The Republican congressional leadership moved yesterday to derail a hard-won compromise with the Clinton administration aimed at developing a fairer system for organ transplants, outraging the White House and raising concerns that the plan could be delayed indefinitely.
In a late-night maneuver on Wednesday, Senate Majority Leader Trent Lott (R-Miss.) inserted language into a tax bill that would delay by at least three months the implementation of new rules that would make organ allocation more national in scope. The House easily passed the provision yesterday evening.
The leadership action came only a week after Health and Human Services Secretary Donna E. Shalala negotiated a shorter, 42-day delay with members of the Senate and House appropriations committees.
That earlier compromise is part of a $385 billion spending bill moving through Congress. The confusion of having two contrary provisions headed for passage in two different bills will be settled when, and if, President Clinton signs them. The organ language in the last bill signed is the one that becomes law.
Confusion reigned across Capitol Hill in the last desperate days before the Thanksgiving recess, as the leadership and lawmakers scrambled to move big pieces of legislation and fill them up with dozens of special projects benefiting particular states or congressional districts.
The controversy over transplants has simmered since April 1998, when Shalala, in an effort to make the allocation of precious donor organs more equitable nationwide, introduced rules changes that would allow organs to be shared over a wider area.
Currently, organs are allocated locally, then regionally, and only rarely on a national basis. By spreading them more widely, the regulation seeks to get more organs to more seriously ill patients. About 20,000 organ transplants are performed each year, but three times as many people are awaiting them.
The Richmond-based United Network for Organ Sharing (UNOS), which oversees the national system on contract from the government, opposes the proposed changes, charging that smaller centers would go out of business because they would have to send organs to big-city transplant centers with a shortage of donors.
Sources from both sides of the debate agree that the controversy has little to do with partisanship and mostly pits states and districts with large transplant centers and a shortage of donors against those with smaller transplant centers and larger numbers of donors.
For this reason, the administration found staunch allies in Republicans such as Sen. Arlen Specter (Pa.) and senior House appropriator John Edward Porter (Ill.), while fierce Democratic partisans including Rep. David R. Obey (D-Wis.), a senior appropriator from a state with a strong donor program, have battled efforts that would force them to share donated organs more widely.
After agreeing to delay the implementation of the new rules for a year, Shalala and the appropriations committees appeared to have reached a deal last week. Then Wednesday Lott added new language to a House tax bill, essentially extending the 42-day waiting period to 90 days, and providing a new "comment period" that could lead to longer delays.
The new proposal enraged the administration. "We never agreed to this language and we find it extremely objectionable," said Dan Mendelson, associate director for health for the White House budget office. "We implore the Republican leadership not to do this."
But Lott is facing pressures from other directions. In a Nov. 15 letter, Sen. Jeff Sessions (R-Ala.) threatened a filibuster by promising to "do everything within my rights" to block the Shalala rules changes.
Sessions was pleased with the new language, his office said Thursday, and so was House Commerce Committee Chairman Thomas J. Bliley Jr. (R-Va.), Shalala's leading House opponent and author of a pending bill that would remove transplant policy altogether from Health and Human Services.
Bliley, whose home town is home to UNOS, decried the Shalala changes as "misguided" and suggested in a statement that the added delay would give Congress "ample time" to act on his bill, and "not allow policy to be set by presidential appointees."
Transplant policy was but one legislative drama among dozens of sideshows being played out as lawmakers hustled to hook dozens of special provisions to the session's last pieces of legislation.
The biggest train was the gigantic spending bill, and it was loaded with freight. There were little provisions, such as a $500,000 plan to revitalize the Sunrise Mall in the city of Citrus Heights, Calif., and major ones, such as exempting the recycling industry from liability for the cleanup of toxic waste sites.
GOP leaders said the exemption was needed as "furtherance of goals of waste minimization," but insurance companies and chemical manufacturers complained that it would force them to bear more of the cleanup costs.
And the California Center on Race, Poverty and the Environment charged that the exemption would leave poor communities--often the sites of junkyards and battery recycling plants--no recourse in cleaning up scrap dealers' messes.
Although the defense spending bill was enacted weeks ago, Senate and House leaders added $100 million to the new measure to test the "New Army Vision Concept," a system designed to speed the deployment of fast-moving, lethal forces to foreign trouble spots.
Congressional sources said some of the funds will go to military units stationed in Alaska and Hawaii, home states of Sens. Ted Stevens (R) and Daniel K. Inouye (D), chairman and ranking minority member of the defense appropriations subcommittee.
These two states are always big winners in the spending competition, and both got their share of grants this year, among them $2.5 million for buses for the Special Olympics in Anchorage, and a provision to study the need for additional federal payments to skilled-nursing facilities in both states.
But other states, districts and special interests also benefited from the federal largess, reflecting members' priorities and the leadership's wish to provide ample incentives for passage.
There was $5 million for the Tillamook Railroad in Oregon; $60 million to convert the James Farley Post Office in New York into a train station and civic center; and $100,000 for St. Mary's College in Maryland to carry out its St. Mary's River Project.
Lumped in with the spending bill was major legislation to increase Medicare payments to teaching hospitals, skilled-nursing facilities, ambulance services and hospitals serving large numbers of poor people. The package also singles out hospitals in Mississippi, Alabama, Pennsylvania, Indiana, Illinois and New York for individualized help.