[Congressional Record Volume 143, Number 69 (Thursday, May 22, 1997)]
[Extensions of Remarks]
[Page E1036]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            THE MANAGED CARE PLAN ACCOUNTABILITY ACT OF 1997

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                         Thursday, May 22, 1997

  Mr. STARK. Mr. Speaker, together with Mr. Kildee, Mrs. Lowey, Mr. 
Miller of California, Mr. Frank of Massachusetts, Ms. Pelosi, Mr. 
Sanders, Mr. Tierney, Mr. Frost, Mr. Dellums, Ms. Christian-Green, Mr. 
Lewis of Georgia, Mr. DeFazio, Mr. Waxman, Mr. Rangel, Mr. Kleczka, Mr. 
Berman, Mr. Kennedy of Rhode Island, Ms. Rivers, Mr. McGovern, Mr. 
Kucinich, and Ms. Tauscher, I am proud to introduce the Managed Care 
Plan Accountability Act of 1997, a bill which amends ERISA to provide 
equality and fairness to the millions of Americans whose health 
benefits are regulated by the Federal Government.
  ERISA was enacted in 1974 to uniformly govern employee benefit plans. 
To this end, ERISA includes a wide-ranging preemption provision that 
supersedes any and all State laws insofar as they relate to an employee 
benefit plan, including health insurance.
  Under current law, ERISA managed care plans are often completely 
exempt from liability for any medical decision made as a result of plan 
policy. If a patient is injured as a direct result of a plan's cost-
containment policy, for example, the patient is entitled to sue only 
for the value of the denied treatment. Patients in ERISA plans are not 
entitled to other compensation, such as lost wages or pain and 
suffering, as is currently available to patients in non-ERISA plans.
  For example, Newsweek magazine recently reported a case in which a 
managed care plan denied a heart attack victim's request for surgery 
because the only hospital qualified to perform the needed procedure was 
located outside of the plan's service area. By the time the patient 
appealed the decision and received the necessary approval, it was too 
late. The patient's heart was damaged beyond repair, and he died 
shortly thereafter while awaiting a heart transplant. In this case, the 
patient's health insurance was part of an employer-sponsored benefits 
package and therefore, regulated by ERISA.
  Under current law, the family was entitled only to the cost of the 
denied procedure. In other words, the most damaging thing that could 
happen to the HMO responsible for the loss of their loved one is the 
cost of the procedure that could have saved the person's life.
  While a price tag should never be put on a human life, there should 
be some reasonable compensation paid to patients and their families who 
are victims of medical malpractice. This is especially true when 
victims suffer life-altering, if not fatal injuries due directly to the 
negligence of a plan executive attempting to save money.
  Imagine if your child died of leukemia because your HMO would not 
authorize an early blood test. The twisted irony is that you could 
recover no more than approximately $130--the cost of the test. A 
child's life is surely worth more than $130. This is a travesty.
  This bill would create a new cause of action under ERISA which would 
allow consumers to seek additional damages from employer-sponsored 
health plans. The new cause of action would have concurrent 
jurisdiction, allowing the action to be brought either in Federal or 
State court. Additionally, this legislation would protect physicians 
from unfair lawsuits by making the health plan responsible for 
constraints they place on providers.
  Our legislation is fair and long overdue. Plans that actively manage 
the care of their enrollees must be held accountable for their 
decisions. Employees of ERISA-regulated health plans deserve the same 
rights and protections as people in non-ERISA plans.

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