"The Republicans have been holding together well," reports TIME congressional correspondent John Dickerson. "They believe they have managed a series of votes that will give them cover as having addressed HMO complaints." Democrats, while somewhat disappointed that the HMO debate has not created more of a national stir, have passionately denounced the Republican moves as an attempt to pass an industry-protection act instead of a patient-protection act. The White House continues to send signals that it will veto the Republican bill if it emerges from Congress unchanged. "Clinton solidly believes that the defeated Democratic positions are controversial only inside the Beltway and that health care was one of the key issues that helped his party do well last November," says TIME White House correspondent Jay Branegan. The President accordingly believes Democrats are well positioned: Even if he has to nix the bill, his party will get an issue for 2000.
The final lines are being drawn in America's great HMO debate — and it looks as if the issue will mostly be settled at the ballot box. The Senate on Thursday slogged through a second day of grueling partisan combat, eventually passing a more limited Republican version of a Patients' Bill of Rights. Amendment by amendment, the GOP majority struck down every Democratic attempt to give broader access to specialists and emergency-room care to the broadest possible number of insured patients, some 161 million persons. In nearly every case, Republicans came back to pass similar, but more limited, measures that would cover only the 48 million enrolled in federally regulated plans. And by a 53-to-47 vote on Thursday, the Senate struck down the Democrats' centerpiece: a provision enlarging the rights of many patients to sue their HMOs for the denial of treatment. In the wings, President Clinton waited, hinting that he'll veto any watered-down legislation and essentially hand the issue over to voters in next year's elections.