gesture from her Republican colleagues, she was allowed to offer an alternative that grants broader coverage than any other feature of the Republican bill. It would apply to all managed care patients, except employees of state and local governments.

But the Snowe amendment, which the Democrats offered to back, had the effect of killing another Democratic proposal, to assure managed care patients coverage for life-saving procedures conducted as part of government research. Snowe personally supports that Democratic proposal on "clinical trials." But Republican leaders would not allow the two issues to be combined.

Another key point of dispute is the scope of the coverage.

Except for the Snowe mastectomy proposal, the Republican bill would apply only to the 48 million Americans who receive health coverage through employers that are regulated by federal law.

Sen. Edward M. Kennedy, a Massachusetts Democrat, said the Republican "minimalist approach" would have almost no impact, leaving out 68 percent of Marylanders and similar majorities in other states.

Democrats failed in their effort to expand that coverage to include 113 million Americans who work for state-regulated employers or state and local governments or who buy individual policies.

"This is about arrogance," said Sen. Rick Santorum, a Pennsylvania Republican who argued that Washington should not overrule regulatory decisions by many states, like Maryland, that have their own patient protections.

The House passed its own version of an HMO patient protection bill last year, but it has yet to take up the issue in this term.

Members of both parties are eager to be seen as concerned about the issue of patients rights.

"Both sides want better care, access to better care, for every American who belongs to an HMO," said Sen. Kay Bailey Hutchison, a Texas Republican. "I think we should acknowledge that we do have a different approach for how to get there."

Pub Date: 7/15/99

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