By Amy Goldstein and Helen Dewar
Washington Post Staff Writers
Thursday, July 16, 1998; Page A01

Senate Republican leaders yesterday disclosed their version of a plan to safeguard the rights of health care patients, calling for a set of federal restrictions on health maintenance organizations but proposing that they cover tens of millions fewer Americans than rival bills backed by the White House and congressional Democrats.

The Senate GOP bill sets the stage for a public showdown in what has emerged as the dominant issue before Congress this term, and lays bare just how sharp the partisan divisions are over the government's role in addressing growing unrest with the nation's health care system.

While it has become clear in recent weeks that both parties were moving to embrace the cause of patients' rights, the details revealed in yesterday's Senate proposal deepened the parties' philosophical differences just as top-level political jockeying has reached a frenzied pace.

Comparing the Main 'Patients' Rights' Bills Congress is considering three main pieces of legislation that would increase government regulation of managed care: a bill by the Senate Republican leadership; one by the House Republican leadership; and a Democratic leadership bill -- resembling a White House proposal -- that has been introduced in both chambers. * All three measures would require health plans to pay for more emergency room visits, forbid plans to "gag" doctors from discussing expensive treatments with their patients, allow patients to visit obstetricians and pediatricians without prior approval, and -- with some variations -- strengthen patients' ability to appeal denials of care or payment to their insurer and outside grievance boards. The Senate bill, though, would extend some of these protections to substantially fewer Americans than the other versions. Here are other ways that the bills differ. Malpractice suits against health plans SENATE GOP: No provision. HOUSE GOP: Patients in federally protected health plans could not sue their insurer, but plans could be fined under certain circumstances for withholding care. DEMOCRATS: Would let states decide whether to allow malpractice suits against "self-insured" plans. Medical savings accounts SENATE GOP: Would allow unlimited access to tax-exempt medical savings accounts, and would permit employees who have "cafeteria-style" benefits to devote the money to MSAs. HOUSE GOP: Would expand access to such accounts, but to a lesser degree. DEMOCRATS: No provision. Increased access to insurance SENATE GOP: For self-employed Americans, would expand tax deductions for health insurance from 45 percent to 100 percent, as of January 1999. HOUSE GOP: Same tax deduction provision. Also would create two new ways for small companies to band together to buy less expensive health insurance. DEMOCRATS: No provision. Mastectomy coverage SENATE GOP: Would prohibit health plans from setting caps on how long women may stay in the hospital after breast cancer surgery. HOUSE GOP: No provision. DEMOCRATS: Would require health plans to pay for hospital stays of at least 48 hours. Improving medical quality SENATE GOP: Would spur more research into how to measure what kind of treatment is most effective and encourage doctors to provide state-of-the-art treatment. HOUSE GOP: No provision. DEMOCRATS: Would require health plans to monitor the care they provide and develop explicit plans for improving medical quality.

As the Republican senators were extolling the merits of their plan, Senate and House Democrats staged a form of live theater in hopes of broadening support for their more extensive approach to regulating insurers -- bringing to Capitol Hill doctors, patients and former HMO employees to illustrate the human toll wrought by some penny-pinching health plans.

One former employee of a health maintenance organization, who addressed the Democratic hearing via video with his appearance and voice disguised, told of one case in which his employer relentlessly badgered a grieving wife to cut off her husband's respirator. She finally agreed, but the hospital insisted on waiting a day before carrying out her wish. To the wife's astonishment, her husband awoke that day from his coma.

If not for the hospital's policy, the patient "may well have been murdered by HMO greed," said Sen. Carol Moseley-Braun (Ill.), one of a chorus of Democratic senators arguing that the government needs to take strong steps to intervene.

The political maneuvering comes less than a week before the Senate is slated to begin debate on the issue and illustrates how much mileage politicians of divergent beliefs have decided they can gain from trying to ease public discontent over managed care.

Despite the widespread zeal for patients' rights, the Senate Republicans made clear yesterday how much disagreement remains over exactly what the government should do.

The Senate version is the latest in a series of legislative proposals that have emerged since last fall, when President Clinton called on Congress to adopt a set of managed-care regulations. In addition to yesterday's Senate proposal, the main bills include a measure proposed by the House Republican leadership three weeks ago and a Democratic proposal introduced by Senate Minority Leader Thomas A. Daschle (S.D.) and Rep. John D. Dingell (Mich.). The Democratic bill would go the furthest in placing new restrictions on HMOs and other forms of managed care.

Several aspects of the Senate GOP plan are not found in the other approaches. They include a longtime Republican interest in expanding the use of tax-free medical savings accounts, an emphasis on health care for women, and an effort to prohibit insurers from charging more to certain people based on their family history of diseases or genetic tests. It also calls for an infusion of money to expand fledgling research efforts to measure the effectiveness of medical treatments.

But the most striking difference in the new proposal lies in how many patients would be covered by a set of core patient protections -- including payment of emergency room bills, an end to "gag" rules that restrict doctors' ability to tell patients about expensive treatments, and several provisions intended to gave patients easier access to doctors of their choice.

The other bills would extend those protections to anyone covered by an insurance plan. The Senate GOP bill would extend them only to the 48 million people covered through federally protected health plans sponsored by large employers -- plans that are exempt from state health care laws. For all other patients, senators said yesterday, they would defer to the states.

Senators said they did not want to preempt state prerogatives to decide what kind of health care laws their residents need, and cautioned that excessive regulation could drive up insurance costs and ultimately cause more people to become uninsured.

Democrats yesterday swiftly seized on the bill's limits, saying as many as 100 million insured patients would remain unprotected. Labeling the measure "a bill of goods," Daschle told a news conference, "The Republican proposal is a desperate attempt to dodge the American people's demands for real patient protections."

At the White House, Chris Jennings, the main health policy adviser, said: "This doesn't achieve the gold, silver or lead standard. . . . They've left millions of [Americans] unprotected."

Yesterday, Clinton visited the American Medical Association, where he convened a round table of aggrieved patients and physicians. Today, he plans to go to Capitol Hill for a midday rally with Democratic lawmakers.

The pace of political activity is being matched this week by intensified lobbying on the part of interest groups with divergent views.

The American Association of Health Plans, which represents more than 1,000 HMOs and other managed-care plans, released a survey of its members in an attempt to suggest that government intervention is unnecessary because the industry polices itself.

Its survey showed that two-thirds of its members comply completely with a voluntary code of conduct that resembles some of the provisions Congress is considering, while 95 percent comply with almost all the voluntary rules.

On the other side of the debate, the consumer group Families USA is preparing to release a study today in an attempt to demonstrate why federal regulation is needed. The analysis found that no state has enacted all of what the group considers 13 basic patient protections, and most states that have passed laws have addressed only a few areas.

Meanwhile, the AFL-CIO yesterday announced a drive to build grass-roots support for the Democratic bill through a $1 million campaign of radio and television advertising that will target 21 House members and five senators.

Staff writer Thomas B. Edsall contributed to this report.