[Congressional Record Volume 142, Number 59 (Thursday, May 2, 1996)]
[Senate]
[Pages S4640-S4641]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          NEWBORNS' AND MOTHERS' HEALTH PROTECTION ACT OF 1996

  Mr. ROCKEFELLER. Mr. President, I want to follow on the comments that 
were made by Senator Bradley with respect to the Newborns' and Mothers' 
Health Protection Act of 1996. I think it is an absolutely classic 
example of what it is the American people do expect us to do in 
Congress and what they would like us to take on. It is a very real 
problem. As he indicated, they are very real families, very real people 
and they are in this situation, very helpless.
  I also join Senator Bradley in urging the majority leader, Senator 
Dole, to bring this bill to the floor as soon as possible. It did pass 
Labor and Human Resources by 14 to 2. That is not a close vote. That is 
virtually a unanimous vote. We are approaching Mother's Day. It would 
be nice to have this bill debated at that time.
  The legislation is absolutely vital in the turmoil which is now our 
health care system. It shifts the decisionmaking power of when a mother 
and her baby would be leaving a hospital, discharged home, so to speak, 
from an insurance company or an HMO, which has interesting missions in 
all of this, and then send it back to the doctor and to the patient. 
That is, the decision when to leave. That is why I signed on to this 
bill and became a cosponsor very, very early.
  Many large insurers are refusing to pay for more than 24 hours of 
maternity care. I do not know where managed care is going to take this 
country. I can tell you this, I am extremely worried about it, and I am 
even more worried about for-profit HMOs and managed care. Some HMOs 
even require discharge within 8 hours of delivery. I cannot imagine 
such a thing. I am sure that can happen from time to time, but I just 
cannot imagine that happening very often.
  These quick discharge practices can, in fact, enormously endanger the 
life of the mother and endanger greatly the life of the child. Newborns 
are prone to problems such as dehydration. They are prone to problems 
like jaundice that are not even detectable until they have been alive 
for 24 hours. So, by definition, how are doctors going to be able to 
determine infants' condition if they are already at home?
  New mothers are themselves very susceptible to pelvic infections, to 
breast infections. A new mom may be, probably is in most cases, too 
fatigued, just too tired, has been through too much in the delivery to 
properly care for an infant 24 hours after a normal but nonetheless 
exhausting delivery problem or experience.
  Quick discharges can result in devastating medical consequences, in 
devastating human consequences and, yes, they can result, and have 
resulted, in death, because new mothers and fathers are sometimes 
unable to detect these early symptoms of potentially life-threatening 
conditions. This is not ideological talk, this is medical talk.
  Right now, insurance companies start the 24-hour clock, or even the 
8-hour clock or the 12-hour clock ticking the minute the child is born. 
The minute the child emerges, the minute of the first cry, the clock 
begins.
  The insurance companies do not distinguish between those mothers who

[[Page S4641]]

have had a 2-hour birth and a mother who has been through 12 hours or 
18 hours and had an extremely painful, exhausting, debilitating birth. 
They make no distinction whatsoever between the two; just out of here 
in 24 hours.
  Their rules do not distinguish between an experienced mother, a 
mother perhaps having her third or fourth child with a father or a 
grandmother at home ready to help, ready to help the mother, ready to 
help the child, on the one hand, and then on the other hand, a 16-year-
old teenage mother with an exhausting birth process who is discharged 
after virtually no time. A teenage mother, who is terrified at the 
prospect and has no idea of how to care for a healthy baby, much less a 
baby showing some kinds of symptoms which that 16-year-old teenage 
mother cannot understand. It makes no difference to the insurance 
company. The circumstances make no difference: 24 hours, they must all 
be discharged from the hospital, period.
  How do we get here? I mean, this is the great debate. The Clinton 
health care bill did not pass, I understand that. It tried to bite off 
too much, I understand that. The free market is working, I understand 
that, but there are some very dangerous things going on. Some of the 
most unhappy people in America right now, and the ones most worried 
about quality of care, are physicians.

  Judith Bowman is a first-time mom from Fairmont, WV. She recently 
experienced one of these speedy discharges. She wrote to me:
  ``I was surprised by the almost drive-thru like approach put on 
bringing a precious new life into the world. The information concerning 
the baby and personal follow up care comes fast.''
  ``I was,'' she said, ``exhausted. I couldn't understand it all. It 
was new to me. I couldn't take it all in. I was still recovering from 
the birth experience.''
  ``The total length of my stay after delivery was approximately 20 
hours.''
  Mr. President, in concluding, I say that one would hope that the 
Congress would not need to legislate on this kind of matter. I mean, to 
be quite honest with you, I think it is rather shocking. It is the kind 
of thing that you think that the private sector would pick up 
immediately at the first sense of difficulties and simply stop. But, 
no--insurance companies are motivated by other things.
  I would think that we could trust insurance companies to do the right 
thing on an individual case-by-case basis. What is so strange about 
that? What is so radical about that? To let doctors make patient-care 
decisions without concern of financial or other penalties being imposed 
on them.
  Of course, what I am saying is, if doctors who belong to HMOs want to 
keep the mother more than 24 hours, they may be threatened, saying, 
``You either start discharging after 24 hours or you're off our 
payroll.'' Do not think for a moment that is not happening. It is 
scary. It is scary.
  So this bill would require insurers to pay for a 48-hour stay 
following an uncomplicated vaginal delivery and 96 hours for an 
uncomplicated Caesarean section. The bill permits, as Senator Bradley 
said, shorter stays. But, again, it puts the decision in the hands of 
the physician of the mother to decide if that is appropriate. That is 
who should make this critical decision, not an insurance company driven 
by other considerations, including those of their stockholders.
  Mr. President, I conclude my remarks simply by thanking Senator 
Bradley and Senator Kassebaum for leading this effort. I again hope we 
will be able to take this matter up somewhere around Mother's Day. I 
thank the Chair, and I yield the floor.
  Mr. PELL addressed the Chair.
  The PRESIDING OFFICER. The Senator from Rhode Island.

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