Copyright 1999 Times Publishing Company
October 07, 1999, Thursday, 0 South Pinellas
SECTION: NATIONAL; Pg. 1A
LENGTH: 1037 words
Today, House wades into patients' rights
JACOBY; SARA FRITZ
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.
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.
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.
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
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
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.
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
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
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
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
- Information from Knight Ridder Newspapers was used in
GRAPHIC: COLOR PHOTO; House
Speaker Dennis Hastert
LOAD-DATE: October 7, 1999