After weeks of contentious debate, the House on Friday passed a Republican managed-care regulation proposal by a slim 216-210 margin. The focus now shifts to the Senate debate, which continued to slide into disarray last week amid partisan bickering.
The House vote came less than a day after the American Hospital Association, which previously had insisted it did not support any legislation, reversed course and endorsed the GOP bill, allowing the nation's largest hospital trade group to avoid appearing obstructionist.
AHA Executive Vice President Richard Pollack said that although the association would prefer private-sector regulation, "given the current circumstances, the Republican bill is the best one out there."
The American Medical Association, in contrast, has backed the Democratic alternative to the GOP plan (See story, p. 8).
The Senate had planned to begin debate on the issue later this week, but Republicans and Democrats have been unable to come to an agreement on rules for the debate. Democrats are insisting they be allowed to offer at least 20 potentially embarrassing amendments to the GOP bill, a request being resisted by Senate Majority Leader Trent Lott (R-Miss).
Late last week Senate Minority Leader Thomas Daschle (D-S.D.) hinted the Senate might not take up the managed-care issue until it returns from its August recess.
In the House, passage of the GOP plan, which was sponsored by J. Dennis Hastert (R-Ill.), came after the narrow defeat of a competing Democratic plan by 212-217.
Debate was heated as Democrats charged the Republican bill is little more than a symbolic gesture to move the managed-care debate off the table without inflicting serious damage on insurance companies.
Republican members countered that the Democratic proposal would increase health insurance premium costs and, thus, the number of uninsured.
Republicans made several concessions to Democratic concerns before the bill's passage. The most significant was an increase in the penalties for health plans that ignore the coverage decisions of an external review panel. An amendment beefed up maximum penalties per case to $250,000 from $100,000.