Clinton Makes Push for Patients’ Rights

COLUMBIA, Mo. —  President Clinton flew halfway across the country Thursday to make a heartland pitch--aimed directly at one recalcitrant Republican senator--for stalled legislation intended to protect the rights of patients in managed health care plans.

“We need a real patients’ bill of rights, with real accountability and real rights--not one that just provides cover for the special interests,” the president said, sharply critical of legislation favored by the Senate’s GOP leadership.

The president’s target, unmentioned but obvious, was John Ashcroft of Missouri--one of a small number of senators running for reelection who are in such close contests that the future control of the chamber may hang in the balance.

On stage with Clinton at a University of Missouri auditorium was Gov. Mel Carnahan, the Democrat who is seeking to unseat Ashcroft.

The senator has been consistent in his opposition to the health care measure favored by the president, which Clinton said is only one vote away from passage.

“I want you to think about the one vote standing between all America and the kind of health care system we need,” he said, eliciting knowing laughter from the audience of several hundred, including a dozen medical workers on stage with him.

Ashcroft bypassed the chance to take on Clinton on the patients’ bill of rights and instead used rhetoric on managed care similar to that of the Democrats, even though the bill he voted for is far less expansive than the one Clinton supports. “I am fighting for a patients’ bill of rights that puts doctors and patients in control of health care decisions instead of insurance claims adjusters. . . . To win these fights for the people will require us to work together.”

Clinton argued that a version of the legislation approved last week by the Senate would apply only to a fraction of the people in managed health care plans, would limit convenient access to specialists for many patients, would restrict covered participation in clinical trials of medicines and would penalize patients who do not receive their managed care program’s authorization for use of an emergency room.

“Whoever wrote that,” Clinton said of the requirement for prior approval, “has never been hit in a crosswalk by a passing car.”

Imitating the plaintive call of a would-be patient to a health care plan, he said: “I have three broken ribs, my nearest relative is 500 miles way, I also have a concussion, but could you please wait before you put me in that ambulance and let me call my health plan?”

Clinton also said that a legal analysis, prepared by professors at George Washington and Rutgers universities, concluded that the Republican version would preempt state laws--such as those in Missouri and California--that allow some patients to sue plans for medical malpractice if they are injured by the plan’s decision to delay or deny care.

“That’s not a step forward; it’s a leap backward,” he said.

The president’s foray into the Midwest was one more skirmish in what has turned into a long-running, low-key campaign intended to put pressure on the Republican congressional leadership to reach a compromise before the elections in November.

A bipartisan version of the measure has been approved by the House and is favored by the White House. Every effort to reconcile the differences between the Senate and House measures has failed.

Clinton’s choice of Missouri carried clear political connotations, given Ashcroft’s close race and his potentially pivotal position in the Senate debate.

Administration officials are hoping that, with sufficient pressure, the senator will push GOP leaders to reach a compromise that is acceptable to the White House.

Several other GOP senators--including Spencer Abraham of Michigan and Rod Grams of Minnesota--are in similarly close races and also are under pressure to push for a deal before Congress adjourns.

The legislation Clinton favors is intended to go to the heart of some of the greatest complaints about the changes that have swept through American health care as more patients are covered by managed health care plans.

It has foundered over two main issues: Senate Democrats and a bipartisan group in the House support provisions that guarantee a range of patient protections to roughly 170 million Americans, or everyone covered by private health plans. And they support making managed care companies liable when a patient is injured as a result of a plan’s medical decisions.

Senate Republicans want to restrict much of the legislation’s reach to the 56 million Americans whose health plans are already regulated by the federal government.

Times staff writer Alissa J. Rubin contributed to this story.