Confronted with a budding rebellion within his own party, House Speaker J. Dennis Hastert (R-Ill.) yesterday agreed to allow a vote on the divisive issue of "patients' rights" early next month, freeing the House to move beyond the Senate in clamping down on the nation's HMOs.
Hastert decided to permit the vote after trying fruitlessly for weeks to quell a drive by House Democrats and a faction of GOP dissidents to enact broad new protections for Americans in managed-care plans, including giving patients greater freedom to sue HMOs for malpractice.
Unable so far to broker a compromise, the speaker announced that he would allow the House to consider at least two bills that would regulate managed-care plans far more stringently that he and other Republican leaders want, essentially conceding that he cannot dictate the will of the chamber.
While the various measures before the House differ in scope and strength, the proposals all attempt to give patients in health maintenance organizations more clout, including making it easier for them to visit medical specialists, get bills for emergency room visits paid, find out about their HMOs' rules and protest if they don't receive the medical services they want.
Aides to Hastert said yesterday that he has not abandoned hope of finding common ground with GOP dissidents. But other members said that the odds remain long, raising the prospect that patients' rights will join campaign finance as a major issue on which the House leadership ultimately is forced to acquiesce to legislation it opposes.
Yesterday, Hastert said the debate, which he scheduled for the week of Oct. 4, "will allow members of the House to fairly express their views on the important subjects of patient protections and access to quality health care."
The speaker's awkward position highlights how difficult it is to guide the House this year, as the Republican edge in votes has dwindled from 11 to five. The party's clout is considerably less than it was a year ago, when Republicans, marshaled by Hastert before he led the House, pushed through a conservative version of a patients' rights bill that passed by just five votes.
Shortly after becoming speaker, Hastert promised to revive the issue this year. He promised to bring the issue to a vote before the August recess, then by the end of this month, but delayed each time because he could not corral his party's rebels.
The disagreement over how to regulate managed care, an issue that polls show has great appeal among voters, centers on the possibility of opening HMOs to malpractice lawsuits by patients who believe they have been denied medical care they need. This right, absent from a limited managed-care bill the Republican-controlled Senate approved in July, is vigorously opposed by insurance and employer groups but is considered vital by House Democrats, the White House and the dissident band of Republicans.
Patients would be allowed to sue their HMOs under a bipartisan bill, developed by Reps. Charles Whitlow Norwood Jr. (R-Ga.) and John D. Dingell (D-Mich.), which has more than enough support to pass the House, according to its backers. Trying to blunt the momentum behind that bill, Hastert last month encouraged two other Republicans to develop a more modest alternative.
But the speaker has refrained from supporting that alternative, designed by Reps. Tom Coburn (Okla.) and John Shadegg (Ariz.), because it, too, includes the possibility of lawsuits against HMOs, although under far more limited circumstances.
Yesterday, Coburn said in an interview that he told Hastert Wednesday evening that he would abandon his own bill and support the more expansive bipartisan version -- that is, the version most abhorrent to the GOP leaders -- unless the speaker scheduled a vote. "If he wants to have any chance of success in getting a more moderate position than Dingell and Norwood, he better get busy," Coburn said he told the speaker.
"The leadership has misread the number of people in our [GOP] conference who believe plans ought to be held accountable," said Coburn, a physician. And in light of widespread public resentment against managed care, he said, the leaders' opposition to letting patients sue would give the party "a black eye on this issue."
Coburn said he will continue to negotiate with Hastert and his allies, but that he will abandon his bill in favor of the more liberal one if the speaker tries to "play games to dilute the vote" by allowing a third, more conservative patients' rights bill to come to the floor.
The White House gently issued a similar threat yesterday. President Clinton released a statement predicting that the bipartisan bill will be adopted "if the House leadership permits a fair process for debating and voting on this important issue."
Norwood, a dentist and leader of the GOP dissidents, praised Hastert yesterday as "a man of his word." Until now, Norwood had been unable to secure a floor vote on any of the patient protection bills he has sponsored annually since 1995.
Noting that Democrats and the rebellious Republicans were prepared to try to force the issue to the floor, Norwood called the decision to schedule a vote "a very common sense approach to the fact we are going to have this debate, and they know it. . . . I know [Hastert] doesn't like it, but he's doing it, and that's what counts."
Staff writer Juliet Eilperin contributed to this report.