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Copyright 1999 Newsday, Inc.  
Newsday (New York, NY)

July 13, 1999, Tuesday, ALL EDITIONS


LENGTH: 1013 words



DATELINE: Washington

Washington - The Senate began debate yesterday on the politically potent issue of patients rights, sparking a furious nationwide advertising campaign by health-care-industry groups with billions at stake.

Republican and Democratic leaders jockeyed for position on the Senate floor yesterday and argued over whose legislation would help patients more. Democrats said their bill, which would cover 161 million Americans and allow them to sue their managed-care plans, was more comprehensive. Republicans maintained that the Democratic bill would dramatically drive up the cost of health care and said their more modest legislation, covering 48 million Americans, was the way to go.

With health maintenance organizations and other managed-care plans the targets of consumers wrath, both parties have acknowledged the potency of the issue with voters. But with such dramatically differing solutions being proposed and little room for compromise, advocates give either plan only a 50-50 chance of being enacted into law. There is little doubt the issue will be settled at the ballot box in November, 2000.

Under rules set for the Senate debate, final votes will be taken on the issue by week's end. With Republicans holding a 55-45 majority, it's likely the Republican plan will pass, but President Bill Clinton has promised to veto it. It's not likely the Senate could muster the 67 votes needed to override a veto.

The House, which passed its own fairly comprehensive "Patients Bill of Rights" during the last Congress, has not yet acted this year. The House Commerce Committee may begin work on a bill this week or next.

In the Senate, Republicans, in a surprise procedural maneuver, decided to use the Democratic version of the bill as the starting point. This was done to make it awkward for Democrats to amend their own proposal. But Democrats countered with their own counter move and offered the Republican version as a substitute, thus making it also a subject for debate.

Senate Minority Leader Thomas Daschle (D-S.D.) said the parliamentary situation was less important than the votes he expects this week that will force senators to take a public stand on everything from a patient's right to sue a health maintenance organization to a woman's right to designate a gynecologist as her "primary-care" doctor.

But Senate Majority Whip Don Nickles (R-Okla.), predicted Republicans would "win the debate and win the vote."

Republicans argue the more comprehensive Democratic plan would drive up the cost of health care and force companies to drop health insurance as a benefit.

Democrats argue the Republican plan would leave too many patients without recourse to battle managed-care companies and protect insurance companies.

Nationwide advertising campaigns by doctors, HMOs and insurance companies are competing to influence votes on the Senate floor and to persuade Americans of their positions.

The American Medical Association began running $ 200,000 worth of ads last week asking citizens to call Congress in support of the liability and medical necessity provisions in the Democratic version.

By contrast, a coalition of unions and consumer advocates ran an ad asking: "Does the Senate support insurance industry protections or patient protections?"

And The Coalition for Affordable Quality Health Care, an alliance of insurance companies, trade associations and large employers, launched a $ 10.5-million nationwide advertising campaign in Chicago yesterday featuring television spots of doctors discussing positive experiences with managed-care plans.

Republicans and Democrats held competing rallies on Capitol Hill featuring ordinary people describing experiences with health maintenance organizations.

Ron Pollock, president of Families USA, a liberal consumer advocacy group, put the chances of passage of the Democratic bill at "6 to 5, pick em." But, he said, if it doesn't pass: "Then the Republicans are taking a big risk of having this be a big issue in the 2000 election, and it will be." Comparing Patient's Rights Here are some major differences between the Republican and Democratic patient's rights proposals to revamp laws governing health maintenance organizations. Democrat Republican Covers 48 million Americans in company self-insured Covers 161 million Americans who now get their plans. The estimated 110 million others insured would Coverage health insurance through managed care plans. be governed by state laws. CostEstimated 4.8% increase in health insurance premiums. Estimated 0.8% increase in health insurance premiums. EmergencyProvides coverage for emergency care without prior Provides coverage for emergency care that a "prudent room careauthorization from managed care company. layperson" would deem necessary. Allows patients to sue their HMO, insurance company or Includes no provision termitting patients to sue their employer in state courts for malpractice or HMO, insurance company or employer but provides for Lawsuits mismanagement including denial of treatment. internal and external review to arbitrate disputes. Doctors Doctors determine what treatments Insurers determine what treatments decisions are "medically necessary." are "medically necessary." Women's Allows women in plans underwritten by large companies health Allows women to designate gynecologists as to see an OB/GYN provider w/o prior permission care primary care provider. from primary care doctor. Continuity Provides 90 days of continued treatment for an ongoing Covers 90 days of appropriate treatment of careillness and unlimited care for terminal illnesses. for terminal illnesses. Medical Makes tax-deferred savings accounts generally savings available; they are now available to only self-employed accounts No provision. or small employers. Gag Prohibits HMOs from restricting what physicians Prohibits HMOs from restricting what physicians can tell rule can tell patients. patients about a disease they are being treated for. SOURCE: Congressional Research Service, party analyses.

GRAPHIC: Chart - Comparing Patient's Rights (SEE END OF TEXT)

LOAD-DATE: July 13, 1999

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