[Congressional Record Volume 142, Number 83 (Friday, June 7, 1996)]
[Extensions of Remarks]
[Pages E1036-E1037]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     NONPHYSICIAN PROVIDERS PROVIDE INVALUABLE HEALTH CARE SERVICES

                                 ______


                        HON. FRANK PALLONE, JR.

                             of new jersey

                    in the house of representatives

                          Friday, June 7, 1996

  Mr. PALLONE. Mr. Speaker, last week, the Subcommittee on Health and 
Environment held a hearing on issues surrounding managed care that I 
hope will lead to passage of much-needed legislation.
  The focus of the hearing came down to choice. Patients want to be 
able to choose their own doctor. They want to be able to know of all of 
the treatments that are available to them. They want to be able to rely 
on the expertise of a medical specialist for a very specific medical 
problem. And as we continue to consider proposals to restructure 
Medicare, I would like to add that many seniors do not want to give up 
their choice of providers.
  Real problems do exist and I believe that there are many legislative 
vehicles before Congress that will work to ensure quality care, while 
preserving choice. I am a cosponsor of the Family Health Care Act, H.R. 
2400, which would set a ground floor, a minimum set of standards that 
all health plans would have to follow, including important point-of-
service options and quality assurance mechanisms. This legislation will 
enable patients to see the providers of their choice, including 
nonphysician providers, such as opticians who provide quality care 
services to their patients.
  I would like to include in the Record the statement of Paul 
Houghland, Jr., CAE, executive director, Opticians Association of 
America that was presented before the subcommittee on May 30, to 
further shed light on issues surrounding choice in a managed care 
setting.

 Statement by Paul Houghland, Jr., CAE, Executive Director, Opticians 
                         Association of America

       On behalf of the Opticians Association of America (OAA), 
     which represents the interests of more than 35,000 dispensing 
     opticians throughout the United States, I am pleased that the 
     Subcommittee on Health and Environment has convened hearings 
     on managed care issues. As the panel with jurisdiction over 
     health insurance it is important that you hear the view of 
     all participants in the health care delivery system including 
     nonphysician providers.
       OAA wishes that these hearings had provided more of an 
     opportunity for nonphysician providers to participate. This 
     group of health care providers is responsible for many of the 
     most cost-effective approaches to health care delivery. Yet 
     nonphysician providers have had many difficulties being 
     included in many managed care organizations (MCOs). For this 
     reason OAA and many other nonphysician providers have joined 
     the Coalition for Health Care Choice and Accountability 
     (CHCCA), a group dedicated to making MCOs more accountable 
     for their actions and more patient and provider friendly.
       OAA wishes to associate itself with the written statement 
     provided to this subcommittee by CHCCA and also to associate 
     itself with the testimony presented by the American Dental 
     Association, a CHCCA member. The concerns raised by these 
     organizations reflect legitimate issues that should be 
     addressed legislatively by this subcommittee at its earliest 
     convenience.
       OAA believes that many of the managed care problems that 
     nonphysician providers in general and opticians in particular 
     face are corrected by HR 2400, the ``Family Health Care 
     Fairness Act'' introduced by Representative Charlie Norwood 
     of Georgia, a member of this subcommittee. OAA commends 
     Representative Norwood for his leadership in calling 
     attention to aspects of the managed care industry which need 
     modification. We thank Representative Bill Brewster of 
     Oklahoma for being the prime cosponsor of this measure. As a 
     pharmacist, Representative Brewster understands well the 
     struggles which far too many nonphysician providers have had 
     with MCOs. OAA also appreciates the bipartisan support 
     expressed for HR 2400 by its Republican and Democratic 
     cosponsors.
       The health subcommittee could prove its commitment to 
     innovative solutions to health care problems by favorably 
     reporting the Norwood bill to the full committee within the 
     next 60 days. While aware of the shortness of the 1996 
     legislative calendar and the numerous demands upon your time, 
     managed care issues are too important for Congress to abandon 
     this year without significant action. Market-based solutions 
     are not adequate to correct abuses within the managed care 
     industry. HR 2400 provides fair and equitable solutions to 
     real problems.
       Many of managed care's shortcomings are discussed in the 
     ADA and CHCCA testimony. After reading the stories collected 
     by the CHCCA I am certain this panel will agree that action 
     on HR 2400 will benefit the public interest. What more 
     positive message could you take back to your constituents 
     this fall than news that you approved a bill to make 
     managed care more accessible, more accountable, more 
     patient friendly?
       OAA's national legislative agenda can be summarized very 
     concisely: maximize competition within the health care market 
     place and maximize freedom of choice for consumers. We 
     support HR 2400 because it promotes equity for both consumers 
     and providers. It contains nondiscrimination language which 
     would assure that both those using the health care system and 
     those providing the services are treated fairly.
       A second major component of HR 2400 would require all MCOs 
     to offer a point-of-service (POS) option to all subscribers. 
     The health care marketplace has confirmed that a POS option 
     is very popular and cost effective. Approximately three-
     quarters of the managed care plans offer this option. OAA and 
     the CHCCA believe that all plans should include this option 
     with a reasonable cost-sharing formula so that it is a viable 
     alternative.
       The POS issue was debated last fall in the Commerce 
     Committee during the Medicare reform debate. Two members of 
     the Health and Environment Subcommittee offered POS 
     amendments supported by OAA and the CHCCA members. OAA 
     appreciates the efforts of Representatives Greg Ganske of 
     Iowa and Tom Coburn of Oklahoma. Unfortunately, both the 
     Ganske and Coburn amendments were defeated because most 
     members of the majority party refuse to support maximizing 
     freedom of choice for consumers.
       In a discussion of managed care issues last week on WPFW-FM 
     in Washington, DC, Cindy Elkin, a Northern Virginia optician, 
     described her experiences with managed care programs. She 
     pointed out that many managed care vision programs referred 
     eyewear customers for dispensing purposes to personnel who 
     are often unlicensed, or uncertified, in short to persons who 
     are not well trained or in a position to provide quality 
     service. And this lesson is not lost on customers. 
     Frequently, persons with managed vision care programs have 
     found the quality to be so low

[[Page E1037]]

     compared to their previous service that customers frequently 
     vote with their feet. However, by choosing to forego a 
     benefit provided by their employer these persons wind up with 
     a self-chosen POS option with a 100 percent copayment.
       OAA and its members strongly support competition and free 
     market solutions within the health care sector. Because OAA 
     believes so strongly in the principle of competition within 
     the marketplace it will unveil a managed vision care program 
     for its members next month at its national convention in St. 
     Louis. The OAA managed vision care program, unlike so many 
     vision care programs currently available, will be open to all 
     vision care providers willing to meet the terms and 
     conditions of the program. We welcome participation by our 
     friends in the ophthalmological and optometric community. We 
     not only support the concept of provider equity, but we 
     practice it in our own managed care initiatives.
       While opticians are willing to compete within the free 
     market for managed vision care business, we are well aware 
     that a start up vision care plan offered by opticians will 
     not level the playing field overnight. Our members still face 
     numerous instances of disciminatory practices by managed 
     vision care plans which simply exclude independent opticians. 
     This deprives the consumer of freedom of choice and the 
     opportunity to shop for eyewear at the provider of choice. It 
     also frequently denies the consumer a least-cost alternative.
       Congress can level the playing field for opticians and all 
     nonphysician providers who wish to compete within the managed 
     care system by passing HR 2400. OAA calls upon this panel to 
     begin the legislative process by sending this bill to the 
     full committee for consideration with a strong endorsement.