The Great HMO Debate: Now It's Up to the Voters

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Vice President Al Gore came to the Senate, just in case his vote was once again needed to break a tie and to showcase his strong support for health care reform. Unlike the debate over gun control, however, there was no tie and Gore cast no vote. But very much like the gun control battle, what Gore and the Democrats got late Thursday from the Senate’s 53-to-47 watered-down Republican patients' bill of rights against HMOs was a red-hot campaign issue for 2000. After a passionate amendment-by-amendment fight, in which the Senate rejected Democratic attempts to broaden access to specialists and emergency room care to all 161 million insured patients, the chamber adopted more limited measures that for the most part would cover only the 48 million enrolled in federally regulated plans. In particular, Republicans killed a showcase Democratic provision that would have enlarged the rights of many patients to sue their HMOs for denying treatment; instead, they adopted an out-of-court review process.

"Both sides got what they wanted," says TIME congressional correspondent John Dickerson. "Republicans managed a series of votes that will allow them to claim they did something about health care; Democrats got another campaign issue." The White House strongly threatened to veto the Republican bill if it emerges from Congress unchanged (it next goes to the House of Representatives). Some changes, in fact, may not be entirely out of the question. "A small group of Republican moderates in the House who want to see more reforms than those that passed the Senate are trying to come up with a thoughtful compromise," reports Dickerson. But whether the group succeeds or not may be academic. "Clinton solidly believes that the defeated Democratic positions in the Senate 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. Most Democrats agree, and from the vice president on down they are ready to go for a repeat performance in the 2000 elections in the hopes of getting even better results next year.