Managed-care reform tied the Senate in knots last week as Democrats used an unrelated spending bill as a platform to promote their "patients' bill of rights" legislation.
Democrats delayed action on the little-noticed annual spending bill for agriculture programs in an effort to force the Republican leadership to agree to a debate and vote on patient-protection legislation as a stand-alone measure.
They did so first by offering their comprehensive patient-protection bill as an amendment to the agriculture spending bill, which the Senate defeated on a 53-47 vote, and then by proposing 20 separate amendments that contained some of the key provisions of the Democratic patient-protection bill.
The Senate also defeated a GOP alternative on a 55-45 vote.
By week's end, the two sides could not agree on how to debate the patient-protection bill.
The Democratic and Republican proposals differ most significantly on whether enrollees could sue health plans for death or injuries that result from the denial of coverage of healthcare services.
The Democrats' bill allows such suits, but the GOP bill offers as an alternative an appeals process under which the denial would be reviewed outside of the health plan.
Republicans said the Democrats' bill would increase costs on the private sector by $41 billion over five years and make 1.4 million workers lose insurance coverage.
In the House, meanwhile, Democrats kicked off their push for passage of the same bill of rights by circulating a petition that would force a debate and vote on the measure in the full House. Last week, they had obtained 168 of the 218 votes necessary to force such a debate.
House Speaker J. Dennis Hastert (R-Ill.) said the House Education and Workforce Committee will vote on a package of managed-care reforms this week, and the full House will vote on it in July.