House Republicans push toward quick vote on patients’ rights
WASHINGTON (AP) – In a victory for President Bush, the Republican-controlled House voted for limited lawsuits against HMOs Thursday night as it moved toward passage of patients’ rights legislation providing sweeping new protections for millions of Americans with health insurance.
The vote was 218-213 in favor of a legal liability provision crafted to ratify the deal that Bush and a pivotal Republican lawmaker sealed scarcely 24 hours earlier in the Oval Office.
”Like it or not we have to work with this president, who has to sign this bill,” said the lawmaker, Rep. Charles Norwood, responding to dozens of Democratic critics who attacked the provision as a giveaway to the HMOs. Opponents ”are deluding themselves if they think they can force a bill down this president’s throat,” he said.
Republicans sent a cheer up from the House floor when the vote was announced. Chants of ”Nor-wood, Nor-wood” were audible above the din of the packed chamber.
The vote made final passage of the legislation a formality, a mid-evening vote that would clear the way for a three-way negotiations on a final compromise among the House, the Senate and the White House.
There was widespread support for the protections in the bill. Under the measure, all Americans with insurance would be guaranteed new protections designed to combat HMO horror stories, including coverage for emergency room care, treatment by medical specialists and access to government-sponsored clinical trials. Patients denied coverage could appeal the ruling to an outside, independent expert and would be guaranteed a timely verdict.
But the issue of lawsuits, and limits on damages that patients could receive if they were successful in court, divded the House along partisan lines.
”This is not a patients’ bill of rights. This is an HMO and health insurance companies’ bill of rights,” said House Democratic leader Dick Gephardt of Missouri. His voice rising and his face growing red, he added, ”In the name of God … vote against this bill.”
The developments unfolded after Bush’s Oval Office agreement with Norwood. The president had threatened to veto Democratic legislation, arguing it would encourage frivolous lawsuits that would drive up the cost of insurance and prompt some employers to drop or reduce coverage.
”Get it done, Bush encouraged fellow Republicans earlier in the day as he joined Vice Presidnet Dick Cheney and the GOP rank and file in the Capitol.
Republicans labored through the day to firm up their support, hoping that Norwood’s stature on the issue would encourage wavering Republicans to side with them. They paid particular attention to New Jersey’s six Republicans, most of whom had been supporting the bipartisan bill but were under pressure to reconsider.
By early evening, Speaker Dennis Hastert, R-Ill., said, ”I think we’re there, but you never know until the vote.”
The House debated as more details emerged of the GOP two-track effort in recent days: trying to negotiate with Norwood while preparing to try to defeat him in a showdown if necessary.
Two administration sources, speaking on condition of anonymity, said Norwood was told at the White House on Wednesday he faced losing if he chose to stick with the Democrats.
Passage would set the stage for compromise talks involving the House, the Senate and Bush this fall – negotiations that offer no guarantee of success. ”This is not the last word,” said Senate Majority Leader Tom Daschle, D-S.D.
The Senate-passed measure that Bush has threatened to veto and the bill in the House are identical in terms of the patients’ protections they provide.
In addition, the House bill provides for full deductibility of health insurance costs for the self-employed and other tax breaks designed to expand access to insurance, although Democrats complained there was no money in the bill to pay for them.
The principal area of dispute concerns lawsuits: whether they could be filed in state or federal court and whether there would be limits on damages.
Under the GOP plan, most suits could be brought in state court, but under uniform federal rules. Suits against companies that administer and fund their own insurance plans would go to federal court. Suits would be permitted even in cases in which the outside expert rules in favor of the HMO – but the patient would have a higher burden of proof.
Patients could sue for punitive damages only in cases in which an HMO had disobeyed an appeals board ruling, and even then they could not seek more than $1.5 million.
By contrast, most Democrats favor legislation that would allow lawsuits in state courts, where lawyers say patients are more likely to prevail. Democrats also favor more generous damage limitations.
The developments unfolded rapidly after Bush’s agreement Wednesday with Norwood.
Bush told reporters he intended to thank Norwood publicly for ”being realistic and reasonable. I’m going to thank the members who stayed up all last night writing the amendment and I’m going to, of course, urge the members to vote with the speaker and get it done.”
In daylong debate on the House floor, Republicans heaped praise on Norwood – and defended him from criticism by Democrats who had worked closely with him for years.
Rep. Mark Foley, R-Fla., reading earlier glowing statements of praise from Democrats, added sarcastically, ”That’s yesterday. Today they’ll have you think he’s become Dr. Kevorkian,” the suicide doctor.
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