The Senate Thursday finished work on its fiscal 1998 supplemental appropriations bill, including $18 billion in loan guarantees for the International Monetary Fund and a new set of conditions for the controversial organization.
Action came after senators narrowly voted to strike from the measure an amendment that would have provided $16 million for the Health Care Financing Administration to enforce elements of the 1996 Health Insurance Portability and Accountability Act.
The Senate approved the bill after four days of debate, although procedurally, it is not considered as passed until the House sends over its version of the disaster relief and military expenditure bill, expected next week.
By custom, all appropriations bills carry House bill numbers.
The same unanimous consent request approving the bill will also serve to insert the IMF language, a compromise approved by the Senate 84-16 Thursday afternoon, into a separate bill if the House sends over a second supplemental containing its IMF provisions, as it is expected to do after the recess.
Although the IMF issue was resolved early in the day, members spent several hours untangling a heated controversy over a relatively small sum for HCFA.
The Clinton administration had requested, and the Senate Appropriations Committee approved, an additional $6 million for HCFA to hire 65 new workers to enforce the portability provisions of the bill in the five states that have yet to pass their own legislation to implement the federal requirements.
The bill also included $10 million for HCFA to fulfill the bill's requirement for administrative simplification activities, including development of a standardized claim form that could be used by both public and private insurance programs.
Senate Majority Whip Nickles said the money was unnecessary, and offered an amendment to strike it. "The question is, are we going to spend $16 million to expand the bureaucracy at HCFA?" he said.
Further, he added, since the administration proposed to offset the $16 million from savings in the Medicare Peer Review Organization budget, "We're raiding the Medicare trust fund to hire more federal employees."
But Democrats, led by Labor and Human Resources ranking member Edward Kennedy of Massachusetts, a co-author of the 1996 law, said the money was needed, particularly in light of a recent GAO report that found insurance companies were violating the spirit, if not the letter, of the law in terms of offering coverage.
"This is a test of whether the Senate wants to protect greedy insurance companies that break the law or American families," Kennedy said.
Nickles ultimately prevailed, but only after members rejected, by a vote of 51-49, a Kennedy amendment that would have cut the new HCFA spending by $8 million rather than $16 million. Four Republicans, Sen. Christopher (Kit) Bond of Missouri, Environment and Public Works Chairman John Chafee, R-R.I., Banking Chairman Al D'Amato, R-N.Y., and Labor and Human Resources Chairman James Jeffords, R-Vt., joined with all Democrats in voting for Kennedy's amendment. Nickles' amendment to strike the entire $16 million was subsequently adopted by voice vote.
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