Trying to put Democrats on the defensive, Senate Majority Leader Trent Lott (R-Miss.) this week will put Democratic-sponsored legislation before the full Senate when it debates managed-care reforms.
The purely tactical maneuver will force Democrats to defend their bill rather than attack the Republican alternative. Most observers had believed the GOP would offer its own bill-likely to be the bill that passed the Senate Health, Education, Labor and Pensions Committee in March-and then be forced to vote against Democratic amendments.
Lott's ploy could prevent Democrats from forcing Republicans to vote against meaningful amendments, such as allowing enrollees to sue for injuries or deaths that result from coverage denials.
Republicans will be able to substitute provisions from GOP-drafted legislation. It's expected that a final amendment will replace the entire text of GOP legislation for the Democratic bill.
The tactic probably won't stop Democrats from offering amendments that highlight the differences between the two proposals, however. Such amendments include health plan liability language, a requirement that physicians decide whether procedures are medically necessary and direct access to specialty care.
The GOP move will enable Republicans to cite costs to the federal government and increases in health insurance premiums projected by the Congressional Budget Office should the Democratic bill pass.
The CBO estimates, for example, that federal revenues will drop by $7 billion between 2000 and 2004, when increases in nontaxable employer-paid health insurance premiums will squeeze out increases in taxable wages.
Meanwhile, the CBO estimates, federal costs would increase by $555 billion because of increased premiums under the Federal Employees' Health Benefits Program and increased regulatory activity.
Mandates on private health insurers would cost insurers and employers $41 billion, according to the CBO. Private health insurance premiums would increase an average of 4.8%.
Under an agreement between party leaders, a vote on managed-care legislation will come after four days of debate, on July 15. Each amendment will be subject to an hour and 40 minutes of debate.
The agreement does not bar Democrats from bringing up managed-care legislation later in the session.
Trying to fend off legislation, the American Association of Health Plans will be running television and newspaper advertisements this week as part of a continuing multimillion-dollar effort to improve HMOs' image.
This week's ad campaign targets Republican senators who might be willing to vote for stronger patient protections. The AAHP spent $5 million on advertising, public relations and grass-roots advocacy in 1997 and 1998.