The legislation passed by the House not only gives patients the right to sue HMOs that wrong them, it guarantees immediate access to care in an emergency and prompt access to specialists. Federal law now effectively bans such lawsuits for millions of Americans, even if they are injured or die because of an HMO's decision.
The final vote, 275-151, came after intense lobbying on both sides. Even President Clinton made an effort, phoning lawmakers from Air Force One.
"It is time we asked the insurance industry to be responsible for its actions," said Rep. Charlie Norwood, R-Ga., who joined with Democrats to push the bill, first to the House floor and then on to passage.
It was a classic Washington moment, CBS News Chief Washington Correspondent Bob Schieffer reports: so many lobbyists converged on the Capitol during the vote, police were called in for crowd control.
The insurance industry had poured millions into blocking reform and was taking no chances. "It looks like they've moved their offices up here for the afternoon," quipped Rep. Ray Lahood, an Illinois Republican.
For all its power, the lobby just couldn't match the HMO horror stories from constituents that members brought to the floor.
David Bonior, D-Mich., told of a woman who "desperately needed to see a specialist, but her HMO was worried about the cost;" Debbie Stabenow, D-Mich., recalled the story of a patient named Jessica "who died while her family was fighting the HMO;" and Thomas Barrett, D-Wis., said that in one case, "The HMO bureaucrat demanded the patient be sent home. The patient went home and swallowed a bottle of antifreeze."
For two years, Democrats have put the GOP on the defensive over the politically popular HMO issue. Republican leaders, struggling with a slim majority and a fractured caucus, did not endorse any bill until debate opened on the issue this week.
Earlier Thursday, the House rejected a GOP-backed patient protection bill that included new rights to sue, but only in federal court and only in limited circumstances. That vote was 238-193, with 29 Republicans joining all but two Democrats.
The GOP strategy has been to focus attention on the uninsured, as Republicans argue that new rights will drive up the cost of insurance and force employers to drop coverage. Hammering the point Wednesday, Republicans pushed through a bill, 227-205, aimed at reducing the ranks of the uninsured, which now stand at 44 million.
They worked fiercely in recent days to rally support for their version of the patients' rights bill. Many Republicans reluctantly supported it in hopes of defeating the broader Democratic bill, and supporters painted it as a compromise btween the Democratic approach and doing nothing.
"We've got a solid, balanced approach that I urge you to support," said House Speaker Dennis Hastert, R-Ill. "The difference in these bills is how far you go. How far you give license to the trial lawyers."
But Democrats successfully argued that it did not go far enough.
"It fails to hold health care providers accountable. It lets them off the hook," said Minority Leader Dick Gephardt, D-Mo.
The president was delighted by the vote. He said, "This is the sort of thing America wants us to do. We can work together across party lines to get things done. There will be plenty for the two parties to argue about in good conscience in the coming election."
Though the winning side was euphoric, Michigan Democrat John Dingell cautioned, "We have a lot to rejoice, but the time for rejoicing is not here. We can have a little fun, but we've got to go back to work." That's because Senators must also approve the reforms when the bill goes to a conference committee.
But whatever happens there, Schieffer reports, Thursday will be remembered as the day a group of Republicans and Democrats finally banded together, took on one of the biggest and most powerful lobbying concerns in America, and beat them.