"For GOP, the Fight Becomes Riskier"
By David S. Broder
Washington Post Staff Writer
Saturday, June 30, 2001; Page A01
The political pincers are beginning to close on President Bush and the Republicans on the patients' bill of rights issue. They may still find a way to shape the outcome into a White House signing ceremony, but GOP leaders concede that -- with Senate approval of the measure -- the political and policy risks they face are formidable.
The House plans to take up the issue in mid-July, with every prospect that a bill regulating HMOs and other managed care organizations will be passed before the August recess. The House in 1999 endorsed a measure as strong in most respects as the current Senate bill in a lopsided 275 to 151 vote, but Republicans are hoping to substitute a milder version, endorsed by Bush, next month. If they do not succeed, the president has threatened a veto -- a step that would increase the political stakes by making Bush seem as if he is blocking popular legislation.
Democrats, who have made patients' rights a rallying cry in the past two elections, are savoring the situation. Their first action when they took over the Senate early this month was to move the issue to the top of the agenda, and they pushed to get their bill passed before the Senate breaks for the Fourth of July holiday.
Both sides hope to drum up public support for their positions while members are back home, but Democrats clearly have the upper hand. A CNN-USA Today poll early this month found 49 percent of those surveyed saying they had confidence in Senate Democratic leaders on the patients' rights issue, while 34 percent expressed more confidence in Bush. A Wall Street Journal-NBC News poll this week gave Democrats a 41 percent to 20 percent edge over Republicans on health care.
Bush and the GOP leadership in the House and the Senate have been arguing for months against legislation allowing patients wide latitude to sue, contending that it would push up the cost of health insurance and prompt employers to drop coverage, increasing the ranks of the uninsured. The managed-care industry and allies in large and small businesses have lobbied hard on the issue, unsatisfied with the amendments the Senate has adopted to limit employers' liability.
But they have made little headway with public opinion, as proponents have cited case after case of patients dying or suffering lifelong health damage allegedly because HMO policies and decisions denied them the care doctors said they needed.
It was that public sentiment that fueled a surprise setback for House GOP leaders in October 1999, when 68 Republicans joined all but two Democrats in passing a patients' rights bill guaranteeing certain services, setting up an independent appeals process and granting access to state and federal courts to people with injury claims.
The current version of that bill carries the names of the dean of House Democrats, Rep. John D. Dingell (Mich.), and two Republican legislators with medical backgrounds, Reps. Charles Whitlow Norwood Jr. (Ga.), a dentist, and Greg Ganske (Iowa), a physician. The alternative, endorsed by the White House and the House GOP leadership, has as its main sponsor another physician, Rep. Ernie Fletcher (R-Ky.), with Rep. Collin C. Peterson (D-Minn.) as co-sponsor. That bill does not eliminate court suits but restricts them.
Bush has had two meetings this week with Republicans who supported the Norwood-Dingell bill in 1999. "There was no arm-twisting," said Rep. Sue W. Kelly (R-N.Y.), adding that Bush "knows that bill cold" and was persuasive. John Feehery, spokesman for House Speaker J. Dennis Hastert (R-Ill.), said yesterday that "we're making progress" in lining up votes for the Fletcher-Peterson version, but others in the administration and the House GOP leadership said the odds are against it prevailing.
Republicans note that while 68 of their members voted with the Democrats in 1999, all but 21 of them had supported GOP substitutes before that final vote. House Minority Leader Richard A. Gephardt (D-Mo.) said yesterday that Norwood has told him he expects no more than 20 Republicans to break ranks this year, but GOP leaders are trying to limit the defections to single digits.
Republican leaders said they are prepared to make further modifications in their version to attract more votes to their side, and that they hope Peterson can bring some of his fellow "Blue Dog" conservative Democrats aboard.
But Gephardt said: "I remain optimistic that we can pass a bill very much like the Senate bill." His worries, he said, are that the Republican leadership may delay a vote, if they do not think their substitute can prevail, or, failing that, "try to steer the House and Senate bills into what I call a cul de sac conference."
The broad House-passed bill of 1999 and a more restricted measure that passed the Senate a week later were allowed to die in conference -- much to the relief of the health maintenance organizations and business groups that opposed both versions. But with Democrats now in control of the Senate and public attention focused on the issue, pollster Linda DiVall, who is close to the House GOP leadership, said: "Letting it die in conference would be a lot more ticklish this time around."
Bush's veto threat is designed, in part, to stiffen the backbones of House Republicans and give wavering members an additional reason to shift their support to the Fletcher-Peterson alternative. The president's allies in Congress insist the threat is real, pointing out that Bush vetoed the first version of a patients' rights bill passed by the Texas Legislature before allowing the compromise version he now cites as a model to become law without his signature.
But one of his strongest supporters in the House yesterday called the veto threat "a high-risk strategy," arguing that Democrats would "never let another bill see the light of day," preferring to take the issue into the mid-term campaign.
And DiVall, noting that White House press secretary Ari Fleischer had said Bush finds "90 percent of the Senate bill acceptable," said: "It will be difficult for Bush to veto it; and if he does, he's got to have a firm set of reasons, broader than the cost to employers."
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