Health reform again took center stage in Congress on Thursday, as the House approved a GOP bill that would make it easier for job-switching workers to keep medical coverage, and harder for insurers to turn away sick people.
The vote was 267-151, largely along party lines. But the chances of getting Senate approval and President Clinton’s signature were clouded by House Republicans’ addition of controversial provisions that benefit doctors and insurers.
“A loaded bill is a dead bill,” warned Senate Democratic Leader Tom Daschle of South Dakota. The Senate’s simpler version of the legislation, which is expected to go to the floor in the next few weeks, has the support of Clinton and lawmakers of both parties.
Defending the House bill, Speaker Newt Gingrich said late Thursday, “We don’t think the House is bound to just say, ‘Send us over something we can rubber stamp.”’ The House bill improves on the Senate bill, the Georgia Republican said, but hinted that he would not risk a veto to make the point.
Nearly 30 million Americans - almost 25 million people with pre-existing medical problems and 4 million workers who would take another job if they could keep their coverage - could benefit if lawmakers are able to resolve their differences.
The Senate bill - co-sponsored by Sens. Nancy Kassebaum, R-Kan. and Edward Kennedy, D-Mass. - concentrates on the insurance problems of job-switching workers and people with pre-existing health problems.
The more ambitious House bill, meanwhile, incorporates parts of the GOP budget vetoed by Clinton last year, such as limits on medical malpractice judgments, and tax-sheltered medical savings accounts that allow individuals to act as their own insurers.
One add-on does have Democratic support: a provision that would let self-employed people deduct more of their health insurance costs from taxes.
But for the most part, complained House Democratic Leader Dick Gephardt of Missouri, “They’ve added a whole bunch of special interest stuff that blows the bipartisan agreement.”
Republicans rejected the accusations. The legislation “is a reasonable beginning for resolving our nation’s health-insurance problems,” said Rep. Michael Bilirakis, R-Fla.
On any given day, some 40 million Americans are without health insurance. Yet studies have shown that about 40 percent of them will regain coverage within a year and are probably in the midst of some kind of life transition.
Because being uninsured is a temporary setback for so many people, legislation to address waiting periods and exclusions has enjoyed broad bipartisan support since President Bush’s administration. But it has always gotten trapped in a political tug-of-war over bigger health-reform issues.
This year, both the House and Senate started out with modest proposals that address some of the most annoying health insurance headaches.
Generally speaking, both bills would allow workers who already have health insurance to switch jobs without losing their coverage.
From this point, the two bills part company. The House bill charges onward, resurrecting controversial proposals from last year’s budget battle. For example, it would:
Limit “pain and suffering” awards in malpractice cases to $250,000. Punitive damages would be limited to the same amount. Malpractice limits are strongly supported by doctors - and opposed with equal vigor by lawyers and consumer groups.
Increase penalties for Medicare fraud but weaken some laws that prosecutors now rely on.
Create tax-sheltered medical savings accounts (MSAs) that would let individuals set aside money for routine health costs while carrying lower-cost “catastrophic” insurance for a major health problem.
MSAs are supported by insurance companies selling catastrophic coverage and by doctor groups. One insurer, Golden Rule of Indiana, has been a significant contributor to Republican campaigns.
Consumer groups and many health-policy experts argue MSAs would entice healthy people to leave the broader insurance pool.