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Legislation Department
July 16, 1999

Patients’ Bill of Rights

On Thursday night, the Senate completed four days of debate on managed care reform by approving a version of S. 326, the Republican leadership bill approved by the Senate Health, Education, Labor and Pension (HELP) Committee this spring. The vote on the bill was largely along party lines with all Democrats opposing and all but two Republicans voting for it. The two Republicans who voted against the bill were Sens. John Chafee (RI) and Peter Fitzgerald (IL).

Both the Democrats’ Patients’ Bill of Rights (S. 6) and the Republicans’ S. 326 were debated and during the course of the week amendments to both bills were offered. On most amendments, two or three Republicans joined with Democrats. Sen. Chafee joined the Democrats most consistently, with Sens. Arlen Specter (R-PA) and Peter Fitzgerald (R-IL) joining Democrats on at least a few votes. Sens. John Warner (R-VA), Olympia Snowe (R-ME), John McCain (R-AZ) and Spencer Abraham (R-MI) joined Democrats on one vote each.

AFSCME requested the Senate Democratic leadership offer an amendment to the GOP leadership bill which would add patient advocacy, or whistleblower, protections for health care workers. The amendment which was offered by Sen. Ron Wyden (D-OR) was struck by a competing amendment offered by Sen. John Ashcroft (R-MO). All Republicans but John Chafee voted in favor of the Ashcroft amendment, effectively deleting patient advocacy protection from the bill.

Democrats made two efforts during the course of the debate to expand the scope of coverage under the Republican bill to include state and local government employees and others excluded from S. 326. Both efforts failed. All but two provisions of the bill cover only 48 million individuals in private plans, leaving 123 million Americans excluded from most features of the bill. The final bill approved by the Republicans lacks patient advocacy protection; continues to allow health plans to override treatment decisions of physicians; and prevents patients from suing plans for economic or punitive damages. Those consumer protections provided in the bill are inadequate and frequently full of loopholes which make them meaningless.

After the vote, President Clinton vowed to veto S. 326 if it came to his desk. The House has yet to hold a full Committee mark-up of legislation although Speaker Dennis Hastert (R-IL) has indicated that he wants a bill to be considered on the House floor before the August recess.

SIGN THE PBR PETITION TO CONGRESS

Tax Cut Plan Moves to House Floor

The House Ways and Means Committee approved a massive tax cut which will now be taken up by the full House of Representatives. The $864 billion tax cut approved by the committee on a party line vote contains hundreds of provisions granting major new tax breaks for the wealthy and corporations. According to the nonpartisan group, Citizens for Tax Justice, three quarters of the tax cut goes to the best-off 10 percent of taxpayers. The top 10 percent of all taxpayers, those with incomes averaging $204,000, would get 60 percent of the 10 percent income tax cut, 91 percent of the capital gains tax cut and virtually all of the state tax reduction. Meanwhile, the bottom three-fifths of all taxpayers, those with incomes averaging just $19,000, would get only 6.5 percent of the overall tax cuts. President Clinton said he would veto the bill because it is fiscally irresponsible and threatens the future of Social Security and Medicare. The Senate Finance Committee is also expected to take up a similar sized tax cut bill.

Federal Budget Picture Looking Gloomy

The fiscal year 2000 budget debate is heating up in Congress, not just over tax cuts versus Social Security and Medicaid, but also over the impact of cuts in vital domestic programs impacting children, the elderly, the environment and working people and which help fund the jobs of tens of thousands of AFSCME members. As Congress rushes to put finishing touches on the various federal spending bills, the GOP leadership has come up with a plan to save the best for last. The two bills that provide the most funding to state and local governments, the important Veterans Administration/Housing and Urban Development (VA/HUD) bill, and the Labor, Health and Human Services and Education (LHHS) bill are being held hostage until the end and slated for deep cuts to pay for defense and other pet programs of the congressional leadership. The HUD bill would suffer cuts of between 8 and 13 percent below current levels in important programs like public housing and the Community Development Block Grant (CDBG). The LHHS bill would suffer a 12 percent across-the-board cut if evenly applied to all programs, including the Employment Service, various social service programs, and public education. Remember, the funds for these and other programs directly fund AFSCME member jobs. It’s time to call Congress at 1-877-722-7494 and ask your senators and representative to ensure that these vital bills are adequately funded.

Federal Unemployment Insurance Tax Cut

Among the business tax breaks in the House tax cut bill is a repeal of the Federal Unemployment surtax. This "temporary” surcharge, which costs employers $14 per employee per year, was originally imposed in the 1970s. Repeal of this surcharge is a high priority for business organizations working on unemployment insurance issues. AFSCME strongly opposes repeal of the surcharge in the tax bill. We are working on a broader unemployment insurance reform package and believe that any consideration of repealing or adjusting this tax surcharge should take place in that context. During the Ways and Means Committee consideration of the bill, we worked with members of the committee to establish bipartisan opposition to the provision. At the request of AFSCME, Rep. Phil English (R-PA) offered and then withdrew an amendment to delete the repeal of the surcharge. He was joined by Reps. Ben Cardin (D-MD) and Sander Levin (D-MI) who also spoke against the provision. We will be working to see that it is dropped from any tax bill which eventually will be enacted into law.

Social Security

The 10-year term budget projections released last week by the Congressional Budget Office (CBO) closely mirrored the rosy projections released days earlier by the number crunchers at the Office of Management and Budget (OMB). CBO projected almost a $3 trillion total federal budget surplus over 10 years with a $14 billion non-Social Security surplus for FY 2000. The administration and the congressional leadership of both parties are unified in "locking away” 100 percent of the Social Security surplus for that program but major partisan differences exist over what to do with the non-Social Security surplus. But, inside the Beltway "preserving the Social Security surplus for Social Security” has more than one meaning. President Clinton and many Democrats say that this surplus should be credited to the Social Security Trust Fund so that 100 percent of guaranteed benefits are assured for a minimum of the next 50 years. Others -- the GOP leadership and a bipartisan group of Republicans and conservative Democrats -- say that the Social Security surplus should be used to privatize the program.

Meanwhile, House Ways and Means Chairman Bill Archer (R-TX) lashed out at the unyielding opposition by organized labor to the privatization of the Social Security system. Archer said that if there was no "deal” on Social Security this year it would be because the union movement is totally opposed to any plan which includes some form of privatization.

ENDA Reintroduced

Sen. Jim Jeffords (R-VT) and Rep. Chris Shays (R-CT) reintroduced the Employment Non-Discrimination Act (ENDA), S. 1276 and H.R. 2355, to prohibit employment discrimination based on sexual orientation. The bill differs from previous versions by eliminating language in most civil rights laws addressing affirmative action. The legislation has 155 House cosponsors and 35 Senate cosponsors.