House Republican Leaders Delay Patients’ Rights Vote

House Republican leaders, hoping to "head off a political defeat," on July 25 postponed a vote on patients' rights legislation, the Los Angeles Times reports. According to House Speaker Dennis Hastert (R-Ill.), GOP leaders may delay the vote until next week and possibly after the August recess to allow President Bush to "build support" for the bill (HR 2315) favored by the House GOP leadership, sponsored by Rep. Ernie Fletcher (R-Ky.) (Miller/Hook, Los Angeles Times, 7/26). Under the bill, patients could sue health plans in federal court for quality of care issues and non-quality of care issues, but could only sue in state court in cases where health plans refused to abide by decisions made by outside appeals panels. The bill would cap non-economic damages in federal court at $500,000, but state courts could award as much money in damages as the state allows. The legislation would prohibit punitive damages (Kaiser Daily Health Policy Report, 7/9). GOP leaders said that they would postpone the vote "until they had the votes" to pass the Fletcher bill, adding that "as of [yesterday] ... they clearly did not" (Pear, New York Times, 7/26). Although Hastert said that the House may vote on patients' rights legislation next week, other GOP leaders said that "it was unlikely the bill would resurface" before September (Welch, USA Today, 7/26).

Seeking Support
Most House Democrats and "at least 11" Republicans support a rival bill (HR 2563), sponsored by Reps. Greg Ganske (R-Iowa), John Dingell (D-Mich.) and Charlie Norwood (R-Ga.), similar to legislation passed last month in the Senate. Bush has threatened to veto these bills (Malone, Atlanta Journal Constitution, 7/26). Under the Ganske-Dingell-Norwood bill, patients could sue HMOs in state court for denial of benefits or quality of care issues and in federal court for non-quality of care issues, such as those involving violations of their health plan's contract. The legislation would cap damages awarded in federal court at $5 million, but state courts could award as much in damages as the state allows (Kaiser Daily Health Policy Report, 7/19). House GOP leaders "insisted" that "they were making progress" in efforts to "draw" supporters to the Fletcher bill. But Norwood spokesperson John Stone said, "They're not going to get those last 10 votes; it's over" (Hosler, Baltimore Sun, 7/26). Ganske said that the delay "indicates that, despite the fact they're breaking arms, they don't have the votes" (New York Times, 7/26).

Negotiations
The AP/Nando Times reports that House leaders' decision to postpone the patients' rights vote will allow Bush more time to "lobby a number of stubborn Republicans" who back Ganske-Dingell-Norwood (McQueen, AP/Nando Times, 7/25). Bush "moved swiftly to take advantage" of the delay, "summoning" 10 "wavering" Republicans to the White House on July 25. After the meeting, however, "it was not clear that Bush had made much headway, or could," in building support for the Fletcher bill, with some GOP moderates expressing "growing weariness" with White House "pressure" (Los Angeles Times, 7/26). Ganske said that "speculation was rife" that the White House has offered lawmakers "political favors" in exchange for votes. According to Republican sources, administration officials have discussed offering New Jersey lawmakers additional funds for state hospitals (Espo, AP/Bergen Record, 7/26). Bush has also "entered an intense new phase" of negotiations with Norwood, and White House officials and top Republicans admit that a potential compromise offers the "most realistic possibility of a quick resolution that would avert a major GOP defeat" in the patients' rights debate (Washington Post, 7/26). The Wall Street Journal reports that supporters of Ganske-Dingell-Norwood, hoping to avoid a Bush veto, have discussed adding a provision that would divert lawsuits against employers to federal court, rather than state court, "making only the health plan providers subject to litigation at the state level." In addition, the White House "is showing a greater willingness" to allow lawsuits against HMOs in state court, the Wall Street Journal reports (Rogers, Wall Street Journal, 7/26).

Strategy
House GOP aides said that leaders may bring Ganske-Dingell-Norwood to the floor for a vote but allow lawmakers to vote on the Fletcher bill as an amendment (Washington Post, 7/26). Alternatively, House Republicans may vote to amend Ganske-Dingell-Norwood on the floor to "move it toward Bush's position" and "make it easier for the president to sign" (Baltimore Sun, 7/26). The Wall Street Journal reports that "tactics have shifted to focus on a few select amendments, including provisions to shield employers from liability and provide tax credits to help Americans purchase health insurance" (Wall Street Journal, 7/26). While supporters of the Ganske-Norwood-Dingell bill do not have the votes to override a Bush veto, they "are betting" that Bush would "back away" from his veto threat rather than "risk a political backlash," USA Today reports (USA Today, 7/26).