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Copyright 1999 Times Publishing Company  
St. Petersburg Times

October 07, 1999, Thursday, 0 South Pinellas Edition


LENGTH: 1037 words

HEADLINE: Today, House wades into patients' rights



 Sensing a flood of internal opposition, the speaker allows the debate on competing versions to come to the floor.

When it comes to managed care reform, House Speaker Dennis Hastert resembles a boy with his finger in a dike, watching in horror as water squirts out.

Hastert has been forced to schedule a vote in the House today on proposals that would expand the right of patients to sue their health maintenance organizations for negligence.

Republican leaders and their business allies have strongly opposed the possibility of new lawsuits, arguing they will drive up health care costs and increase the ranks of the 44.3-million uninsured Americans.

But rank-and-file Republicans, worried the GOP will suffer politically if it doesn't approve a "patients' rights" bill, have wrested control of the House agenda from the Republican leadership.

By banding with Democrats - or merely threatening to do so - the renegades have forced consideration of three reform proposals, ranging from a relatively weak version that offers no new right to sue to a much stronger bipartisan bill that allows lawsuits in plaintiff-friendly state courts.

The outcome of today's vote is uncertain, because the Hastert-controlled Rules Committee has put up procedural roadblocks before the most popular bill, the bipartisan effort sponsored by Republican Charlie Norwood of Georgia and Democrat John Dingell of Michigan.

The procedural maneuvering was condemned by President Clinton.

"The leadership makes a deal with the special interests and figures out some procedural way to tie everything up in knots to keep it from passing," Clinton said.

As a prelude to today's vote, the House on Wednesday passed a package of tax breaks to help people buy or keep health coverage. The 227-205 vote was largely along party lines. Democrats oppose the bill's expansion of medical savings accounts, arguing the tax-exempt accounts favor the wealthy and do not help the poor obtain insurance.

As for HMO reform, Rep. Mark Foley, R-West Palm Beach, said House leaders could have avoided the current awkwardness.

"We slipped on a banana peel," Foley said. "We wouldn't be in this place had the Republican leadership paid attention" to the sentiments of its foot soldiers.

Foley is one of 21 Republicans who have signed onto the Norwood-Dingell bill. He said he has been under pressure from GOP leaders to support one of the other versions of HMO reform today.

That's because the leadership has used a parliamentary maneuver that will allow the Norwood-Dingell bill to come up for a vote only if the two alternatives are first defeated.

Norwood and Dingell have urged their bill's supporters not to vote for the two other versions of reform. But there are signs Hastert has chipped away support among other Republicans. Rep. E. Clay Shaw Jr. of Fort Lauderdale, for one, has not ruled out voting for an alternative. He is the only other Florida Republican to have signed onto the bipartisan bill.

Some Republicans and the health insurance industry oppose the Norwood-Dingell bill because it would allow patients to sue at any stage of their fight with an HMO over denial of care. The lawsuits could be filed in state court, where awards tend to be large.

Current law allows lawsuits only in federal court, which restricts awards to attorneys' fees and the cost of denied care.

"Our preferred outcome would be for this legislation to go away," said Chip Kahn, president of the Health Insurance Association of America. "The most important protection people need is protection from higher health costs."

Hastert, too, has hoped the issue would go away.

But with 21 Republicans and nearly all Democrats potentially ready to sign a parliamentary petition that would allow them to bring the Norwood-Dingell legislation to the House floor, Hastert lost control of the process. Normally, the speaker controls the flow of legislation through the GOP-controlled Rules Committee.

With his hand forced, Hastert allowed the issue to come up for debate. He also said he will probably support a reform proposal developed by Republican Reps. Tom Coburn of Oklahoma and John Shadegg of Arizona that also allows the right to sue.

This was a change in heart for Hastert, who after originally asking Coburn and Shadegg to develop the proposal declined to endorse it when he found it included the right to sue.

The Coburn-Shadegg bill has undergone revisions recently with the help of Rep. Porter Goss, R-Sanibel, and other lawmakers. But now, the bill appears to be even more unfriendly to the health industry.

It would allow a patient to file a lawsuit even if the independent injury board determined the HMO had done the patient no harm. However, a patient who received an adverse ruling from the board would then have to pay the HMO's court costs if he or she filed a lawsuit and lost.

But a spokesman for Goss said the leadership is comfortable with the approach. "Everything he's done has been with the blessing of the speaker," Jennifer Millerwise said.

The first proposal that will be voted on today, written by Rep. John Boehner, R-Ohio, does not expand the right to sue. But the insurance industry still opposes it because it would mandate dozens of new requirements and regulations that HMOs consider unnecessary red tape. With little or no Democratic support, this bill is expected to be defeated.

The next vote will be on the Coburn-Shadegg proposal, which has a chance of passing if it attracts enough conservative Democrats and a majority of Republicans.

If Coburn-Shadegg is defeated, it is likely the Norwood-Dingell bill will pass. House Republicans number only 222 and can afford to lose only six of their camp to the rival bill, assuming all Democrats support it.

Even if all the dominoes were to fall just right for the bipartisan bill, it still doesn't mean it will become law.

The Senate in July passed an HMO reform bill that did not expand the right to sue. Any House-passed bill would have to be reconciled with the Senate version, another highly uncertain prospect, given stiff opposition to lawsuits by many Senate Republicans.

- Information from Knight Ridder Newspapers was used in this report.

GRAPHIC: COLOR PHOTO; House Speaker Dennis Hastert

LOAD-DATE: October 7, 1999

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