For most Americans, legislative details are a snooze. But supporters of the patients' bill of rights are holding their breath to see what parliamentary rules House Speaker Dennis Hastert, R-Ill., uses to introduce the bill this week, a decision that should be announced Tuesday night.
The rules under which the bill is introduced will determine much about the debate, as well as reveal whether Hastert continues to indulge his newfound predilection for hardball tactics. The last time Hastert got funky with the parliamentary rules, he managed to derail campaign finance reform -- another popular, high-profile piece of legislation that had already passed the Senate despite President Bush's opposition.
This time, he is likely to use the rules to benefit a more conservative version of the patients' rights bill by Rep. Ernie Fletcher, R-Ky., which is supported by Bush, over the more expansive patients' bill of rights offered by Reps. Greg Ganske, R-Iowa, and John Dingell, D-Mich. The Ganske-Dingell bill, supported by Democrats, is the twin to a bipartisan bill sponsored by Sen. John Edwards, D-N.C., Sen. Ted Kennedy, D-Mass., and perennial Bush foe Sen. John McCain, R-Ariz.
The Ganske-Dingell bill would allow consumers to sue their HMO or health insurance company for coverage denied if the denial adversely affected the patient's health. The Fletcher bill is a much more limited version, placing serious restrictions on which lawsuits could be filed, and capping non-economic damages awards at $500,000. "We think we have enough votes," says Ganske. "They can't win [without using] subterfuge."
Right now, the vote seems close. Though 68 Republicans voted for final passage of Ganske-Dingell last time it came up for a vote in 1999, strategists believe that they'll be able to count on 20 Republican votes this time, including 10 GOP co-sponsors and an additional 10 Republicans who want to keep a low profile to avoid the pressure tactics of Majority Whip Rep. Tom DeLay, R-Texas. And while the White House's aggressive pursuit of the 33-member conservative "Blue Dog" Democrat coalition to support the Fletcher bill has been substantial, including a July 12 invitation to the Oval Office, that lobbying has garnered only one supporter, Rep. Colin Peterson, D-Minn.
"People have been lobbied up the wazoo on this," says Ganske of the leadership's efforts to peel away support from his bill. "I don't know that they can exert much more than they've already done."
One way to scuttle it, though, is a "King of the Hill" amendment, in which both the Ganske-Dingell bill and then the Fletcher alternative are introduced under a rule dictating that the last bill to pass will be the one that counts. Under this scenario, the Ganske-Dingell coalition would have to hold together not only to support its bill but to defeat Fletcher's.
"We urge you to support only our bill when it comes to the House floor for a vote," Ganske, Dingell and Reps. Charlie Norwood, R-Ga., and Marion Berry, D-Ark., wrote colleagues earlier this month. Ganske says that all 10 Republican co-sponsors of his bill will vote to defeat the Fletcher bill in such a scenario.
So the GOP House leadership has other tactics at its disposal as well. Two weeks ago, faced with the popular campaign finance reform measure offered by Reps. Chris Shays, R-Conn., and Marty Meehan, D-Mass., Hastert proposed a rule that would have broken out an addition to the bill into 14 separate amendments. Calculating that their fragile coalition couldn't survive such a process, Shays and Meehan led a vote against the rule -- and won, with 19 Republicans joining the entire Democratic caucus (save for fringe Democrat Rep. Jim Traficant, D-Ohio).
But Hastert then exercised the speaker's prerogative and pulled the bill from the floor altogether, leaving its future uncertain but bleak. Like Shays-Meehan, the Ganske-Dingell bill has been changed, since its introduction in February, to coincide with the changes made to the Senate bill.
And as it did with Shays-Meehan, the GOP leadership might require that the Ganske-Dingell changes be voted upon one after another, which would make it more difficult for the Ganske-Dingell coalition to stay together.
But a GOP leadership aide says that unless his bosses come up with a parliamentary scheme to allow the Fletcher bill to pass, "it's certainly possible" Hastert could remove the patients' bill of rights from the calendar altogether.
Ganske insists there will be a vote. "I think the longer they string this out -- the closer they get to the next election cycle -- the worse it is, especially if they're in opposition to it," says Ganske, who's retiring from the House to run for the Senate in 2002 against Sen. Tom Harkin, D-Iowa.
So far, Hastert seems to have walked away completely unscathed from his campaign finance reform showdown with Shays, Meehan and McCain. But patients' bill of rights supporters argue that their bill is of more interest to Americans, who express loathing for HMOs in poll after poll, than an inside-the-Beltway debate over the evils of "soft money."
A front-page story in the Washington Post Monday described Bush's political strategy on the issue as defensive, recounting an anecdote in which Bush, at a June 27 meeting with 20 House Republicans, seemed to acknowledge that he knew his position was unpopular.
"I've got a beautiful ranch in Crawford, Texas," Bush said when asked about the consequences of his position. "If I get sent back there for vetoing a bill I honestly believe will hurt people, then I'll go."