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LATE BREAKING HEALTH CARE NEWS

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IN A STRING of votes, Republicans also opted to restrict many of their provisions to the 48 million Americans whose health plans fall exclusively under federal regulation. They also rejected Democratic amendments on women’s health and emergency room care.
“All in all, I think we had a pretty productive day,” said Sen. Don Nickles, R-Okla.
Despite the defeats, Democrats believe they scored points in a political debate that has become as much about next year’s elections as policy. Neither side has been willing to compromise, and President Clinton has signaled he will veto the GOP bill.
At every turn, Democrats are trying to expand HMO protections, while Republicans prefer a more modest approach.
Nothing illustrated that better than who would be covered.
On a 53-47 vote, the Senate opted to apply many of the new rights only to the 48 million Americans in health plans that are now exempt from state regulations. This includes patient protections involving emergency room care, access to obstetricians-gynecologists and the right to keep a doctor during a course of treatment.
Democrats want to cover another 113 million others who live in states that may or may not have approved the protections on their own.
“This is about denying millions of Americans the right to protection,” Senate Minority Leader Tom Daschle, D-S.D., said.
Republicans argued that the federal government should not interfere with health plans that are already subject to state regulation.
Democrats’ effort to make HMOs pay for many treatments they do not now cover — one of the most contentious issues in the debate over HMOs — failed on a 52-48 vote.
The Democratic bill would have made health insurance companies pay for care consistent with “generally accepted principles of medical practice.”
Republicans argued that sometimes the most common practices are not the best. They replaced the Democratic provision with their own system allowing patients to appeal if care is denied.
Republicans also:
—Won adoption of a measure that would allow self-employed people to deduct the full cost of their health insurance from their taxes.
—Defeated, 52-48, a Democratic measure that would let women designate their obstetrician-gynecologist as their primary care doctor. It also would have allowed women to stay overnight in the hospital after a mastectomy if a doctor recommended it. Republicans said they would offer a modified version of the same idea later this week.
Interest in federal legislation has grown over the past few years as health maintenance organizations and other managed care plans have come to dominate the health insurance market.
Today, some 80 percent of people with private insurance are in managed care, which tries to control costs by eliminating unnecessary care and coordinating treatments.
States have adopted many of the rules being debated in Washington, but their laws do not affect health plans that fall under federal regulation. Different rules from state to state also have created a patchwork of benefits across the country.

Democrats have said they will introduce 20 amendments — each targeting a different piece of the medical insurance reform package. The strategy is intended to force GOP senators to support the Democratic plan or risk looking like they don’t want to protect patients.
But the Republicans are expected to use their 55-45 majority to push through their own proposals in a final vote on Thursday.
In general, businesses and health care companies favor either the Republican bill or no bill at all, while the American Medical Association and many patients’ advocacy groups back the Democratic measure.

‘THEY ARE WRONG’
Clinton sought to turn up pressure on the Republicans. “They allege that a strong patients’ bill of rights would cause premiums to rise beyond the reach of average Americans,” Clinton said Tuesday in a statement outside the White House. “They are wrong.
“This is about political power in Washington trying to shut off something that is manifestly in the best interest of the average citizen of this country — and not just the average citizen — every single person covered by an HMO.”


The patients' rights debate

• A rundown of Democratic and Republican proposals

In debate Monday over rival plans to give patients more power in dealing with health maintenance organizations and other managed-care plans, Republicans accused the Democrats of underestimating the cost of their plan. The GOP contends the Democratic plan would result in 1.8 million people losing coverage and increase annual premiums by $355 per family.
Daschle and Sen. Edward Kennedy, D-Mass., co-sponsors of the Democratic proposal, dismissed the claims. They said it would increase premiums by only about 4.8 percent over five years, or about $2 per person per month. That estimate did not include the extra costs for employers, however.

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