- The Washington Times - Thursday, July 26, 2001

House Republican leaders, facing perhaps two dozen GOP defections from a White House-backed patients' protection bill, signaled yesterday they will delay a vote until after Labor Day despite pleas by President Bush to complete legislation earlier.

Mr. Bush summoned a dozen wavering Republican lawmakers to the White House, saying he still wants a bill that minimizes unnecessary lawsuits that would drive up health care costs.

"I'm hopeful we'll get a bill I can sign, and I appreciate so very much the hard work that's going on, particularly now in the House of Representatives, to bring a bill that is fair to patients," the president told reporters before the meeting.

"There was a lot of negotiations going on when I was gone [in Europe], and there still seems to be a lot of talk. And obviously, we'd like to get this bill finished and on my desk," Mr. Bush said. "I laid out the principles that would allow me to sign a bill and I still stand by those principles, but I can report we're making pretty good progress."

Before the White House meeting, House Speaker J. Dennis Hastert, Illinois Republican, met privately with GOP lawmakers and told them he would likely pull the patients' protection issue from the legislative calendar until after the August recess, apparently because the votes are not there to pass the GOP-backed bill authored by Reps. Ernie Fletcher, Kentucky Republican, and Collin C. Peterson, Minnesota Democrat.

Rep. J.C. Watts Jr. of Oklahoma, chairman of the House Republican Conference, said later: "I doubt we're going to do it Friday. It wouldn't surprise me if we had it in September."

Mr. Fletcher, a family physician, said Mr. Bush "was very clear" to Republican lawmakers that he would sign the Fletcher-Peterson bill, but that he would veto a rival bill sponsored by Reps. Greg Ganske, Iowa Republican, John D. Dingell, Michigan Democrat, and Charlie Norwood, Georgia Republican. The Ganske bill is companion legislation to a Senate-passed bill.

"He's very clear he will veto the Ganske-Dingell bill," Mr. Fletcher said. "He said it several times. He said he will sign this bill. So that's a very effective mechanism."

But the Kentucky Republican acknowledged his bill has flaws. "No bill is perfect. There's changes to both bills that could always, you know, improve the product," he said. "Our bill, I believe, is far superior as far as addressing the uninsured; addressing the patient's need; giving appropriate, focused redress; and holding HMOs extremely accountable."

Rep. Bob Barr, Georgia Republican, said he believed the president was open to compromise because many Republicans support the Ganske-Dingell-Norwood bill. "I still support the Norwood bill," he said, despite two meetings with the president. "It creates and puts in place a truly meaningful mechanism to make an HMO accountable if, in fact, that HMO makes a decision on health care that harms a patient."

"The president recognizes that this is an issue on which virtually every member of Congress feels very strongly. The numbers are very close," Mr. Barr said.

Two other Republicans undecided on the patients' rights issue — Reps. Michael N. Castle of Delaware and James T. Walsh of New York — also said their minds were not changed by the meeting with Mr. Bush.

"The votes are not moving a whole lot right now," Mr. Walsh said.

The speaker's decision to delay action "shows they don't have the votes," Mr. Castle told Reuters news agency. Liberal Republicans "have advocated positions that we are not going to abandon — that is the way it is," he said of differences with the GOP congressional leadership and administration.

Rep. Steve Horn, California Republican and backer of the Ganske-Dingell-Norwood bill, said the president's pressure tactics might backfire. "It's not working with me," Mr. Horn said. "Nobody's going to twist my arm. It'll have the opposite effect."

Rep. Christopher H. Smith, New Jersey Republican, also said he would not succumb to White House pressure because the GOP-backed Fletcher-Peterson bill would pre-empt strong state-passed patients' protection laws in about a dozen states and would allow health maintenance organizations (HMOs) to continue "getting away with abuses."

Mr. Norwood told reporters lawmakers were being pressured on all sides. "Everybody with a broken right arm also has a broken left arm," he said.

Mr. Ganske, a surgeon, said many Republican House members were studying criticisms of the Fletcher-Peterson bill issued July 18 by health policy and law professors at George Washington University in the District and Rutgers University in Camden, N.J.

The Fletcher bill "would significantly restrict legal remedies that now are potentially available under state law in the case of death and injury caused by managed care organizations that operate medically substandard systems of care and that make substandard medical treatment decisions," the critique said.

"In so doing, the legislation would displace decades of American jurisprudence regarding the liability of health organizations for the death and injury they cause."

The critique was signed by GWU health law and policy professor Sara Rosenbaum and Rutgers law professors David M. Frankford and Rand E. Rosenblatt.

The Fletcher bill "would have the effect of federalizing managed care medical liability law," the analysis said. "This could leave physicians, other health professionals and hospitals totally exposed under state professional liability laws because managed care companies would be insulated from liability.

"The remedy also would force injured persons into federal court, and because of its heavy restrictions on recovery [limited to $500,000 in punitive damages for pain and suffering], could make it almost impossible for injured persons or their survivors to find counsel to represent them," the analysis said.

Mr. Fletcher did not respond to requests for a response to the GWU/Rutgers criticisms.

• Joseph Curl contributed to this report.

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