MAY 15, 2006 -- A week designed to showcase the Senate Republican health care agenda ended with no legislation moved, but it did give Democrats a chance to air their grievances on several health issues and Republicans an opportunity to play to their base with White House–backed bills to help doctors and small businesses.
Senate leaders tried to move three measures last week: two that would have limited medical malpractice awards and one intended to provide small businesses with more affordable health insurance. The small-business health bill was blocked from a floor vote after Republicans fell short of the 60 votes required to overcome a filibuster, 55–43. Even so, it was a baby step forward for legislation that had never made it out of committee in previous Congresses.
The Senate spent the bulk of the GOP's designated "health week" debating that bill (S 1955), sponsored by Wyoming Republican Michael B. Enzi, which was intended to make it easier for small employers to band together to buy cheaper health insurance—a goal that would be achieved by allowing insurers to largely sidestep state laws requiring coverage of certain conditions or procedures.
Insurers that offer such plans, however, also would be required to include a plan that mirrors health benefits available to state employees of one of the five most populous states.
Democrats and patient advocacy groups protested the bill, saying it would allow insurers to offer primarily "bare bones" plans that would leave many employees underinsured and without coverage for conditions and procedures, such as some cancer screenings and diabetes care. They also noted that it had the potential to significantly increase insurance premiums for less healthy patients.
As the week went on, Enzi tried to win over some skeptics by tweaking his bill language to reduce the variance allowed between the highest premiums and the lowest premiums an insurer could charge for different groups of employees. But Democrats, who had their own legislative alternative designed to help small businesses, did not budge.
Moderate Republican Olympia J. Snowe of Maine—where more than 90 percent of employers are small businesses—also tried to win the support of some Democrats by proposing an amendment that would have required the health plans to retain coverage mandates that are required by at least 26 states. According to Snowe, mandates that would have been preserved included alcoholism treatment, breast reconstruction, diabetic supplies, mammography, hospital maternity stays, mental health services, and prostate cancer screenings.
But her last-minute tinkering was not enough to win over enough Democrats to move ahead with the bill.
"I introduced an amendment that I believe would have provided the necessary impetus to bring both political parties to the table," Snowe said. "However, we now will not have an opportunity to vote on my bipartisan measure and build the necessary consensus."
Two Democrats—Ben Nelson of Nebraska and Mary L. Landrieu of Louisiana—joined the majority on Enzi's bill. But for the most part, members held the party line.
Supporters of small-business health plans have been working for more than a decade to bring legislation to the Senate floor. Despite the rejection of cloture on Enzi's bill, several lawmakers claimed a victory of sorts because it marked the first time such legislation had ever made it out of committee.
"I'm pleased with the vote we got," Enzi said. "I'm disappointed we didn't get to 60 . . . but this is the first time the Senate has gotten it to a cloture vote."
Eager not to be cast as obstructionists who are unconcerned with the plight of small-business employees, Democrats offered an alternative to Enzi's health insurance plan. Cosponsored by Democrats Richard J. Durbin of Illinois and Blanche Lincoln of Arkansas, their bill (S 2510) would create a Small Employers Health Benefits Program modeled on the Federal Employees Health Benefits Program, allowing small businesses and the self-employed to join a large insurance pool with at least two insurers participating. Sponsors said that would help offset the cost of less healthy patients with premium contributions of healthier ones.
Lincoln has said Enzi's bill would encourage healthier people to buy lower-cost plans with limited benefits, leaving the less healthy in costly, broader plans.
Priority List
As Democrats successfully rebuffed two cornerstones of the Bush administration's health care platform, they assailed Republicans for not acting on a number of health issues that they consider higher priorities.
Democratic senators took to the floor last week to criticize the administration decision's not to extend the May 15 deadline for seniors to sign up for a Medicare prescription drug plan without paying a penalty.
They have charged that the new drug law (PL 108-173) is too complex for seniors to sort through in time, especially after widely reported problems with the drug plans early this year showed that seniors were not getting the coverage they selected because of missing or inaccurate information in pharmacy databases.
The GOP's refusal to include on the "health week" schedule a bill (HR 810) that would expand federal funding for embryonic stem cell research, which passed the House last May, was another target of Democratic ire during debate on Enzi's legislation.
Majority Leader Bill Frist, R-Tenn., made a pledge last fall to bring the House version of the stem cell bill to the Senate floor early this year, but has not scheduled time for it on the increasingly crowded Senate calendar.
Election-Year Tactics
After the failed closure vote on the small-business health insurance plan, both sides worked quickly to turn the outcome into an asset for their parties during an election year.
With the legislative defeat, Frist jumped on the opportunity to cast the Democrats as obstructionists on an issue that is usually associated with the minority party.
"Senate Republicans voted to provide affordable health insurance for millions of uninsured American workers," Frist said. "Senate Democrats should be ashamed of themselves for refusing to allow a vote on this important legislation that would help small businesses offer quality, affordable health coverage to their employees."
Democrats, meanwhile, fought to turn the tables on Republicans, charging them with ignoring the health needs of employees and states' policies.
"The first rule of medicine is to do no harm," said Minority Leader Harry Reid, D-Nev. "But with the one week this year that Republicans in the Senate chose to devote to health care, they chose legislation that would have done real harm to the American people."
Patient advocacy groups had launched one of their most intense lobbying campaigns in years as they worked to defeat Enzi's legislation in the weeks running up to "health week." The coalition of disease advocacy groups and the seniors' lobby AARP placed newspapers ads in states where a Senate vote was considered up for grabs.
The American Cancer Society and the American Diabetes Association were among the most visible opponents, with ads that emphasized the potential treatments that could be lost if Enzi's bill became law.
The Cancer Society said its ad campaign had generated more than 55,000 e-mails to congressional offices.