Anxiousness over patients' rights

The bill could get bumped to the fall, Hastert warns in a closed-door meeting.

Published July 26, 2001 10:43PM (EDT)

Though originally slotted for a House vote this week, the patients' bill of rights legislation may not come up for a vote until the fall, House Speaker Dennis Hastert, R-Ill., said at a closed-door GOP caucus meeting Wednesday.

"The speaker said this could very well go past the August recess," announced Rep. Greg Ganske, R-Iowa, the feisty surgeon and cosponsor of the more expansive version of the bill that President Bush has vowed to veto. At a briefing on the bill for reporters with his fellow cosponsors -- Reps. Charlie Norwood, R-Ga., John Dingell, D-Mich., and Marion Berry, D-Ark. -- Ganske said Hastert, an opponent of the bill, was accomplishing through parliamentary maneuvering what he had been unable to accomplish through arm-twisting.

"Despite the fact that they've been breaking arms, they don't have the votes," said Ganske, who is retiring from the House to run for the Senate against Sen. Tom Harkin, D-Iowa, in 2002. He called the possible removal of the patients' bill of rights from the legislative calendar "a pocket veto by the speaker."

Hastert's spokesman, John Feehery, said Hastert had made no definitive plans for the bill one way or another. "The speaker basically said that it's most likely going to be next week that it's going to be on the floor," Feehery said. "It's always possible that it will come up earlier and it's always possible that it will come up later."

One GOP House leadership aide acknowledged that Hastert "was pretty vague" in his comments in the caucus meeting, but guessed that the bill would come up for debate and a vote next week.

Hastert's announcement of a potential delay -- if not outright shanking -- of a House vote has been discussed by Capitol Hill watchers as a possibility, especially as the week for the debate arrived with the House leadership still without the votes it needs to pass the rival bill offered by Rep. Ernie Fletcher, R-Ky. Supporters of the patients' bill of rights, and the Senate version that passed in June offered by Sens. John Edwards, D-N.C., Ted Kennedy, D-Mass., and John McCain, R-Ariz., have been waiting to see what parliamentary tactics Hastert would employ in introducing the Ganske-Dingell bill. They've anticipated that the "rule" governing the bill's debate would give a boost to the Fletcher bill.

Both bills offer a variety of protections for patients enrolled in HMOs or health insurance agencies, but they vary widely when it comes to a consumer's ability to sue an insurer for damages over health coverage that has been denied. The Ganske-Dingell bill would allow state courts to hear these cases, while the Fletcher bill would favor federal courts. The Ganske-Dingell bill, amended to more closely reflect the Edwards-Kennedy-McCain bill, would cap punitive damages awards at $5 million, while Fletcher would cap these awards at $500,000.

Supporters of Ganske-Dingell argue that the Fletcher bill would actually be a step backward for patient protections. A July 18 analysis by officials at the George Washington University School of Public Health and Health Sciences concluded that "the liability provisions of [the Fletcher bill] would reduce rather than strengthen the current accountability of managed care companies to consumers for the medical treatment-related injuries they cause."

While President Bush was in Europe, Hastert's office expressed the desire that Bush get more involved in lobbying members for the Fletcher bill. So Wednesday, at 1:15 p.m. in the Cabinet Room, Bush met with 11 GOP House members, including Fletcher, Reps. Bob Barr and Saxby Chambliss of Georgia, Mike Castle of Delaware, Elton Gallegly of California, John Hostettler of Indiana, William Jenkins of Tennessee, Rob Portman of Ohio, Charles Taylor of North Carolina, James Walsh of New York, Curt Weldon of Pennsylvania and Heather Wilson of New Mexico. Most of these individuals are undecided; Barr is a cosponsor of the Gankse-Dingell bill.

"I am hopeful we'll get a bill I can sign, and I appreciate so very much the hard work that's going on, particularly down in the House of Representatives, to bring a bill that's fair to patients," Bush said. "There was a lot of negotiations going on when I was gone and there still seems to be a lot of talk, and we'd like to get this bill finished and on my desk, and a bill I can sign."

Berry, a "Blue Dog" conservative Democrat who's helped secure the support of a vast majority of his 33-member group, called the Fletcher bill "nothing more than a decoy to give folks some cover so they can vote for a patients' bill of rights." The Bush White House has lobbied hard to get Blue Dog Democrats on board -- including an Oval Office invitation earlier in the month -- but so far this effort has only managed to secure the support of Rep. Colin Peterson, R-Minn.

Decoy or not, the Fletcher bill gained a supporter Tuesday, when Rep. Peter King, R-N.Y., announced his backing for the bill despite his support for Ganske-Dingell's 1999 incarnation, "Norwood-Dingell."

"I met with the president a number of times," King told CNN's "Inside Politics" on Tuesday. "My feeling is that the president definitely wants a patients' bill of rights. He's also going to veto the [Ganske-Dingell] bill. And the only way to get a patients' bill of rights through is to get the Fletcher bill through the House, send it to conference committee. And then I believe the president will sign it."

Ganske alluded to enticements that GOP House leaders might be offering its members in exchange for support for the Fletcher bill -- and charged the media to "look very carefully at the people who flipped their vote." But when CNN's Kate Snow asked King if he'd been "promised anything by this White House" in exchange for his vote, King joked, "No, I really wasn't. But now that I hear this, maybe I'll go back in."

Each and every member's vote is significant; Dingell announced that he's secured the support of all but one or two Democrats. Though 68 Republicans voted for the bill in 1999, Norwood claims to have 25 Republican supporters for this year's efforts. In a House with a six-vote majority, that would be enough to pass the bill and to defeat the Fletcher legislation.

"That isn't a group that's gonna all admit it; they'd be crazy to," Norwood drawled, arguing that some of these below-the-radar Republican supporters want to avoid aggressive whipping by the GOP leadership. But he added that his team has been equally effective at the tough whipping practices employed by their opposition.

"Most people with a broken right arm have a broken left arm, too," he joked. Whenever the GOP House leadership coaxes a member for his or her support, the Ganske-Dingell team pounces as well. "We're observant," he said.

Ganske-Dingell strategists chuckle at what they see as political pageantry by the White House and GOP House leadership trying to create the illusion of momentum for the Fletcher bill. In the last few days supporters of the Fletcher bill have rolled out "new" supporters, ones who either have been on board the Fletcher train forever, like Rep. Nancy Johnson, R-Conn., or ones whom Ganske-Dingell strategists say they never saw as faithful supporters of the 1999 legislation, like King. But Wednesday's news that Rep. Ben Gilman, R-N.Y., one of the Ganske-Dingell bill's 10 GOP cosponsors, might be wavering seemed to bode slightly ill for the team.

"I think we had, clearly, some indication from some of those that are with us that they were very encouraged that they'd be able to support my bill," Fletcher said after the White House meeting with Bush. "We still, obviously, have some work to do, but things are coming our direction; we're building momentum, and I'm very optimistic about things." He said the Ganske-Dingell bill will drive up insurance costs, thus indicating "a flagrant disregard for the uninsured, and who is this legislation going to be bad for -- that's the most vulnerable, the low income and minorities."

Bush is "very clear he will veto the Ganske bill, the Ganske-Dingell bill," Fletcher said. "He reiterated that; he said it several times. He said he will sign this bill. So that's a very effective mechanism."

In Feburary, Norwood and Ganske were asked by the White House to refrain from introducing their bill. Ganske didn't heed the request; Norwood did and spent several months negotiating with the White House on legislation, only to have those negotiations hit an impasse. He rejoined the Ganske-Dingell team, but continues to talk to the White House, which he did as recently as Tuesday night.

In that conversation, however, Norwood said, "I aggravated them.

"The White House continues to want to go into federal court and preempt state law," Norwood said. "The White House is not fond of our $5 million cap. That is a real hurdle for them to cross." He expressed the hope that there exists room for compromise between the $5 million cap and the $500,000 cap in the Fletcher bill. "I'm sure to God we can find somewhere in between them that we can agree to. That's a pretty broad spread."

Dingell said that he was "not surprised" by the speaker's comments, recalling that what was then called the Norwood-Dingell bill only hit the floor in 1999 after members of Congress began signing a "discharge petition" to force the bill onto the floor. Despite the opposition of then-Speaker Newt Gingrich, R-Ga., enough supporters signed the petition to get close enough to the 219 necessary signatures that Gingrich allowed the vote to occur. Dingell said that his team would not yet seek a discharge petition on the bill this year.

"We have not embarked on that; we prefer to work with the leadership rather than to oppose them in that act of reform," he said.

"I'm so eager to get this to the floor!" bubbled Ganske with a combination of frustration and eager-beaverness. But he noted that one other person on his coalition might be even more inspired.

"Charlie [Norwood] has been on this diet," Ganske said, pointing to the dentist whose wife, Gloria, has had him on a salad and tomato-shake regime since November, causing him to lose 60 pounds. "And his wife promised him a great big juicy T-bone when the debate on this is over."

By Jake Tapper

Jake Tapper is the senior White House correspondent for ABC News.

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