‘Angry, Confrontational’ Opening Day for Patients’ Rights Debate
The "struggle" in the Senate over patients' rights legislation opened on an "angry, confrontational note yesterday," with Republicans delaying debate and Senate Majority Leader Tom Daschle (D-S.D.) saying he might to cancel the July 4 recess to finish the measure, the Washington Post reports. "The United States Senate will not leave Washington, D.C., until this legislation is passed," Daschle said. At the end of the day yesterday, party leaders had reached agreement and they will likely begin debate on the legislation Thursday (Dewar/Goldstein, Washington Post, 6/20). The bill up for debate (S 283) is favored by Democrats (S 283), sponsored by Sens. Edward Kennedy (D-Mass.), John McCain (R-Ariz.) and John Edwards (D-N.C.), would allow patients to sue HMOs in state court for denial of benefits or quality of care issues and in federal court for non-quality of care issues. In addition, the bill would cap damages awarded in federal court at $5 million, but state courts could award as much money in damages as the state allows. Republicans say that the bill "goes too far," and President Bush has threatened to veto the legislation. On Monday, Republicans moved to delay debate on the bill in order to allow lawmakers more time to review revisions made over the weekend. Although Daschle threatened to force a vote to stop Republicans' "delaying tactics" -- which would have required 60 votes -- party leaders "averted" the move last night, agreeing to proceed with the bill Thursday (Washington Post, 6/20). The New York Times reports that Republicans said they "needed more time" to "expose ... flaws" in the legislation and "educate senators and the public" through debate and advertising (Pear, New York Times, 6/20). "I don't think we should be railroaded into passing bad legislation. And we won't be," Sen. Don Nickles (R-Okla.) said (Washington Post, 6/20).
Republicans and Democrats "described the stakes as enormous" and predicted a "long fight" over patients' rights legislation (Washington Post, 6/20). The Los Angeles Times reports that observers have predicted "two weeks of intense debate punctuated by dozens of votes on amendments" (Miller/Hook, Los Angeles Times, 6/20). Nickles said that Senate Republicans have "no plans" to offer a competing patients' rights bill (S 889) sponsored by Sens. John Breaux (D-La.), Bill Frist (R- Tenn.) and Jim Jeffords (I-Vt.), but plan to "focus on a series of amendments" to the McCain-Kennedy-Edwards measure (Malone, Cox News Service/Atlanta Journal-Constitution, 6/20). Nickles said that amendments would likely include expanded medical savings accounts and a provision that would offer employers tax incentives to purchase health insurance for employees. Daschle said that he "did not know if he would always be able to round up 51 votes" to defeat the amendments, but added, "It's going to be fun to find out" (New York Times, 6/20). The Wall Street Journal reports that the Bush administration "believes it is within striking distance of snaring enough votes" to revise the bill's liability provisions, with Democratic moderates "open to compromise." However, Breaux predicted that Bush would have to veto the bill (Rogers, Wall Street Journal, 6/20).
According to Republicans, the Kennedy-McCain-Edwards bill would expose employers who manage health coverage for employees to a "flood of costly lawsuits." Nickles called liability provisions in the legislation a "knife at the throat of businesses," adding, "Employers beware. There is language in this bill that can bankrupt you" (New York Times, 6/20). Sen. Judd Gregg (R-N.H.) said that "[e]mployers are subject to the right to be sued" under the bill. Kennedy and Edwards denied Judd's charge, saying that patients could only sue employers who had "direct participation" in a decision to deny coverage for care. "We specifically exempt employers from being sued," Kennedy said (Archibald, Washington Times, 6/20). However, Republicans "contend" that under "vague" language in the bill, businesses would have to "go to court to prove" they did not have direct participation in medical decisions (Kuhnhenn, Philadelphia Inquirer, 6/20). Paul Dennett, a lobbyist for the American Benefits Council, said that employers "could easily be caught in the net of lawsuits" (McQueen, Associated Press, 6/20). The Wall Street Journal reports that business groups have "stepped up the pressure" against the bill (Wall Street Journal, 6/20). According to the Philadelphia Inquirer, liability concerns have "galvanized" business groups to organize a "major lobbying campaign" to thwart the legislation, including a five-state effort launched by the National Federation of Independent Business (Philadelphia Inquirer, 6/20).
In the House, GOP lawmakers are "weigh[ing] a concession" to allow patients to sue HMOs in state courts -- a provision opposed by Senate Republicans and Bush -- in limited cases. Under the provision, patients could sue health plans in state courts when the plans refused to abide by the decisions of outside appeals panels (Welch, USA Today, 6/20). "House leaders want to make sure we get the right bill that's signable and not veto bait," a senior House Republican leadership aide said (Washington Times, 6/20). House Speaker Dennis Hastert (R-Ill.), who has "spoken favorably" about allowing patients to sue in state courts, met with key lawmakers last night as part of an effort to "fashion a bill that could serve as an alternative" to the House version (HR 526) of the Kennedy-McCain-Edwards bill, sponsored by Reps. Charlie Norwood (R-Ga.), John Dingell (D-Mich.) and Greg Ganske (R-Iowa), (AP/Baltimore Sun, 6/20). Rep. Billy Tauzin (R-La.) said that Republicans will finish drafting the bill "as early as a day (from now), or as late as two days," although he conceded that "four or five sticking points" remain. In addition, CongressDaily/AM reports that the legislation "faces the difficulty of winning over moderate Republicans and Democrats" while "keeping conservatives on board." Rep. John Boehner (R-Ohio) said, "Many conversations still need to take place" (Rovner/Fulton, CongressDaily/AM, 6/20).
Meanwhile, the New York Times reports that the patients' rights debate has "triggered a brutal political war" among health insurers, doctors, trial lawyers, consumer groups and employers. The groups have spent "millions of dollars" on advertising, grass-roots efforts, polling and lobbying on the issue over the past five years -- a "lobbying war of near epic proportions" about to reach a "clamorous peak" (Toner, New York Times, 6/20). In addition, Salon reports that patients' rights is the current "sexy thing" in Congress (Tapper, Salon, 6/20). According to a new public opinion poll conducted by the Pew Research Center, 77% of those surveyed favored passage of a bill that would allow patients to sue HMOs, with "overwhelming support" among Democrats, Republicans and independents (Washington Post, 6/20).