WASHINGTON - One day after President Bush brokered a deal with an influential Republican, the House last night approved a bill granting patients broad access to medical care and bestowing some limited rights to sue a health insurer if quality care is delayed or denied.
Mr. Bush's compromise led to a near party-line vote on the patients' rights bill, which passed the Republican-controlled House 226-203. No Republicans opposed the final bill; only five Democrats supported it.
Relieved Republicans credited Mr. Bush's intense personal involvement with avoiding an embarrassing defeat for his party. But the Senate passed its own patients' rights bill in June with more ample litigation provisions that Mr. Bush has said he can't accept.
“What this means is that they have a bill, and now we have a bill, and we'll go to conference and try to work out our differences,” Senate Majority Leader Thomas Daschle, (D., S.D.), said yesterday. “It shouldn't be viewed as the last word. I believe this [House version] is harmful to the best interests of every person in this country who has an insurance policy.”
Mr. Bush praised the House vote in a statement issued last night.
“Today's action brings us an important step closer to ensuring that patients get the care they need and that HMOs are held accountable,'' he said. “As this bill heads to conference committee, I remain committed to extending the hand of cooperation to all who share a commitment to achieving real results for better health care for every American.''
After several months of negotiations, Mr. Bush announced a deal Wednesday evening with Rep. Charles Norwood, (R., Ga.) a key sponsor of the House version that the President had threatened to veto. Mr. Bush convened an upbeat meeting with GOP lawmakers yesterday morning to solidify support for their compromise.
“It shows the power of the presidency when it's properly used,'' said Rep. Rob Portman, (R., Cincinnati), who was given the task of rounding up Republican support for the compromise. “Having Norwood on board creates a whole new dynamic.''
Most Democrats had supported Mr. Norwood's bill, which was also sponsored by Reps. John Dingell (D., Michigan) and Greg Ganske (R., Iowa). It would have offered patients a broader ability to sue their health plans in state and federal court and to win large sums of money from insurers.
The version that the Senate approved was nearly identical. But the compromise Mr. Bush brokered with Mr. Norwood allowed Republican leaders to craft an amendment to the Democrat-backed bill. It establishes federal standards for all lawsuits against health insurers, even those in state courts.
It allows patients to take their grievances to state court, even if an independent review panel rules against them - a concession by Mr. Bush. But the patient must surmount a very high burden of proof to prevail.
Just before the House voted on Mr. Norwood's amendment, he made an emotional appeal to his colleagues, expressing his respect and affection for his former allies and pleading for a bipartisan vote. “Like it or not, we have to work with this president, who has to sign this bill,” Mr. Norwood said.
The amendment passed 218-213.
Local lawmakers voted along party lines. Mr. Dingell and Rep. Marcy Kaptur (D., Toledo) opposed Mr. Norwood's amendment and the final bill.
Republican Reps. Michael Oxley of Findlay and Paul Gillmor of Old Fort supported Mr. Norwood's amendment and the final bill.
Mr. Norwood's former allies yesterday expressed frustration and disappointment at what they regard as his defection. At a morning news conference, Mr. Dingell noted that he had spent six years working to enact a patients' rights bill with colleagues, often with Mr. Norwood.
“Sadly to say, I think Mr. Norwood left us last night, before he really knew what was being done to him or what was involved in the legislation,” he said. “The results of that agreement with the White House is one which puts patients and doctors behind HMOs.”
But many Republican lawmakers praised the compromise as a way to control health-care costs and thus prevent millions of Americans from losing their health insurance.
“It will not unduly raise the cost of health insurance,” said Rep. John Boehner (R., West Chester, Ohio). “I think we've struck the right balance for the American people, and we ought to stand up today and think of the patients, not the trial lawyers.”
Rep. Ernie Fletcher (R., Ky.) described Mr. Norwood's compromise as a “win-win” result for all sides. Mr. Fletcher had sponsored a bill with even narrower lawsuit provisions that Mr. Bush had endorsed initially, but it failed to muster enough support to convince House GOP leaders that it could be passed.
All competing versions of the measure offer patients access to medical specialists, guarantee emergency-room treatment, and permit women to go directly to an obstetrician or a gynecologist.
When insurers' decisions do give rise to patient grievances, patients must go to an independent review panel before they file suit. Democrats said that the Bush-Norwood compromise would require courts to presume that the review panel was correct when it ruled in favor of the insurance company, but wouldn't call for a similar presumption when the review panel sided with the patient.
It “holds HMOs and insurers to a different standard than doctors,” said House Minority Leader Richard Gephardt (D., Mo.).
Mr. Ganske and his Democratic allies said the compromise would wipe out existing state laws, including those in Texas, and ultimately could be ruled unconstitutional.
The Bush-Norwood compromise significantly limits the damages that courts could award patients harmed by a health plan's decision.
Mr. Ganske and Mr. Dingell's bill would have allowed unlimited damages for pain and suffering and capped damages designed to punish an insurer at $5 million in federal court.
The Bush-Norwood agreement would permit only $1.5 million for pain and suffering. It would permit another $1.5 million for damages to punish a health plan, but only if an insurer ignores the review panel's ruling in favor of a patient.
Mr. Dingell and Mr. Ganske tried unsuccessfully to persuade Republican leaders to delay the vote until lawmakers reconvened after their August recess to give members more time to study the compromise.
In 1999, 68 House Republicans bucked their leaders to pass the bill supported by Mr. Norwood and Mr. Dingell. The Senate passed a weaker patients' rights bill. House and Senate lawmakers were unable to reconcile the two versions, and the bill died in a conference committee.
But Sen. Edward Kennedy (D., Mass.), who sponsored the patients' rights bill that passed the Senate in June, said he does not expect that outcome to recur. If the patients' rights bill stalls in the conference committee, he said, Democrats who control the Senate will attach it to other bills in an attempt to pass it.
“This issue is not going away,” Mr. Kennedy said.