September 17, 1998
      
      Patient Rts. Issue Goes to Medicaid
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      Filed at 5:38 p.m. EDT
     
      By The Associated Press
      
     WASHINGTON (AP) -- With health legislation stuck on Capitol Hill,
     President Clinton announced new protections for patients in
     Medicaid HMOs Thursday, continuing to press what has become a major
     issue in Democratic and GOP campaigns across the country.
     
     Just a day earlier, Senate Majority Leader Trent Lott used a
     parliamentary maneuver to prevent the Democrats' health measure
     from coming to the floor for debate.
     
     ``Can you believe that?'' the president asked in a speech to the
     International Brotherhood of Electrical Workers' convention. ``Why
     would they shut the Senate down? Because when you go to an
     emergency room or an operating room or a doctor's office, nobody
     asks you whether you're a Republican or a Democrat.''
     
     Clinton said the administration was extending patient protections
     to 15 million people in Medicaid, the health insurance program for
     the poor, which is increasingly steering people into health
     maintenance organizations and other managed care plans. He already
     took similar action for Medicare beneficiaries.
     
     The new rules require states to give Medicaid recipients a choice
     of HMOs if they require them to go into managed care.
     
     Medicaid also must guarantee patients the right to appeal if they
     are denied care and give people easy-to-understand information
     about their benefits.
     
     And Medicaid HMOs must pay for reasonable emergency room visits,
     allow women direct access to gynecologists, and let people with
     severe medical conditions see specialists without having to go to a
     primary care doctor first, under the measure.
     
     Many of these provisions are in Republican legislation, including a
     bill approved by the House and one backed by GOP leaders in the
     Senate.
     
     But there are differences over details and who would be covered.
     The biggest dispute is over Democrats' wish to give patients the
     right to sue their HMOs.
     
     On Wednesday, Lott stopped Senate action to prevent Democrats from
     attaching their bill to an unrelated spending measure. Lott is
     insisting on a controlled debate with limits to the number of
     amendments.
     
     Meanwhile, a new poll by the independent Kaiser Family Foundation
     finds already-low public opinion toward HMOs falling further, with
     56 percent of Americans now saying managed care has decreased the
     quality of care for patients.
     
     Fifty-nine percent of people worry that if they became sick, their
     health plan would be more concerned about saving money than
     offering the best treatment, up from 47 percent a year ago.
     
     The telephone survey, conducted in August, had a margin of error of
     plus or minus 3 percentage points.
     
     It also found concern about costs, with the public divided when
     asked if they would support legislation if it increased premiums by
     $200 per year.
     
     Still, experts predicted the issue will remain on the political
     landscape because so many people have concerns and because
     virtually no one believes the legislation will leave them worse
     off.
     
     The topic is being used by candidates across the country from both
     major parties and for state and federal offices, said John J. Kohut
     of the Rothenberg Political Report.
     
     ``This issue, probably more than any other, is part of every
     campaign,'' agreed Doug Bailey, publisher of the Hotline, which
     tracks politics across the country.
     
     Still, the conventional wisdom in Washington is that whatever
     chance a patient protection bill had, it evaporated as talk of
     impeachment gripped the Capitol.
     
     Republicans may have little incentive to compromise with a weakened
     president. At the same time, Clinton needs an issue he can use to
     pound the GOP as he tries to keep focused on policy, said GOP
     pollster Frank Luntz, who tried early on to get congressional
     Republicans to focus on HMOs as a winning issue.
     
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