Democrats yesterday intensified efforts in both houses of Congress to grab the offensive on legislation to regulate health maintenance organizations -- an issue that both parties see as critical for next year's elections.
Senate Democrats halted action in their chamber for a second day to force Republicans to schedule votes, while House Democrats started circulating a petition to bring their bill to a vote over the objection of GOP leaders.
"We'll get votes," vowed Senate Minority Leader Thomas A. Daschle (D-S.D.). "It is either that or we'll sit on the Senate floor looking at each other."
As of late yesterday, Republicans and Democrats were still at odds over procedures to schedule votes in the Senate. And, in the House, the Education and the Workforce Committee postponed action on a GOP managed-care bill because Republicans could not agree on its provisions.
Both parties have bills aimed at providing new protections for patients in managed-care plans, including new processes for review of patient grievances. But they differ in critical details, including the extent of government regulation and whether patients or survivors should be able to sue their health plans. Democrats generally favor more regulation than Republicans and want to expand access to lawsuits, while most Republicans would curtail them.
For their first vote, Senate Democrats want to focus on another key difference: who decides a patient's treatment. They are pushing for immediate action on a proposal to require that doctors, rather than health plan officials, be empowered to decide what is "medically necessary" for a patient. The Senate Republicans' bill is silent on that point, although it allows appeals to health professionals when treatment is in dispute. Critics argue that the Democrats' proposal could drive up costs and threaten the financial viability of HMOs.
But, for the time being, little was moving, except the House Democrats' petition, which had gathered 167 signatures by early evening, all from Democrats. Democrats will need 218 signatures, representing a majority of the House, in order to force votes and cannot succeed without some Republican support.
In the Senate, a $60.7 billion farm spending bill -- and everything else on the calendar -- was held hostage as Republican and Democratic leaders struggled behind the scenes to end a deadlock over ground rules for votes on the Democrats' proposals.
Republicans would allow votes on the two parties' bills but balk at the Democrats' demands for separate votes on 20 amendments covering their main proposals.
The dispute evoked memories of the deadlock that led to shelving of similar legislation in the waning days of the last Congress. Democrats, citing polls showing that their proposals have strong public backing, are determined to keep from being trampled again in an adjournment rush and so are pushing hard for early consideration of the measure.
Republicans succeeded Tuesday in blocking Democrats from adding their version of the legislation to the agriculture appropriations bill, prompting Democrats to respond by bombarding the farm bill with their proposal, piece by piece, until the Republicans blink.
This was, in some ways, the Republicans' worst nightmare. Democrats would be running them through a gantlet of tough votes on such issues as how quickly patients should be sent home after mastectomies. "I don't want our members to go through a lot of votes that can be misconstrued for political purposes," said Assistant Majority Leader Don Nickles (R-Okla.).
So Republicans counter-charged, accusing the Democrats of sacrificing the interests of farmers to the political demands of trial lawyers, who have a big stake in patients' right to sue HMOs. "It looks like they're acting on behalf of trial lawyers and stepping over the corpses of American farmers," Majority Leader Trent Lott (R-Miss.) complained.
In the House, Democrats trotted out the petition both to put pressure on Republicans and to illustrate their unity on the issue. Rep. John D. Dingell (D-Mich.), who helped stymie Democratic efforts to pass gun control legislation last week, announced the managed-care effort while standing next to Rep. Carolyn McCarthy (D-N.Y.), who had led the unsuccessful gun control push.
"The American people are tired of excuses from insurance companies, and they are tired of excuses from the Republican Congress," said Rep. David E. Bonior (D-Mich.), the minority whip.
In response, Republicans accused Democrats of trying to kill HMO reform in order to preserve a political issue, noting that Democrats on an Education and the Workforce subcommittee that drafted the GOP bill had voted against six of its eight patient protections.
"We're trying to put together a common-sense bill that will address this issue without raising costs too much," said Rep. John A. Boehner (R-Ohio). "They're more interested in trying to make political hay."
"Obviously, we'll try to blame the Republicans if nothing gets done," said Rep. Fortney "Pete" Stark (D-Calif.). "But we want to get this done. People are crying out for real reform."
CAPTION: Rep. John D. Dingell (D-Mich.), is backed in announcing managed-care effort by Rep. Carolyn McCarthy (D-N.Y.), left, his recent adversary on gun control.