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Copyright 1999 Times Mirror Company  
Los Angeles Times

June 24, 1999, Thursday, Home Edition

SECTION: Part A; Page 5; National Desk

LENGTH: 700 words




Democrats on Wednesday brought the Senate to a standstill in an effort to force a wide-ranging debate on legislation to guarantee patients certain rights in dealing with their managed care plans.

Under heavy pressure from the health insurance industry and business, Republican lawmakers rebuffed the Democrats' request for a chance to offer multiple amendments to a GOP version of the legislation. The Democrats, who had attached their patients' rights provisions to the annual agriculture spending bill, responded by blocking action on that bill or any other.

The bickering about whether to have a full-fledged debate concerning the managed care bill reflects an ambivalence by both parties on whether to enact legislation or save the issue for next year's election campaign.

"It may be that both parties find it advantageous to do nothing," said Sen. Bill Frist (R-Tenn.). Such has been the case for the three years since the parties pledged to enact a "patients bill of rights."

At least two-thirds of all people who buy health insurance through their employers are in managed care plans, which typically try to hold down costs by limiting access to specialists and certain expensive treatments and tests.

The Democrats' bill would allow patients to appeal treatment decisions to the courts, where they could win substantial damage awards.

The Republican version would permit access to independent review boards, but not the courts, and only for the one managed care client in three who is in a self-insured plan--one in which the employer, rather than an insurance company, assumes the risk. It would also permit awards only to the extent of the denied test or treatment, as is the case under current law.

The public broadly--but not deeply--favors guaranteeing patients more rights in dealing with these health plans. Health insurers and employers caution that such legislation would raise their costs.

"Is this a high-ranking issue on which people decide whether to vote for a candidate? No, it really isn't," said Bob Blendon, a professor of health policy at the Harvard School of Public Health. "But is it a popular thing to do? Absolutely," he said.

For Republicans, who listen closely to the concerns of business and the insurance industry, this suggests that they can side with these groups without great political risk. Furthermore, they argue that the higher insurance costs under the Democrats' bill would add to the number of uninsured Americans.

"I know there's little sympathy out there for business, big or small, but there ought to be, because we drive the economy," said Patrick Cleary, vice president for the National Assn. of Manufacturers. "It's unassailable that every time you raise costs, you drive down insurance coverage," he said.

Some Democrats, who know the issue is popular with consumers and who receive less campaign funding from business, believe it may be in their interests to resist compromise and use the issue to tag Republicans as anti-consumer in next year's elections.

Because the Democrats are outnumbered in Congress and unlikely to be able to pass their version of a patients' rights bill, their main goal seems to be to have a debate, in which they can bring out the differences between the two parties' approaches to the issue.

The differences are deep and sometimes subtle. Both parties, for example, would require coverage of emergency room visits--but the Democrats would also require that the insurer pay for post-stabilization care. That means that if a patient came into an emergency room with a smashed elbow, the insurer would have to pay to stabilize the elbow and to have it set at that hospital if the emergency room doctor recommended it. The Republican bill would allow the insurer to ask that the patient go elsewhere for the surgery.

"When you look closely at their 'patient bill of rights,' it's a bill of wrongs," said Senate Minority Leader Tom Daschle (D-S.D.).

Republicans respond that the Democrats' bill would raise the cost of health insurance by 5% over five years, pricing as many as a million people out of health insurance.

Times staff writer Blair Golson contributed to this story.

LOAD-DATE: June 24, 1999

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