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Copyright 1999 St. Louis Post-Dispatch, Inc.  
St. Louis Post-Dispatch

July 15, 1999, Thursday, FIVE STAR LIFT EDITION


LENGTH: 803 words


BYLINE: Laura Meckler; The Associated Press



Senate Republicans, battling Democrats over patient rights, on Wednesday offered a series of modest alternatives on women's health, access to specialists, emergency room care and other popular proposals.

Holding firm for a second day, only a handful of Republicans have defected in a series of votes on the details of new patient protections. That's partly because Republicans answered -- or promised to answer -- popular Democratic proposals.

"That's why people are sticking together, because they know we are going to deliver on the substance," said Sen. Bill Frist, R-Tenn., a surgeon who is helping to lead the GOP effort.

Republicans defeated, 53-47, a Democratic plan to require insurance companies to pay for needed specialists even if the specialists are outside a health plan's network. Republicans promised their own version, which would require "timely" specialist care, but would not give patients the right to go outside a network.

Also, a day after defeating a Democratic measure on women's health, the Senate approved a GOP measure requiring health insurance companies to pay for overnight hospital stays when women are treated for breast cancer, if a doctor recommends it.

While Democrats support that idea, all 45 of them voted no because the GOP version eliminated a Democratic amendment that would have allowed easier access to experimental treatments.

Democrats tried to get the Senate to include both provisions, but Republicans refused. Instead, Republicans promised to produce their own amendment on experimental treatments by today.

"We'll deliver," Frist said, promising to fold some "very good" Democratic ideas into the final GOP bill.

Meanwhile, Sen. John Chafee, R-R.I., was working with a handful of Democrats to fashion a compromise that incorporates much of what Democrats want. His spokesman, Nicholas Graham, said Chafee had four Republicans on board and would need just one more to reach 50 votes if all 45 Democrats went along.

On an issue that sharply divides the parties, the Senate refused to extend new HMO rules to all 161 million people with private health insurance on Wednesday. The 52-48 vote meant many of the provisions would apply only to the 48 million Americans whose health plans fell outside state regulation because their employers provide insurance plans that are federally regulated.

Missouri Sens. Christopher "Kit" Bond and John Ashcroft and Illinois Sen. Peter Fitzgerald -- all Republicans -- voted against the measure. Sen. Dick Durbin, D-Ill., voted to apply the protections to more people.

The only major issue yet to be considered is the right to sue. Democrats want to give patients who are denied care the power to take their health plans to court. That issue was set for debate today, when the Senate will take a final vote on the HMO package.

In the end, the Senate is likely to approve the Republican plan, which President Bill Clinton has signaled he will veto.

Both Democrats and Republicans have legislation offering new federal rights for Americans in health maintenance organizations and other managed care plans. But the GOP plan is more modest than the Democratic bill on virtually every issue.

Many of the Republican proposals were first introduced Wednesday, after the GOP voted down the Democrats' version.
For example:

* On emergency room care, Republicans agreed that insurance companies should pay for care during an emergency -- and after a patient is medically stable, a retreat from their opening position. But Democrats said the plan had too many loopholes.

* On women's health, Democrats would allow women to designate gynecologists as their primary care doctors; Republicans would not. But the GOP came closer to Democrats by allowing pregnant women to see obstetricians without prior approval.

Who is covered is among the most fundamental questions being debated this week, clearly demonstrating each party's approach to the role of government.
Democrats say the new rights must apply nationwide.

"The role of the federal government is to step in when protections need to be everywhere in this country," said Health and Human Services Secretary Donna Shalala.

But Republicans did extend some of their provisions beyond the core 48 million people. The breast cancer amendment, for instance, covers about 140 million people.

No Democrat has voted with Republicans during this week's debate, and only a handful of Republicans have voted with Democrats.

Those siding with Democrats at least once were GOP Sens. Spencer Abraham of Michigan, John Chafee of Rhode Island, Fitzgerald of Illinois, John McCain of Arizona, Arlen Specter of Pennsylvania and John Warner of Virginia.

Chafee's spokesman said Fitzgerald, McCain and Specter were willing to support a compromise.

GRAPHIC: Photo by THE ASSOCIATED PRESS - Rep. Charles Norwood, R-Ga. (right), with Rep. John Cooksey, R-La. (left), and American Medical Association President Ted Riordan, briefs reporters on Capitol Hill on Wednesday on the patients bill of rights.

LOAD-DATE: July 15, 1999

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