[Congressional Record Volume 141, Number 165 (Tuesday, October 24, 1995)]
[Senate]
[Pages S15575-S15580]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. SIMPSON:
  S. 1359. A bill to amend title 38, United States Code, to revise 
certain authorities relating to management and contracting in the 
provision of health care services; to the Committee on Veterans' 
Affairs.


the veterans health care management and contracting flexibility act of 
                                  1995

 Mr. SIMPSON. Mr. President, it is a great pleasure for me, as 
chairman of the Senate Veterans' Affairs Committee, to introduce today 
the Veterans Health Care Management and Contracting Flexibility Act of 
1995. This legislation, Mr. President, would free the Department of 
Veterans Affairs [VA] from a number of statutory restrictions which 
unnecessarily limit its authority to contract for health care-related 
services. It would also ease and clarify current reporting requirements 
which excessively impede VA's ability to manage its own affairs.
  What this bill would accomplish is best understood by considering, 
first, the health care environment within which all health care 
providers--including VA--must operate today, and then the state of the 
law under which VA attempts to so operate. If there is any certainty 
today with respect to health care, it is this: those who pay for health 
care--whether those payers be State or Federal Government agencies, 
insurance carriers or health maintenance organizations, or better 
informed consumers drawing, perhaps some day, from health savings 
accounts or simply from their own bank accounts--will no longer 
tolerate the unrestrained cost inflation that they have been forced to 
put up with in the past. All health care providers, therefore, are 
now--and will continue to be--under unprecedented pressure to rein in 
costs and find operating efficiencies so that they can compete in an 
increasingly cost sensitive environment.
  In light of these realities, all now agree that health care providers 
must restrain the growth of--or affirmatively cut--costs. One sure way 
of doing that is to share certain resources--including, but not 
necessarily limited to, high tech medical resources--lest there be 
wasteful duplications in expenditures and effort within local markets. 
For example, it has become increasingly common for one hospital or 
practice group to sell, for example, Magnetic Resonance Imaging [MRI] 
services to another, while buying other diagnostic services from the 
same purchaser.
  Like any health care provider, VA medical centers ought to be able to 
share, buy and swap all sorts of services with other community 
providers. But they cannot fully capitalize on such opportunities under 
current law.
  Presently, VA can only share or purchase ``medical'' services. It 
cannot share or purchase other critical services, for example, risk 
assessment services, that all health care providers must either buy or 
provide ``in house.'' Even within the narrow authority allowing only 
``medical'' services to be shared or purchased, there is an unnecessary 
restriction. VA cannot purchase or share any medical resource; it can 
only purchase or share ``specialized'' medical resources.
  And that is not all, Mr. President; there is further restriction 
imposed upon VA. VA medical centers are not free to purchase from, or 
share with, any and all health care providers they might find in the 
local community. They can only ``partner up'' with--and, here, I quote 
from statute--``health-care facilities (including organ banks, blood 
banks, or similar institutions), research centers, or medical 
schools.'' 38 U.S.C. Sec. 8153. This restrictive legal rubric does not 
extend to VA authority to enter into sensible sharing arrangements with 
other potential partners such as HMOs, insurance carriers or other 
``health plans,'' or with individual physicians or other individual 
service providers.
  One provision of my bill, Mr. President, would cut through this legal 
thicket by expanding significantly VA's current sharing authority. In 
summary, VA would be authorized to share, purchase or swap any 
resources with any local provider. VA could enter into contracts for 
any and all ``health care resources,'' a term which is considerably 
broader than the ``specialized medical resource'' limitation under 
which VA now operates. That term would include such resources, but 
would also include nonspecialized ``hospital care,'' ``any other 
health-care service,'' and any other ``health-care support or 
administration resource.''
  Further, VA would be authorized to buy from, or share with, any 
``non-Departmental health care provider''--a term which would include 
the ``health-care facilities'' and ``research centers and medical 
schools'' with which VA may not contract, but which would also include 
other ``organizations, institutions, or other entities or individuals 
that furnish health-care resources,'' and also ``health care plans and 
insurers.''

  Thus, Mr. President, my bill seeks to open up to VA an entire new 
world of potential sharing partners and sharing opportunities. While VA 
would not have totally unfettered authority to buy and sell services--
for example, VA would be required to ensure that any such arrangements 
not diminish services made available to its veteran patients--it is my 
intention that VA be freed from restrictions which were applied when VA 
tried to do everything itself ``in-house.'' There was a time, perhaps, 
when VA could afford to try to be everything to everyone, but it cannot 
do so now. No modern provider can afford that mentality today.
  I note for the Record, Mr. President, that VA has requested the 
expanded legal authority that I propose today. But it has done so in 
the context of a much larger bill, S. 1345, that I introduced at VA's 
request on October 19, 1995. The main thrust of S. 1345 is so-called 
``eligibility reform,'' that is, a broad scale revision of current 
statutes defining who shall be eligible for what VA medical services. 
That issue, Mr. President, is an extremely thorny one inasmuch as, 
lying at its very center, are very difficult judgements about who shall 
have priority over whom in securing VA health care in a period of 
limited resources. The Committee on Veterans' Affairs intends to take 
this critical issue up, but it will take time to sort out conflicting 
claims to priority to such limited resources. I think we ought to 
proceed now to streamline the statutes that restrict VA's sharing 
authority--an action which, in my view, can be taken now, and will made 
sense whether or not we are able to accomplish ``eligibility reform.''
  My bill would do more, Mr. President. As I have pointed out, VA now 
has authority--though authority that is, in my view, too narrow--to 
contract for ``specialized medical resources.'' Even so, however, VA 
medical centers are statutorily barred from ``contracting out'' the 
very same services. 38 U.S.C. Sec. 8110(c). In addition, they may not 
contract out activities that are ``incident to direct patient care.'' 
Id. Finally, VA medical centers may contract out other ``activities'' 
at VA 

[[Page S 15576]]
medical centers, for example, grounds' maintenance services--but only 
if VA leaps through a series of substantive and procedural hoops that 
plainly impede the contracting process.
  Under my reading of the law, it is apparently acceptable, under 38 
U.S.C. Sec. 8153, for a VA medical center to contract for supplemental 
``specialized'' medical services--let us say anesthesiology services--
so long as the medical center does not contract out all such services. 
This distinction, Mr. President, makes no sense to me--and, as I will 
discuss in a moment, apparently makes no sense to the Congress any 
longer. Further, it makes no sense to me that VA cannot contract out 
services that are ``incident to direct care''--assuming one can 
identify the legal boundaries of activities that are merely 
``incidental.'' To my way of thinking, if ``direct care'' activities 
ought to be shared and purchased without significant restriction--as VA 
espouses in recommending modifications to 38 U.S.C. Sec. 8153--they 
ought to be subject to purchase wholly by the medical center through 
the ``contracting out'' process. And if ``direct care'' activities 
ought to be subject to contracting, then, clearly, services that are 
``incidental'' to such activities should be too.
  Of course, Mr. President, what is true for direct care services--
services which go to the core of what VA does--is also true for other 
activities at VA medical centers: all such activities ought to be 
subject to contracting if contracting makes economic sense. We can 
afford no other standard. Unnecessary impediments to contracting--such 
as those set up by 38 U.S.C. Sec. 8110(c)--ought to be swept away.
  As I noted a moment ago, the Congress has apparently come to that 
conclusion already. In the 104th Congress, we suspended application of 
restrictive aspects of section 8110(c) through fiscal year 1999. See 38 
U.S.C. Sec. 8110(c)(7). Mr. President, it is clear to us all that VA 
will not be under less budgetary pressure in the year 2000 than it is 
now. We ought not to indulge the fiction that VA will be able to afford 
to hold all activities ``in house'' then, if it cannot afford to do so 
now. In short, we should have repealed section 8110(c) last year--and 
we ought to do so now.

  Finally, Mr. President, I note another restrictive provision of law 
that ought to be swept away--or at least narrowed--now. Under current 
law, VA is precluded from putting into effect certain field facility 
``administrative reorganizations''--essentially, those which will 
result in a force reduction of 15 percent or more at any particular 
site--unless it has first given the Congress 90-days notice computed to 
count only those days when both Chambers of Congress are in session. 38 
U.S.C. Sec. 510.
  Two difficulties arising from this provision of law came into focus 
earlier this year when VA's Under Secretary for Health, Doctor Ken 
Kizer, submitted a proposal to reorganize VA's 172 medical centers into 
22 ``Veterans Integrated Service Networks'' [VISNs]. While Doctor Kizer 
had briefed Congress extensively on his sensible reorganization model 
during its development, he still had to wait more than 3 months after 
the announcement of the reorganization before he could, by law, take 
any ``action to carry out such administrative reorganization.'' 38 
U.S.C. Sec. 510(b). Worse, since the statute specifies that the 90-day 
``notice and wait'' period runs only when both bodies of Congress are 
in session, Id., he--and we--were unable to determine when the 90-day 
notice would expire since no one was able to know when either body of 
the Congress might recess.
  Such obstructionism by the Congress is, in my view, most unfortunate 
and unseemly. I really think that we ought to grant more trust to the 
senior officials we confirm than is reflected in this statute. Yet, I 
remain sensitive to the Members' needs to know if a field office 
reorganization will adversely affect a significant number of their 
constituents. Therefore, I do not propose today that this provision of 
law be totally repealed. I do propose, however, that we reduce the 
``notice and wait'' period to 45 calendar days. That period, I believe, 
is sufficient to allow Senators and House Members an opportunity to 
assess the impact of a given reorganization on their constituents.
  To recap, Mr. President, my bill would expand VA's authority to 
share, purchase and swap resources, as is necessary to meet the 
challenges of 21st century medicine. And it would remove an excessive 
restriction on VA's right to organize and station its employees 
efficiently. These measures are dictated by common sense and are, in 
the main, supported by VA. I request the support of this body.
  I request unanimous consent that the text of my bill be printed in 
the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1359

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Veterans Health Care 
     Management and Contracting Flexibility Act of 1995''.

     SEC. 2. WAITING PERIOD FOR ADMINISTRATIVE REORGANIZATIONS.

       Section 510(b) of title 38, United States Code, is 
     amended--
       (1) in the second sentence, by striking out ``90-day period 
     of continuous session of Congress following'' and inserting 
     in lieu thereof ``45-day period beginning on''; and
       (2) by striking out the third sentence.

     SEC. 3. REPEAL OF LIMITATIONS ON CONTRACTS FOR CONVERSION OF 
                   PERFORMANCE OF ACTIVITIES OF DEPARTMENT OF 
                   HEALTH-CARE FACILITIES.

       Section 8110 of title 38, United States Code, is amended by 
     striking out subsection (c).

     SEC. 4. REVISION OF AUTHORITY TO SHARE MEDICAL FACILITIES, 
                   EQUIPMENT, AND INFORMATION.

       (a) Statement of Purpose.--The text of section 8151 of 
     title 38, United States Code, is amended by read as follows:
       ``It is the purpose of this subchapter to improve the 
     quality of health care provided veterans under this title by 
     authorizing the Secretary to enter into agreements with 
     health-care providers in order to share health-care resources 
     with, and receive health-care resources from, such providers 
     while ensuring no diminution of services to veterans. Among 
     other things, it is intended by these means to strengthen the 
     medical programs at Department facilities located in small 
     cities or rural areas which facilities are remote from major 
     medical centers.''.
       (b) Definitions.--Section 8152 of such title is amended--
       (1) by striking out paragraphs (1), (2) and (3) and 
     inserting in lieu thereof the following new paragraphs (1) 
     and (2):
       ``(1) The term `health-care resource' includes hospital 
     care (as that term is defined in section 1701(5) of this 
     title), any other health-care service, and any health-care 
     support or administrative resource.
       ``(2) The term `health-care providers' includes health-care 
     plans and insurers and any organizations, institutions, or 
     other entities or individuals that furnish health-care 
     resources.''; and
       (2) by redesignating paragraph (4) as paragraph (3).
       (c) Authority To Secure Health-Care Resources.--(1) Section 
     8153 of such title is amended--
       (A) by striking out paragraph (1) of subsection (a) and 
     inserting in lieu thereof the following new paragraph (1):
       ``(1) The Secretary may, when the Secretary determines it 
     to be necessary in order to secure health-care resources 
     which otherwise might not be feasibly available or to utilize 
     effectively health-care resources, make arrangements, by 
     contract or other form of agreement, for the mutual use, or 
     exchange of use, of health-care resources between Department 
     health-care facilities and non-Department health-care 
     providers. The Secretary may make such arrangements without 
     regard to any law or regulation relating to competitive 
     procedures.''; and
       (B) by striking out subsection (e).
       (2)(A) The section heading of such section is amended to 
     read as follows:

     ``Sec. 8153. Sharing of health-care resources''.

  (B) The table of sections at the beginning of chapter 81 of such 
title is amended by striking out the item relating to section 8153 and 
inserting in lieu thereof the following new item:

``8153. Sharing of health-care resources.''.
                                 ______

      By Mr. BENNETT (for himself, Mr. Dole, Mr. Leahy, Mrs. Kassebaum, 
        Mr. Kennedy, Mr. Frist, Mr. Simon, Mr. Hatch, Mr. Gregg, Mr. 
        Stevens, Mr. Jeffords, Mr. Kohl, Mr. Daschle, and Mr. 
        Feingold):
  S. 1360. A bill to ensure personal privacy with respect to medical 
records and health care-related information, and for other purposes; to 
the Committee on Labor and Human Resources.


            the medical records confidentiality act of 1995

 Mr. BENNETT. Mr. President, today I am introducing the Medical 
Records Confidentiality Act of 1995. This legislation is one of the 
many small steps that are needed to reform our health care system. I am 
pleased that a number of my Republican and Democratic colleagues have 
joined me in cosponsoring this legislation.

[[Page S 15577]]

  I can think of few other areas in our lives that are more personal 
and private than is our medical history. Each of us has a relationship 
with our doctors, nurses, pharmacists, and other health care 
professionals that is unique and privileged. They may know things about 
us that we choose not to tell our spouses, children, siblings, parents, 
or our closest friends. While our medical records may contain nothing 
out of the ordinary, to us these records should be strictly personal.
  S. 1360 aims, first, to provide Americans with greater control over 
their medical records in terms of confidentiality, access, and 
security, and second, to provide the health care system with a Federal 
standard for handling identifiable health information.
  Most Americans believe their medical records are protected in terms 
of confidentiality under Federal law. Most Americans are mistaken. 
Protecting the confidentiality of our medical records is an expectation 
that is yet to be guaranteed as a right. This legislation is an 
opportunity for Congress to act in a bipartisan manner to resolve an 
important problem within our health care system. Today over 80 percent 
of our medical records are paper based; however, in the not too distant 
future all of our medical records will be electronic based.
  In my opinion and in the opinion of a number of outside groups such 
as the Center for Democracy and Technology, American Health Information 
Management Association, International Business Machines Corporation, 
Blue Cross and Blue Shield Association, and the American Hospital 
Association, it is time to put into place the safeguards and security 
measures needed to protect the integrity and confidentiality of our 
medical records.
  Patients should be assured that the treatment they receive is 
a matter between themselves and their doctor, regardless if it's a 
yearly physical, psychiatric evaluation, plastic surgery, or cancer 
treatment. The majority of patients agree that treatment and billing 
are the two appropriate uses of medical records. This legislation 
provides patients the right to limit disclosure of medical records for 
purposes other than treatment and billing and requires separate 
authorization forms for treatment, billing and other kinds of 
disclosures. It also requires providers to keep a record of those to 
whom they disclose information.

  In the hospital, most patients are unaware that their records are 
accessible to almost any health care provider walking into their room 
or almost any hospital employee with a computer who can gain access to 
the hospital's computer system. There are a number of doctors and 
nurses who refuse to be treated in the hospital where they practice 
medicine because they know that with a stroke of a keyboard their 
colleagues will know why they are in the hospital and know they are 
being treated.
  One of the most important issues this legislation addresses is that 
of access to personal medical records. It is difficult for most of us 
to understand that in many instances individuals may have great 
difficulty gaining access to their own medical records. There are no 
Federal laws regarding access to medical records and only a few States 
allow patients the right to review and copy their medical records. In 
many instances, if the medical record is incorrect the patient never 
has the opportunity to address those errors. This legislation would 
allow individuals not only access to their records but also the 
opportunity to address any errors.
  This legislation will enable organizations and entities involved in 
providing health care, or who act as contractors or agents to 
providers, to abide by one standard for confidentiality. Our health 
care system grows more complex and sophisticated with each year. Having 
one standard will simplify the business of health care, reduce the cost 
of complying with 50 state standards and allow the continuation of 
research that will improve the efficiency of our health care system.
  Currently, the only protection of medical records is under state 
laws. At this time there are 34 States with 34 different laws to 
protect these records. Only 28 States provide patients with access to 
their medical records. My own State of Utah does not have a 
comprehensive law to protect medical records or provide access. Given 
the transient nature of our society and that fact that more than 50 
percent of the population live on a State boarder, it is vital that 
we provide a national standard for the protection of medical records.

  It is unfair to both the patients and the providers of medical 
services not to clearly and concisely outline the rights of the patient 
and define the standards of disclosure. The effort to provide Federal 
protection of medical records has continued for the last 20 years. Many 
of the outside groups that have provided assistance to me and my staff 
have been involved for many of these years. Those groups that have 
provided assistance include patient right advocates, health care 
providers, electronic data services, insurance companies, health 
researchers, States, health record managers--to name just a few. I am 
grateful to them for their assistance and expertise; without their 
efforts we would not be here today.
  I want to express my appreciation to the two leaders, Senators Dole 
and Daschle for their support as cosponsors. I am very pleased to have 
Chairwoman Kassebaum and the ranking minority member, Senator Kennedy 
of Labor and Human Resources Committee as cosponsors. I want to express 
my appreciation to Senator Leahy for his efforts on this legislation. 
He has been a supporter of this legislation for a number of years and I 
appreciate his cosponsorship I am also pleased to add Senators Hatch, 
Frist, Jeffords, Stevens, Gregg, Simon, Kohl, and Feingold as original 
cosponsors. I hope the Senate will act swiftly to hold hearings and to 
move this legislation through the committee process to the Senate floor 
for final consideration. I would urge my colleagues to support this 
legislation and would welcome their cosponsorship.
 Mrs. KASSEBAUM. Mr. President, I rise today to join Senator 
Bennett, the distinguished majority leader, Senators Hatch, Kennedy, 
Frist, Leahy, Simon, and others in introducing the Medical Records 
Confidentiality Act of 1995.
  We have spent a great deal of time and energy these last several 
months--and will spend even more time during the coming weeks--debating 
changes to the Medicare and Medicaid programs. As we debate these 
changes, the private health care system continues to literally 
transform itself overnight.
  While health providers still wrestle with multiple paper forms and 
bulky files, increasingly health information and data is digitally 
transmitted to multiple databases by high-speed computers over fiber-
optic networks. Many Americans believe their private medical records 
are safely stored in doctors' offices and hospitals. Yet, the evolving 
health care delivery system and the technological infrastructure 
necessary to support it has left gaping holes in the patchwork of 
current State privacy laws and threatened the confidentiality of 
private medical information.
  Let me give just one example that highlights both the promise and the 
peril of medical information. Recent advances have allowed researchers 
to identify a growing number of genetic characteristics that place 
individuals at higher-than-average risk for developing disease. While 
genetic research provides tremendous opportunities to help us better 
treat and manage illness, disclosure of genetic information also may 
place individuals at a greater risk of discrimination in obtaining 
health coverage for themselves and their families.
  The Medical Records Confidentiality Act takes a balanced approach to 
encouraging the continued development of a world-class health 
information infrastructure while, at the same time, assuring Americans 
that their sensitive medical records are protected. The legislation is 
designed to provide all patients with Federal safeguards for their 
medical records, whether in paper or electronic form, and to provide 
doctors, hospitals, insurance companies, managed care companies, and 
other entities that have access to medical records with clear Federal 
rules governing when and to whom they may disclose health information.
  Mr. President, I applaud Senator Bennett for taking on such a complex 
and important issue. I look forward to working with him, and with my 
colleagues on the Senate Committee on Labor and Human Resources, to see 


[[Page S 15578]]
that this very important piece of legislation is enacted during the 
104th Congress.
  Mr. LEAHY. Mr. President, today I join in introducing the Medical 
Records Confidentiality Act of 1995, with Senator Bennett, our 
distinguished colleague from Utah.
  For the past several years, I have been engaged in efforts to make 
sure that Americans' expectations of privacy for their medical records 
are fulfilled. That is the purpose of this bill.
  I do not want advancing technology to lead to a loss of personal 
privacy and do not want the fear that confidentiality is being 
compromised to stifle technological or scientific development.
  The distinguished Republican majority leader put his finger on this 
problem last year when he remarked that a compromise of privacy that 
sends information about health and treatment to a national data bank 
without a person's approval would be something that none of us would 
accept. We should proceed without further delay to enact meaningful 
protection for our medical records and personal and confidential health 
care information.
  I have long felt that health care reform will only be supported by 
the American people if they are assured that the personal privacy of 
their health care information is protected. Indeed, without confidence 
that one's personal privacy will be protected, many will be discouraged 
from seeking help from our health care system or taking advantage of 
the accessibility that we are working so hard to protect.
  The American public cares deeply about protecting their privacy. This 
has been demonstrated recently in the American Civil Liberties Union 
Foundation's benchmark survey on privacy entitled ``Live and Let Live'' 
wherein three out of four people expressed particular concern about 
computerized medical records held in databases used without the 
individual's consent. A public opinion poll sponsored by Equifax and 
conducted by Louis Harris indicated that 85 percent of those surveyed 
agreed that protecting the confidentiality of medical records is 
extremely important in national health care reform. I can assure you 
that if that poll had been taken in Vermont, it would have come in at 
100 percent or close to it.
  Two years ago, I began a series of hearings before the Technology and 
the Law Subcommittee of the Judiciary Committee. I explored the 
emerging smart card technology and opportunities being presented to 
deliver better and more efficient health care services, especially in 
rural areas. Technology can expedite care in medical emergencies and 
eliminate paperwork burdens. But it will only be accepted if it is used 
in a secure system protecting confidentiality of sensitive medical 
conditions and personal privacy. Fortunately, improved technology 
offers the promise of security and confidentiality and can allow levels 
of access limited to information necessary to the function of the 
person in the health care treatment and payment system.
  In January 1994, we continued our hearings before that Judiciary 
Subcommittee and heard testimony from the Clinton administration, 
health care providers and privacy advocates about the need to improve 
upon privacy protections for medical records and personal health care 
information.
  In testimony I found among the most moving I have experienced in more 
than 20 years in the Senate, the subcommittee heard first hand from 
Representative Nydia Velazquez, our House colleague who had sensitive 
medical information leaked about her. She and her parents woke up to 
find disclosure of her attempted suicide smeared across the front pages 
of the New York tabloids. If any of us have reason to doubt how hurtful 
a loss of medical privacy can be, we need only talk to our House 
colleague.
  Unfortunately, this is not the only horrific story of a loss of 
personal privacy. I have talked with the widow of Arthur Ashe about her 
family's trauma when her husband was forced to confirm publicly that he 
carried the AIDS virus and how the family had to live its ordeal in the 
glare of the media spotlight.
  We have also heard testimony from Jeffrey Rothfeder who described in 
his book ``Privacy for Sale'' how a freelance artist was denied health 
coverage by a number of insurance companies because someone had 
erroneously written in his health records that he was HIV-positive.
  The unauthorized disclosure and misuse of personal medical 
information have affected insurance coverage, employment opportunities, 
credit, reputation, and a host of services for thousands of Americans. 
Let us not miss this opportunity to set the matter right through 
comprehensive Federal privacy protection legislation.
  As I began focusing on privacy and security needs, I was shocked to 
learn how catch-as-catch-can is the patchwork of State laws protecting 
privacy of personally identifiable medical records. A few years ago we 
passed legislation protecting records of our videotape rentals, but we 
have yet to provide even that level of privacy protection for our 
personal and sensitive health care data.
  Just yesterday the Commerce Department released a report on Privacy 
and the NII. In addition to financial and other information discussed 
in that report, there is nothing more personal than our health care 
information. We must act to apply the principles of notice and consent 
to this sensitive, personal information.
  Now is the time to accept the challenge and legislate so that the 
American people can have some assurance that their medical histories 
will not be the subject of public curiosity, commercial advantage or 
harmful disclosure. There can be no doubt that the increased 
computerization of medical information has raised the stakes in privacy 
protection, but my concern is not limited to electronic files.
  As policymakers, we must remember that the right to privacy is one of 
our most cherished freedoms--it is the right to be left alone and to 
choose what we will reveal of ourselves and what we will keep from 
others. Privacy is not a partisan issue and should not be made a 
political issue. It is too important.
  I am encouraged by the fact that the Clinton administration clearly 
understands that health security must include assurances that personal 
health information will be kept private, confidential and secure from 
unauthorized disclosure. Early on the administration's health care 
reform proposals provided that privacy and security guidelines would be 
required for computerized medical records. The administration's Privacy 
Working Group of its NII task force has been concerned with the 
formulation of principles to protect our privacy. In these regards, the 
President is to be commended.
  The difficulties I had with the initial provisions of the Health 
Security Act, were the delay in Congress' consideration of 
comprehensive privacy legislation for several more years and the lack 
of a criminal penalty for unauthorized disclosure of someone's medical 
records.
  Accordingly, back in May 1994, I introduced a bill to provide a 
comprehensive framework for protecting the privacy of our medical 
records from the outset rather than on a delayed basis. That bill was 
the Health Care Privacy Protection Act of 1994, S. 2129. I was 
delighted to receive support from a number of diverse quarters. We were 
able to incorporate provisions drawn from last year's Health Care 
Privacy Protection bill into those reported by the Labor and Human 
Resources Committee and the Finance Committee. These provisions were, 
likewise, incorporated in Senator Dole's bill and Senator Mitchell's 
bills, indicating that the leadership in both parties acknowledges the 
fundamental importance of privacy.
  Although Congress failed in its attempt to enact meaningful health 
care reform last Congress, we can and should proceed with privacy 
protection--whether or not a comprehensive health care reform package 
is resurrected this year. I am proud to say that the Medical Records 
Confidentiality Act that Senator Bennett and I are introducing today, 
derives from the work we have been doing over the last several years. I 
am delighted to have contributed to this measure and look forward to 
our bipartisan coalition working for enactment of these important 
privacy protections.
  Our bill establishes in law the principle that a person's health 
information is to be protected and to be kept confidential. It creates 
both criminal 

[[Page S 15579]]
and civil remedies for invasions of privacy for a person's health care 
information and medical records and administrative remedies, such as 
debarment for health care providers who abuse others' privacy.
  This legislation would provide patients with a comprehensive set of 
rights of inspection and an opportunity to correct their own records, 
as well as information accounting for disclosures of those records.
  The bill creates a set of rules and norms to govern the disclosure of 
personal health information and narrows the sharing of personal details 
within the health care system to the minimum necessary to provide care, 
allow for payment and to facilitate effective oversight. Special 
attention is paid to emergency medical situations, public health 
requirements, and research.
  We have sought to accommodate legitimate oversight concerns so that 
we do not create unnecessary impediments to health care fraud 
investigations. Effective health care oversight is essential if our 
health care system is to function and fulfill its intended goals. 
Otherwise, we risk establishing a publicly sanctioned playground for 
the unscrupulous. Health care is too important a public investment to 
be the subject of undetected fraud or abuse.
  I look forward to working with my colleagues both here in the Senate 
and in the House as we continue to refine this legislation. I want to 
thank all of those who have been working with us on the issue of health 
information privacy and, in particular, wish to commend the Vermont 
Health Information Consortium, the Center for Democracy and Technology, 
the American Health Information Management Association, the American 
Association of Retired Persons, the AIDS Action Council, the Bazelon 
Center for Mental Health Law, the Legal Action Center, IBM Corp. and 
the Blue Cross and Blue Shield Association for their tireless efforts 
in working to achieve a significant consensus on this important matter.
  With Senator Bennett's leadership and the longstanding commitment to 
personal privacy shared by Chairman Kassebaum and Senator Kennedy, I 
have every confidence that the Senate will proceed to pass strong 
privacy protection for medical records. With continuing help from the 
administration, health care providers and privacy advocates we can 
enact provisions to protect the privacy of the medical records of the 
American people and make this part of health care security a reality 
for all Americans.
                                 ______

      By Mr. MOYNIHAN (for himself, Mr. Cochran and Mr. Simpson):
  S.J. Res. 39. A joint resolution to provide for the appointment of 
Howard H. Baker, Jr. as a citizen regent of the Board of Regents of the 
Smithsonian Institution; to the Committee on Rules and Administration.
  S.J. Res. 40. A joint resolution to provide for the appointment of 
Anne D'Harnoncourt as a citizen regent of the Board of Regents of the 
Smithsonian Institution; to the Committee on Rules and Administration.
  S.J. Res. 41. A joint resolution to provide for the appointment of 
Louis Gerstner as a citizen regent of the Board of Regents of the 
Smithsonian Institution; to the Committee on Rules and Administration.


     appointments as citizen regents of the smithsonian institution

  Mr. MOYNIHAN. Mr. President, I introduce three joint resolutions to 
appoint Howard H. Baker, Jr., Anne D'Harnoncourt and Louis V. Gerstner, 
Jr., to serve as citizen regents of the Smithsonian Institution. I 
introduce these Joint-resolutions on behalf of my distinguished 
colleagues, Senators Cochran and Simpson, with whom I have the 
privilege to serve on the Smithsonian's Board of Regents.
  Howard Baker, whose reputation is well known among the Members of 
this body, is a superb public servant. After spending 18 illustrious 
years in the Senate, during which time he served 4 years as Majority 
Leader, Senator Baker went on to become President Reagan's most trusted 
advisor. He has since returned to private practice, as the senior 
partner in the law firm of Baker, Donelson, Bearman & Caldwell, but has 
remained an active leader in the political and business communities. 
His commitment to both communities is marked by his membership on the 
Council on Foreign Relations and the Washington Institute of Foreign 
Affairs and his positions on the boards of Federal Express, United 
Technologies, and Penzoil. He has most deservedly received the Nation's 
highest civilian award, the Presidential Medal of Freedom, as well as 
the Jefferson Award for Greatest Public Service Performed by an Elected 
or Appointed Official.
  As the distinguished statesman and gifted strategist that he is, 
Howard Baker would bring to the Smithsonian a voice that can talk to 
Congress at a time when that is what is most urgently needed. The 
Institution would benefit immensely from his political and fiscal 
wisdom, and I urge my colleagues to support his appointment.
  Just as Senator Baker would add his expertise on matters political 
and economic, Ms. Anne D'Harnoncourt would bring to the Smithsonian 
vast experience in the management and oversight of a large museum. 
Having served with her for some 15 years on the Board of the Hirshorn 
Museum, I can think of no person better suited to serve on the Board of 
Regents.
  Ms. D'Harnoncourt has served as an Assistant Curator for the Art 
Institute of Chicago, a Curator for the Philadelphia Museum of Art, and 
is currently the George D. Widener Director of the Philadelphia Museum 
of Art. She has a broad base of expertise in the Arts, and is among the 
most actively involved in that community. As the Smithsonian continues 
to broaden its mission within the Sciences, Ms. D'Harnoncourt surely 
would help the Institution remain focused on its long-standing 
commitment to the Arts. Her knowledge and experience would be of 
inestimable value to the Board of Regents, and I eagerly urge her 
appointment.
  Finally, Louis V. Gerstner, Jr., a gifted leader in the business and 
educational communities. Mr. Gerstner was named chairman and chief 
executive officer of International Business Machines Corporation on 
April 1, 1993, prior to which he served for 4 years as chairman and 
chief executive officer of RJR Nabisco Inc. He received his B.A. from 
Dartmouth College in 1963, his M.B.A. from Harvard Business School in 
1965, and was awarded an honorary doctorate of Business Administration 
from Boston College in 1994.
  Mr. Gerstner has long been an advocate of improving the quality of 
public education in America. He is the co-author of ``Re-Inventing 
Education: Entrepreneurship in America's Public Schools'' (Dutton, 
1994), which documents public school reforms designed to enable our 
children to handle the demands of today's complex global economy. At 
IBM he has re-directed a majority of the company's substantial 
philanthropic resources to support public school reform. His dedication 
to re-inventing both education and management makes him an ideal 
candidate to serve on the Smithsonian's Board of Regents.
  Mr. President, I hope my colleagues will agree that this profoundly 
talented triumvirate is most deserving of these appointments, and I 
urge Senators to support all three resolutions.
 Mr. COCHRAN. Mr. President, I am pleased to join Senators 
Moynihan and Simpson in introducing joint resolutions providing for the 
appointment of Howard H. Baker, Jr., Anne d'Harnoncourt, and Louis V. 
Gerstner, Jr., as Citizen Regents of the Smithsonian Institution.
  Howard Baker is a distinguished public servant well known in this 
body. He was a Senator from Tennessee from 1967 to 1985, serving as 
Minority Leader from 1977 to 1981 and as Majority Leader from 1981 to 
1985. He was Chief of Staff to President Reagan in 1987 and 1988 before 
returning to the private practice of law. He has received the Nation's 
highest civilian award, the Presidential Medal of Freedom, as well as 
the Jefferson Award for Greatest Public Service Performed by an Elected 
or Appointed Official.
  Anne d'Harnoncourt is currently the George D. Widener Director of the 
Philadelphia Museum of Art, having previously served that museum as 
Curator of Twentieth Century Art and as Assistant Curator of Twentieth 
Century Art at the Art Institute of Chicago. A Fellow of the American 
Academy of Arts and Sciences, she is a member of numerous advisory 
committees and boards, including the Board of Directors of The Henry 
Luce Foundation and the Board of Overseers of the 

[[Page S 15580]]
Graduate School of Fine Arts of the University of Pennsylvania.
  Louis V. Gerstner, Jr., is Chairman and Chief Executive Officer of 
International Business Machines Corp. He previously served as chairman 
and chief executive officer of RJR Nabisco and as president of American 
Express Company. He is a director of The New York Times Company, 
Bristol-Myers Squibb Company, the Japan Society, and Lincoln Center for 
the Performing Arts. A lifetime advocate of the importance of quality 
education, he has redirected a majority of IBM's substantial 
philanthropic resources in the United States to the support of public 
school reform.
  I urge Senators to support the resolutions of appointment of these 
outstanding Americans.

                          ____________________