How Bush Lost the GOP on Health Care

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Just a month ago, Republican congressmen and senators couldn't say enough good things about their president. But it doesn't take much to change their mood. They're now grumbling privately about W after last week's Senate passage of the patients bill of rights. George Bush managed to keep in place a well- coordinated media and legislative campaign to pass the tax cut and the bipartisan education bill. But then the White House seemed to go on vacation. "On the other stuff moving through the Congress" such as the patients bill of rights, energy measures, and key appropriations bills, "there has not been the day-to-day event planning and messaging," complains a senior House GOP aide. "They haven't been as good as in the past."

After Vice President Dick Cheney announced Bush's energy plan last May, "he went underground," complains another top GOP aide, leaving Democrats an open field to paint it as pro-business and anti-environmental. Top House GOP leaders like Speaker Dennis Hastert and Majority Whip Tom DeLay felt marooned, along with West Coast Republican congressmen taking the brunt of public anger over energy shortages and rising gas pump prices.

In the Senate, Republican Leader Trent Lott has been privately fuming over White House stumbles in organizing its response to the patients bill of rights. Bush had wanted to delay considering a patient's bill to pursue other priorities like his energy plan. He could stall when Republicans controlled the Senate. White House aides got Republican Congressman Charles Norwood to hold off sponsoring in the House a measure similar to the one Sens. Ted Kennedy, John McCain and John Edwards introduced in the Senate. In exchange, Bush aides promised to negotiate a compromise with Norwood. But while they kept Norwood closeted in endless meetings, they secretly hatched a compromise bill more to their liking with GOP Sen. Bill Frist and moderates John Breaux and Jim Jeffords. That measure channeled all suits into federal courts and limited jury awards for pain and suffering to just $500,000.

But Bush's game plan went out the window when Jeffords' defection from the GOP gave Democrats control of the Senate. Daschle ordered that the patients bill would be the next measure considered after education, not energy legislation. Norwood announced he was introducing his legislation in the House.

Norwood hadn't been the only congressman the White House was ignoring. House Republicans hoping to get a jump on the Democrats in their chamber with a patients rights bill weren't getting much attention from the administration either. Republican Rep. Ernie Fletcher, a doctor, had been talking up his patients bill with White House aides for several months, but getting little more than mild interest. Fletcher's measure was nearly identical to Frist's, except that Fletcher eventually added a provision allowing patients to sue HMOs in state courts in a limited number of cases. Fletcher attached the state court provision as sweetener to draw off Republicans from the Norwood bill. The White House, however, wasn't eager to open the window even slightly to state courts, so the talks with Fletcher meandered.

Bush had another problem within his own party. A majority of the GOP's senators didn't support the patients right bill Frist had introduced. Most backed a more HMO-friendly measure Republican Whip Don Nickles had offered in the past. A week before Daschle planned to bring the Democrats' version of the patients bill to the floor, the White House still couldn't decide how it was going to attack it — whether to push for the Frist compromise measure or to side with the more partisan Nickles version. Lott was forced to stall Daschle on beginning the patients bill debate because he couldn't get Senate Republicans and the White House singing on the same sheet of music. "The White House fumbled around on what they wanted to do," griped a senior Senate GOP aide. "They supported the Frist bill, but less than 15 Republican senators supported it."

Instead of choosing between the Frist or Nickles plan, the White House and Lott settled on a hodgepodge of amendments grafted from both plans that Republicans threw at the Democratic bill to pick it apart. Lott also tried for a while to string out debate on the measure to give attack ads aired by HMOs and health insurance companies time to soften up the Dems. The TV attack ads and GOP rhetoric zeroed in on a provision in the Kennedy-McCain-Edwards bill that allowed employers to be sued if they were directly involved in medical decisions for their workers. Republicans figured that warning about employers going out of business or canceling their health plans would draw the most blood. The White House also hoped to rattle the Kennedy-McCain-Edwards coalition with an explicit veto threat.

But the strategy didn't work. Daschle kept Senate Democrats in line and peeled off enough moderate Republicans to defeat hostile Republican amendments by comfortable margins. The only compromises Democrats were willing to make were on their provision making employers liable in some civil suits. On other issues, such as adding tax breaks to the bill or curbing the liability HMOs faced, the Democrats refused to budge and easily defeated Republican attempts to change the bill. The Kennedy-McCain-Edwards bill guarantees patients that their insurer will pay for emergency care, visits to specialists such as pediatricians, minimum hospital stays after mastectomies and costs associated with clinical trials. The bill gives millions of Americans the ability to go to federal and state courts in disputes with their HMOs. They can sue insurers, and some employers who accept the risk and responsibility of running the plan.

By compromising on the employer provision, Daschle defanged the HMO attack ads and GOP rhetoric that the Republicans thought was their best weapon. "The danger is we made too big a deal about this," Frist says of the employer hullabaloo. "We set it up that way because we said the employers provision is the number one problem and we did pretty well on that all over the country." But Democrats gave Republicans most of what they wanted on exempting employers, creating the perception among the public that they compromised on the bill, as Bush wanted. But the Democrats didn't. On other critical liability issues such as state exemptions, suits in state courts and caps on jury awards, the Democrats didn't give up much. And it was these other liability issues that were far more important to Bush. "The Senate has completely bungled the handing of this bill," gripes a senior House GOP aide.

The last thing Bush wants to do is veto a patients bill of rights. It would just fuel public perception that he and the Republicans are tied too closely to big business. "Sure, there's some nervousness about it," one GOP senator admitted. "This is not an issue where we've been on the offense. The Democrats have been on the offense. We've been on the defense."

Realizing last week that Senate Democrats were poised to shove an unpalatable measure at him, Bush began scrambling for a life raft from the House. Hastert had already signed on to Fletcher's bill. Bush swallowed his opposition to state court suits and publicly endorsed the measure. Bush also tried to pump oxygen into its flagging energy plan, calling for more research into developing energy-efficient products and insisting that he wants the federal government to do more to conserve power. "I think that they're getting reenergized, and that's good," said a senior House Republican aide.

Other House GOP leadership aides report their phones are now jangling with calls from White House aides who want to get reacquainted. "All of a sudden, we're their best friends," says another senior GOP House staffer. "Their presence in my life has increased one-hundred-fold." Bush invited GOP congressmen over to the White House for chats on the patients' bill while his aides swarmed over the House side of Capitol Hill to schmooze. "There's been a wakeup call," says this senior House GOP aide. "The President is finding his new love for House Republicans."

Can they get him out of this fix? Fletcher got some Republicans to bolt from the Norwood bill to sign on to his. But even with Hastert and the GOP leadership behind him, he doesn't yet have a majority. Many moderate Republicans are holding off and only a few Democrats have defected to his measure. "A lot of Democratic members would like to vote for this bill but they're getting unprecedented pressure from their leadership to vote against it," Fletcher tells TIME. Fletcher isn't helped by the fact that the Senate finally passed the Kennedy-McCain-Edwards bill last week largely intact by a vote of 59-36. That will embolden House Democrats and moderate Republicans to stick with Norwood's measure.

Finally, the old GOP strategy of stringing out the debate to give attack ads more time to work now seems to be out the window as well. Time may be working against the GOP. "The patients bill is getting tilted more to the left the longer it hangs out there," worries a House Republican leadership aide. "We might as well do it and get it over with." Hastert is now mulling whether to bring up the bill as soon as he can after congressmen get back from their July 4th recess.