PATIENTS’ RIGHTS: Senate Rejects Democratic Amendments
On a day that featured what FOX News' Julie Kirtz called "a tangled web of procedure even Senate insiders find hard to follow," Republicans defeated several Democratic measures designed to broaden the scope of health plans' responsibilities ("Special Report," 7/13). "I think we're made good progress toward passing our bill and defeating a bill that would increase costs," said Senate Majority Whip Don Nickles (R-OK)(Superville, AP/Nando Times, 7/14). Democrats thought a provision that would have allowed women direct access to OB/GYNs as their primary care physicians "would be their best chance to attract votes from the other side of the aisle." But only three Republicans -- Sens. Arlen Specter (PA), John Chafee (RI) and John Warner (VA) -- defected, resulting in the defeat of the measure 52-48 (Rovner, CongressDaily/A.M., 7/14). The amendment by Sen. Charles Robb (D-VA) would have allowed women to select OB/GYNs as their "gatekeeper" physicians, as well as mandated that doctors determine how long a woman is to remain hospitalized after a mastectomy. Sen. Barbara Boxer (D-CA), noting the support of the American College of Obstetricians and Gynecologists, called the vote "a slap in the face to American women" (Hess, Philadelphia Inquirer, 7/14). Sen. Barbara Mikulski (D-MD) said, "I thought this was the one amendment (on which) we could come together on a bipartisan basis" (CongressDaily/A.M., 7/14). Sens. Spencer Abraham (R-MI) and Olympia Snowe (R-ME) promised to offer a substitute amendment today (CongressDaily/A.M., 7/14). That effort "would allow women to see an OB/GYN without a referral but would not allow the OB/GYN to be a primary care doctor who makes other referrals" (Meckler, AP/Chicago Tribune, 7/13).
On other votes, Republicans prevailed on similar party-line votes. They included a provision that would have required insurers to pay for care in line with "generally accepted principles of medical practice." Republicans argued that "the most common practices aren't always the best, and replaced" the measure with an independent appeals provision. Additionally, the GOP passed an amendment emphasizing the cost of the Democratic bill, and providing that its provisions would be voided if they raised premiums by more than 1%. The AP/Nando Times features links to yesterday's roll-call votes (7/14). Late yesterday, Republicans also eliminated a Democratic amendment that "would make the Republican plan apply to all 161 million Americans with private health insurance," instead maintaining its restriction to the 48 million in self-funded plans (Rubin, Los Angeles Times, 7/14). The GOP also defeated an effort to give patients access to out-of-network emergency rooms and passed an amendment that would "give a 100% deduction for health care coverage to all self-employed individuals" (Mitchell, New York Times, 7/14).
The Hartford Courant reports that the votes "left Republican aides privately confident that their measure will prevail throughout the rest of the week," while Democrats were discouraged. "This is about political power and Washington trying to shut off something that is manifestly in the best interest of the average citizen of this country," said President Clinton in remarks at the White House. Sen. Chris Dodd (D-CT) said, "This is one of those issues where you really do have a partisan divide. It doesn't look good as we begin" (MacDonald, 7/14). The Baltimore Sun reports that the day's voting was a "highly partisan exercise aimed largely at garnering support in next year's election," with some members even discussing it openly now. Sen. Barbara Mikulski (D-MD) said, "If we win these votes, we'll be able to make major national policy. If we don't win, we will at least have heightened attention of the voters, giving us a greater chance of reclaiming the majority" (Hosler, 7/14). The Senate will consider today and tomorrow a measure that would allow patients to sue their health plans, and another by Dodd that would ensure access to clinical trials and "medically necessary prescription drugs" (AP/Nando Times, 7/14).
Last night's "NewsHour with Jim Lehrer" featured a debate over the right to sue between Health Insurance Association of America President Chip Kahn and Connie Barron, associate director of legislative affairs for the Texas Medical Association. Barron said, "There's no incentive for health plans to do the right thing and to be very careful when they're making these decisions to make sure that they're looking carefully at each patient and making the right decision in that case." Kahn responded, "I think situations like that shouldn't be settled in court; they should be settled when the situation arises and good health plans today are providing appeal mechanisms when there are questions like this" (PBS, 7/13).