[Congressional Record Volume 144, Number 2 (Wednesday, January 28, 1998)]
[House]
[Pages H78-H84]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1445
                       MANAGED HEALTH CARE REFORM

  The SPEAKER pro tempore (Mr. Snowbarger). Under the Speaker's 
announced policy of January 7, 1997, the gentleman from New Jersey (Mr. 
Pallone) is recognized for 60 minutes as the designee of the minority 
leader.
  Mr. PALLONE. Mr. Speaker, I just wanted to start out this afternoon 
by saying how happy I was with the President's State of the Union 
address last evening and the reaction of Congress on both sides of the 
aisle.
  The President stressed his pro-family, pro-child message. It is an 
agenda that I think that everyone can get behind. It will have the 
strong support of the American people. And it is very important, I 
think, that in order for us to enact this agenda, that we get the 
Republicans, both the leadership and the rank and file, together with 
my Democratic colleagues so that we can enact what are essentially 
common sense proposals in 1998.
  I, along with several of my colleagues who will join me this 
afternoon, just wanted to call attention to two points that the 
President raised with regard to health care reform which I think are 
particularly important.
  One is managed care reform. The gentleman from Pennsylvania (Mr. 
Klink), who is going to be joining us soon here, stressed that during 
the break, during the congressional district work period. Congressman 
Klink, myself, and others had a number of forums in our districts where 
we heard from our constituents about the problems with managed care, 
with HMOs and managed care organizations.
  I thought it was particularly interesting last evening that when the 
President mentioned the need for consumer protections and a consumer 
Bill of Rights to deal with managed care organizations, that the 
response was overwhelming. I think it had a better response from the 
Congress, again on a bipartisan basis, than almost anything else that 
he talked about. I think that is because we are hearing from our 
constituents and they are telling us the problems and the horror 
stories that exist with regard to existing managed care organizations.
  Mr. Speaker, I would like to at this point yield to the gentleman 
from Pennsylvania who I was listening to his comments before and they 
are really appropriate in terms of some of the problems that we hear 
from our constituents.
  Mr. KLINK. Mr. Speaker, I thank my distinguished friend from New 
Jersey.
  The gentleman from New Jersey (Mr. Pallone) and the gentlewoman from 
Connecticut (Ms. DeLauro) and I and others have had these discussions 
for years. We have watched as this situation with insurance and 
availability of insurance, choice of doctors, all of this has 
deteriorated greatly.
  But it was 1995 when probably the most horrendous story that I had 
ever come into contact with occurred. I became aware of a 4-year-old 
boy named Sean Brake from a place outside of my district called Plum 
Borough. The local TV station was doing a story about the fact that 
Sean's father worked for the insurance company and Sean at the age of 4 
had gotten a rare form of cancer, but it was a highly treatable form. 
With a bone marrow transplant which would cost somewhere around 
$200,000 or more, there was a 90 percent chance that Sean would 
survive, according to the people at Children's Hospital in Pittsburgh,

[[Page H79]]

one of the most renowned children's hospitals in the Nation.
  Yet the insurance company would not pay for this. I heard this on the 
television; and I said, This is amazing. Being a father, here is a 4-
year-old child who has a 90 percent chance of treatment if he gets the 
treatment or he is going to die. And so I called the family and asked 
if they minded if we got involved. It took me personally, and my staff 
members, 3 days on the phone.
  The problem was that the insurance company that Sean's father worked 
for would only cover the first $125,000. They said, Congressman Klink, 
it is not that we do not want to pay out this money, but we need to 
know that our catastrophic carrier will pick up the remainder or why 
bother?
  So I called that other carrier, and they would not talk to me. As a 
Member of Congress, or as anyone else, they would not speak to me. I 
could only talk to their lawyer in Chicago.
  So I talked to the lawyer; and he said, Look, we view this as 
experimental. It is too bad. That is a decision we have made, and he 
was very cold. I could not believe I am talking to another American 
that is going to let a 4-year-old child die when there is a 90 percent 
chance to survive. I was appalled, but I could not reach this 
individual through the phone.
  I could not also understand why, if the child was going to have a 90 
percent chance of success with this treatment, why is that 
experimental?
  Finally, we found out that the Health Care Finance Administration in 
its manual says that if an insurance company wants to bid to provide 
insurance for any Federal employee, it must cover this procedure. It is 
not experimental according to HCFA.
  So we called them back and said, Being good citizens of this good 
United States, if you do not cover this we are going to have to inform 
the Federal Government. Every contract you have with the Federal 
Government will be canceled, and you will not be able to bid for any 
more.
  Mr. Speaker, very quickly they called us back and said, We will take 
care of Sean Brake.
  I had a wonderful opportunity a year ago to sit with Sean Brake and 
his mother. He is alive and thriving, and the bone marrow transplant 
worked. But why did it take a Member of Congress and his entire staff 3 
days to get this child the care in the United States of America that 
every child should be able to get?
  We have had people sitting in front of us. A lady who was a diabetic 
sat there. Her husband had to take an early retirement from Sears & 
Roebuck. Under COBRA, he is covered; and she is sitting there with 
tears streaming down her face.
  She said, There are two things that I love more than anything in the 
world: Number one, I love my husband; and, number two, I am a real flag 
waver. I love my country.
  But I am going blind from diabetes. My husband and I are not old 
enough for Medicare yet. We cannot afford insurance because I have a 
previous condition, and after the COBRA runs out I will not have health 
care coverage. So my choice is either go blind and die or I can divorce 
my husband who I love and go on Medicaid. Or I can leave this country, 
go to Canada, become a citizen and then I will have socialized 
medicine.
  What choices are we giving the citizens of this Nation today?
  I have to thank the gentleman from New Jersey (Mr. Pallone). The 
gentleman has led this fight here in Congress. He has informed many of 
us, his colleagues and friends, of things that are going on. The 
gentleman brings great knowledge and emotion to this debate and 
discussion.
  Mr. Speaker, I would simply say to the insurance industry around this 
Nation that the people are leading and the leaders will follow. People 
are angry. They are upset. They pay increasingly more of their money in 
premiums and the insurance companies give them less in service, less in 
access, no choice of medications.

  Last night, Members in a bipartisan fashion reacted favorably to the 
President's comments. This is just the beginning. They had better 
straighten up. They better start thinking about managing real care, not 
just moving dollars around. Stop giving these seven- and eight-figure 
salaries to their top executives while they are not giving care to the 
people who pay the premium for the policy.
  Mr. Speaker, I thank the gentleman for yielding; and I thank him for 
his leadership on this issue.
  Mr. PALLONE. Mr. Speaker, reclaiming my time, I want to thank the 
gentleman from Pennsylvania for his comments. I think that what the 
gentleman is pointing out, and obviously what we all must do but he has 
done it so well today and, I know, beforehand, is to give the 
individual cases of how people are individually impacted by managed 
care and the problems that we are hearing from our constituents. 
Because everyone can relate to it. It is direct.
  The gentleman mentioned again about last night in the State of the 
Union address how, when the President spoke about this, how there was 
such a positive reaction on both sides of the aisle. But we know that 
the Republican leadership, unlike many of the Republican colleagues, 
rank and file colleagues, have already joined together with this 
coalition of certain business and insurance interests. They are 
starting this million dollar campaign to try to fight the consumer 
protections that we are talking about and that the President talked 
about last night.
  My understanding is that next week some of these special interests 
are going to be down here, and we are going to have a battle. We know 
we are going to have a battle. It is just like we had with kid's health 
care and with the portability provisions of Kennedy-Kassebaum.
  We know that the people and most of our colleagues support this, but 
we are going to get these special interests and big money campaigns 
supported by the Republican leadership against it, and we are just 
going to have to keep bringing up these cases and the problems that our 
constituents talk about.
  Mr. Speaker, I want to thank the gentleman from Pennsylvania again. I 
know it is just the beginning.
  Mr. KLINK. Mr. Speaker, if my friend would again yield, I think my 
point on that would be we know that there is a tremendous amount of 
money and power and influence. This is a trillion dollar industry. The 
profits that are to be made in denying people their health care and 
pocketing the money is an extraordinary amount of money.
  In 1993 and 1994, those insurance interests were able to put the 
Harry and Louise ads on television, spend tens of millions of dollars, 
and they could make the public believe they do not want government 
health care.
  Today in America everyone knows the kind of health care that is 
available, but they also understand it is not available to them. 
Everyone we talk to has a horror story. Even those people who can 
afford the best health care know that when they go to the hospital, the 
hospitals have had to cut back on the number of nurses so they cannot 
get care. They ring the call button and no one shows up.
  I had a gentleman who manages billions of dollars of securities at 
one of the largest investment firms in Pittsburgh who told me a horror 
story about having a back operation. He has got money. That is not a 
problem.
  He goes to the hospital and because of the cutbacks forced by the 
HMOs saying to the hospital that they will take less of a reimbursement 
because all of these patients are ours; we are taking our piece off the 
top. He had to be turned X-number of degrees every so many hours or he 
will go crippled. He said, Congressman Klink, I could not get a nurse.
  People know this, no matter how much money they spend against us, the 
kind of care they are denied. And they cannot get the medication they 
want because deals have been made between the insurance companies and 
the pharmaceutical companies that they will only sell our drugs. 
Patients do not even get the generic brand anymore; they get the 
cheapest in that classification of drugs.
  Mr. Speaker, people know this. They are feeling this every day. The 
public will carry this battle on their shoulders. We just need to be 
there with them as the voice in the people's House to say to the 
special interests who are making billions of dollars, the people of 
this country deserve health care.
  If patients are pro-life, people are dying. If patients are pro-
choice, they

[[Page H80]]

should have a choice of their own doctor; they should have a choice of 
their own medication; they should have a choice to stay in the hospital 
if their doctor thinks they need to.
  It does not matter where people stand on these arguments. Both sides 
can find something that is going to bring us to the argument that the 
system as a status quo is not working.
  In 1993, 53 percent of the people who were working in this Nation 
were in HMOs. Today, 85 percent of the public are in HMOs. They have 
captured the market, but they are not delivering the service.
  Mr. Speaker, I thank the gentleman from New Jersey for his 
leadership.
  Mr. PALLONE. Mr. Speaker, I thank the gentleman again. We are 
obviously going to continue with this over the next few weeks and 
months until we get this legislation passed.
  Mr. Speaker, I yield to the gentlewoman from Connecticut (Ms. 
DeLauro).
  Ms. DeLAURO. Mr. Speaker, I thank my colleague from New Jersey; and 
it is good to be back talking about issues that are facing the American 
public and critical issues.
  And I would say to the gentleman from Pennsylvania, I had the 
opportunity to read through the newspaper clippings of the forum that 
the gentleman held on managed care, and it is heartrending what is 
going on in people's lives. The gentleman really is eloquent and a 
champion of people who are looking, desperately looking for some way in 
which they can figure out the system or not have the system be 
detrimental to their health. That is not what it is about. That is not 
the goal in health care.
  Mr. Speaker, I thank both of my colleagues; and I know that we are 
going to be joined by my colleague from New York.
  This is a critical debate in the country today. I think, as both of 
my colleagues have said, I think the President laid out a challenge to 
all of us last night when he said that we must address the issue of 
managed care reform. And I think in this body, on both sides of the 
aisle, there was a cheering and people who are ready to take on this 
challenge. I think this ought to be one of the first issues that we 
address, since there is good, solid bipartisan support and it is a 
problem, as we have all concluded, that is affecting so many Americans.
  I think why there is such tremendous bipartisan support on this issue 
is because every single Member of this body is listening very carefully 
to those who put their faith and their trust in us to represent them on 
the serious issues that they are facing. Everyone is hearing about the 
horrors of managed care. My hope is that we respond and that we respond 
quickly.

                              {time}  1500

  Today it seems that HMOs are valuing the healthy profits over healthy 
patients. We understand that there has to be costs that are cut. 
Everybody wants to try to make health care and health insurance more 
affordable, but you have to take a look at what price and if you are 
sacrificing the health and safety of the American people, then that is 
not the goal, that is not the goal.
  I was over at a large senior housing complex in my district last 
week, a place called Bella Vista, which means good vistas, good life. 
And there were about 100 people in the room. I was just talking to them 
about the changes in Medicare, what they might be looking forward to 
and also about the extension of Medicare to people who are 55 to 64, et 
cetera. One woman raised her hand. She was carrying around an oxygen 
cart. She told me her story of her husband, middle of the night, rushed 
to the hospital, cancer patient, had a stomach blockage, goes to the 
emergency room. They examined him, said, your are fine, you do not have 
to stay.
  I said, you should have made a fuss there. She said, I did. I did.
  She said, they told me that my husband did not have to stay, that he 
is fine, that he is all right, that they would not admit him. I tried.
  And within several days her husband was dead. She said to me, what 
should I have done? You are left standing there.
  This is real life. She said he was a cancer patient. So you are hard-
pressed. I can get back to her and say, and I said to her, we are 
working on that. Well, that is great. She lost her husband. You do not 
feel like you are really doing your job when you are standing there 
trying to cope or trying to be empathetic and sympathetic to what is 
going on in people's lives.
  My colleagues here know we have all worked together on the issue of 
breast cancer patients, women being treated as outpatients for 
mastectomies. We have a good piece of legislation here with 214 of our 
colleagues who have signed on. Unfortunately we have not been able to 
get the leadership in this House to give us the opportunity for a 
hearing. But over and over again I hear from Members that say, we 
cannot legislate body part by body part. I understand that. I really 
do. But we have to address an issue when it comes before us, and we 
have to take action.
  In the same way that we are talking about the Breast Cancer Patient 
Protection Act to prevent that kind of outpatient treatment for women 
who are undergoing mastectomies, we need to have an overarching set of 
principles, which we do have in a consumer Bill of Rights for people, 
something that the President has proposed. There is a piece of 
bipartisan legislation in this House which we can move on. It is only 
right. It is only just. It is only what people have every right to 
expect, that they in fact can get good quality health care, that 
doctors are not given a gag rule that says that they cannot talk about 
all the medical options that are available to people with a specific 
illness that they have, that they cannot get emergency care because 
someone is deciding what is emergency care for people when you are sick 
and you use the emergency room. When you go in and you truly are sick, 
doctors can determine whether or not someone is seriously ill versus 
someone that has gone in for something that is minor. But to curtail 
the medical profession in this regard I believe is wrong, and we have 
it within our power within this year to pass comprehensive managed care 
reform so that in fact people are the beneficiaries of the very best in 
health care that this country has to offer.
  I know we want all of our colleagues to participate.
  I want to thank the gentleman from New Jersey for taking this time 
and look forward to participating in the conversation.
  Mr. PALLONE. I want to thank the gentlewoman. As you mentioned, the 
President basically put out the challenge last night, and it is our 
obligation now to get the Congress to enact these consumer patient 
protections. I think what we are just going to do over the next few 
weeks is basically bring out all these examples and point out how so 
many of our constituents are negatively impacted and need some kind of 
Federal regulation or patient protection in order to have quality care.
  Mr. Speaker, I yield to the gentlewoman from Connecticut.
  Ms. DeLAURO. We are looking at medical science today. I am a cancer 
survivor, 12 years ago, and I thank God every day for giving me my life 
back. But we now have the capability with science to look at genes and 
to look at someone's genetic predisposition to cancer or to diabetes, 
to any of the diseases that have plagued us. And yet at the same time 
there is a fear that if you have a genetic predisposition to one of 
these illnesses, you do not want to say anything, you do not want to 
tell anybody, because you are fearful that you are going to lose your 
insurance or you will not be able to get insurance.
  Now, this is madness. We are about and the President also talked last 
night about putting so much more money, millions of dollars more, into 
research, health research. We will have the capacity to look at these 
areas. And yet people may not be able to get the kind of health care 
coverage that they will need if they have this predisposition to 
illnesses. We cannot go down this road. We just cannot.
  Mr. PALLONE. I agree.
  I want to yield now to the gentleman from New York (Mr. Engel) who is 
on the Committee on Commerce with me and who for a long time now has 
expressed concern over this issue.
  Mr. ENGEL. I want to thank my colleague from New Jersey for giving us 
this opportunity and my colleague from Connecticut. You are both so

[[Page H81]]

right. When we talk about health care, it strikes me there is no 
Democratic health care or Republican health care. There is an American 
health care, and all Americans of all political stripes, of all 
persuasions, of all races and creeds and colors and regions of the 
country are all concerned about their health care. When I speak to my 
constituents, I know that health care is right up there in terms of 
things that people are very much concerned about.
  My mother, her name is Seroy Engel, she lives in Tamarac, Florida. 
She is actually in the hospital now as we speak. She is my best advisor 
in terms of health care and Medicare and she tells me, what are people 
to do? People in this country, senior citizens who have worked hard all 
their lives, played by the rules, are retired and they do not have 
adequate health coverage. Medicare does not pay for prescription drugs. 
People have to decide whether they are going to eat or take their 
pills. Sometimes they eat half as much as they should eat and only take 
half as many pills as they need to take for medical reasons because 
they simply cannot afford it.
  What is happening is that we are not doing the job. The government is 
not doing the job.
  I want to really take my hat off to the President of the United 
States because I think that last night he made some very bold 
statements about health care. Several years ago when he put forth his 
program for health care reform, I supported that program. I am a 
supporter of the single payer plan as well because I believe that we 
need to cover every American in this country, that it is a national 
scandal that 40 million Americans have no health coverage whatsoever. 
Of those 40 million Americans, people do not realize, 20 percent of 
them are working people. It is not people who are unemployed. It is 
working people that do not have health care coverage. To me that is a 
national disgrace. We could do better in 1998, as we approach the 21st 
century in this country.

  I want to commend President Clinton for raising the issue of health 
care. When his health care plan was shot down for a few years, no one 
wanted to touch health care with a 10-foot pole. But now we understand 
that we have to do it. I am just so proud of the Democrats here in the 
House because we are grabbing the bull by the horns and we are saying 
to the American people, we think health care is a priority.
  We talked about managed care reform. We are listening to our 
constituents. Our colleague, the gentlewoman from Connecticut, is so 
right. Many of these decisions should be made by medical doctors based 
on what is best for the patient, not what is best for the private 
dollar, the almighty dollar or the bottom line.
  We understand that people are in business to make money, but if you 
are providing health care, the bottom line, the most important thing is 
the health care of that patient. That is really what it should be. So I 
think that we have a lot of problems to tackle in terms of health care.
  We participated in a forum several weeks ago about the President's 
proposed expansion of Medicare. It was very interesting because 
yesterday when the President mentioned it during the State of the Union 
and said he was for expanding Medicare for people who are 62 to 65 or 
people who are over 55 who have lost their jobs and that these people 
would pay their own premiums so it would cost the government nothing, 
the Democrats stood up and applauded. I was really very surprised that 
on the other side of the aisle the Republicans did not applaud. They 
just sat there as if they were in opposition to his program.
  I have to tell you, when I speak to my constituents, they all think 
it is marvelous because people who are 62 and have no coverage, they 
are at great risk. And people who have lost their jobs at 55, they are 
at great risk. And the Medicare program, we know we have to improve it. 
And we know we have to get at waste, fraud and abuse.
  But we do know that before there was a Medicare program, the vast 
majority of senior citizens in this country had inadequate or no health 
care coverage whatsoever. And since Medicare they do have health care 
coverage. Some of it is inadequate, but at least it is coverage. If we 
can extend that and at no cost to the government or even a minimal cost 
to the government, it is not so terrible. If it is a minimal cost to 
the government, I am all for it. I think the American people are all 
for it.
  I think the Democratic Party has shown that it is on the side of the 
people, the Democrats in this House, by coming out very forthrightly in 
support of it. So when we talk about the whole issue in this Congress, 
and I hope we will, talk about managed care reform, talk about Medicare 
expansion, talk about giving health care to 40 million Americans that 
do not have it, I think we ought to be proud to tackle these issues 
because health care affects everybody, and everybody is concerned with 
health care.
  And so I want to really just commend my colleague for raising the 
issue, and the President yesterday again brought it to the fore. I 
think it is something the American people care about and want to talk 
about.
  I think hand in hand the other issue that the President mentioned 
which I think goes hand and glove with health care is Social Security, 
because as people get older, they care about Social Security and they 
care about health care. I think the President saying that if there is 
any kind of surplus that every dollar of surplus would go to shore up 
the Social Security system, I think 90 percent at least of Americans 
would agree with that.
  So I look forward to working in this Congress to shore up the Social 
Security system, if there is a surplus, and if there is not a surplus 
we know we need to shore it up anyway and to work on improving health 
care in this country. We have the greatest system in the world in terms 
of health care, but we know along the way there are still some 
problems. I believe that a country that can do so much, as we can do, 
ought to very basically provide decent health care for all of our 
citizens.
  I look forward to working with the White House and with the President 
and with the Democrats in Congress, and hopefully the Republicans will 
come along and work with us in a bipartisan fashion so that we can 
provide the kind of health care to all Americans that all Americans 
know we need.
  Mr. PALLONE. I want to thank the gentleman. I just want to say again 
with regard to two points, you said about the near elderly. I did not 
start out this afternoon talking about the near elderly proposal, but 
that, I think, was just as important in terms of what the President 
mentioned last night. And one of the things that really aggravates me 
is that so many of our colleagues on the other side, not so much maybe 
individuals, but certainly Republican leadership, keep bashing Social 
Security, keep bashing Medicare. We went through the whole Medicare 
debate where they talked about how bad Medicare was. The reality is 
that Medicare is a very good program and Social Security works. People 
are getting their checks. They get their COLA every year. Medicare 
works.
  And if we can institute a program for the near elderly, for people 55 
to 65 or 62 to 64, depending on their circumstances, if they lose their 
job or their spouse is no longer covered, if we can somehow manage to 
get the people who need this Medicare coverage into Medicare without 
any additional cost to the Medicare program, which is what the 
President is talking about, because they would be paying the premium, 
why not?
  Let some of these people take advantage of the Medicare program, 
particularly since we know about downsizing, we know about layoffs, we 
know what is going on out there now so that people in this age bracket, 
where they are close to 65, increasingly have problems keeping or 
getting health care coverage.
  I would say the same thing about Social Security. Social Security is 
great. It was a democratic initiative passed by the Democrats. And yes, 
I think the President is absolutely right. If there is a surplus, when 
there is a surplus, it should be used for Social Security.
  But again I keep hearing on the Republican side about Social Security 
is broken, we cannot fix it. All these suggestions out there to maybe 
privatize and move to another way of doing things. I think it is 
wonderful that the President not only stood up and said, look, Social 
Security is out there and it is working, but also said that if we have 
extra money, we should use it to shore up the system.

[[Page H82]]

  The difference between the President's approach and the Democrats' 
approach and what we hear from a lot of the leadership on the 
Republican side is that we want to improve these programs, Medicare and 
Social Security. We want to improve them. We know that we can improve 
them and we are going to put our dollars where our mouths are in terms 
of improving these programs rather than just say they are not working 
when they are. They are working.

                              {time}  1515

  I wanted to yield again to the gentlewoman from Connecticut.
  Ms. DeLAURO. I think it is important, so that there is no 
misconception about what the health care Bill of Rights is, what it 
contains, so that in fact it is pretty basic. Because the gentleman 
mentioned that next week there are going to be groups up here who are 
rallied and organized and very well financed to try to come in with a 
steamroller, if you will, and just try to knock out this issue of 
managed care reform.
  Also, my colleague from New York made a very good point. Illness is 
not partisan. It is not gender related. It is not age related. Everyone 
gets ill. And people do not want to get sick. People would like to be 
healthy. But there are going to be a group of very, very powerful 
special interests arrayed with lots and lots of money against this 
notion of managed care reform.
  So in stepping back, very simply, what is the President's challenge? 
What is it that will have both Republicans and Democrats in this body 
galvanized around? And, as I say, I think we could move, and move 
quickly, on this issue. The health care Bill of Rights would simply 
ensure that patients have access to health care specialists; access to 
emergency services when and where the need arises; an assurance that 
medical records will be kept confidential; an access to a meaningful 
appeals process to resolve differences with health plans and providers; 
to remove that gag rule that prevents physicians from talking to 
patients about treatments that might not be covered by their plan, even 
the treatments that could give them a shot at beating a deadly disease.
  These are some of the pieces of the health care Bill of Rights. And 
it seems to me that this only says people should get the health care 
that they deserve.
  Mr. PALLONE. Will the gentlewoman yield?
  Ms. DeLAURO. I would be happy to yield to my colleague.
  Mr. PALLONE. I am so glad that the gentlewoman went through the list. 
And, of course, that is sort of general; we could get into the details.
  Ms. DeLAURO. Right.
  Mr. PALLONE. But it is so basic and it so simple, and that is why 
there was so much support here last night.
  Ms. DeLAURO. Right.
  Mr. PALLONE. And the most amazing thing, if the gentlewoman will 
remember last night when the President spoke and he mentioned the 
importance of having confidential medical records, and there was a huge 
roar of applause. And I said to myself, you know, such a simple concept 
that your medical records should be confidential and should not be 
available to everyone.
  Ms. DeLAURO. Everybody.
  Mr. PALLONE. And we cannot even guarantee that. We have people 
spending millions of dollars coming here to Washington next week to 
start advertising campaigns not to keep your records confidential. It 
is amazing how basic these things are and yet we are getting the 
opposition from the other side.
  Ms. DeLAURO. And that is what the public needs to know, is that there 
will be an array of very, very powerful special interests that are 
organizing, taking their resources, vast resources, to try to put an 
end to managed care reform.
  And what the public needs to know is if they do not want that to 
happen, that they need to get engaged in this process; that they need 
to be in touch with those of us who serve on their behalf; that they do 
not want this to happen; that they do in fact want managed care reform 
and that opportunity for choice, for confidentiality, and for knowing 
what their options are when they are ill, no matter whether their 
insurance plan covers that particular option.
  Mr. PALLONE. And such a simple concept. I want to yield to the 
gentleman, but even the disclosure part. We had a hearing last week in 
New Jersey, Senator Torricelli and I, and it was amazing how many of 
the stories just revolved around people's not knowing what their health 
plan consisted of. Just a simple statement so that they know what their 
coverage consists of.
  I yield to the gentleman from New York.
  Mr. ENGEL. I wanted to again raise the issue of the President's 
proposal for expanding Medicare, because I think that that is really 
one of the new proposals that we are going to really have to deal with 
in this Congress. And I really think that the American people really 
are interested in it and I think are overwhelmingly in support of it. 
And I would hope that it does not get buried in the general discussion 
of health care.
  Again, and my colleague was with us when we had the hearings, we had 
three witnesses all in the category of the 62 to 64 range, age range, 
and they pointed out that they are the most vulnerable in terms of 
having no health coverage whatsoever. These are all, again, working 
people.
  There is nothing that aggravates me more, because I represent a 
working class, a middle class district in New York, of people who have 
worked hard all their lives, who have played by the rules, who are not 
looking for handouts, who do not want anything to which they are not 
entitled, who suddenly find themselves in need, after playing by the 
rules all their lives, and we say to them, sorry, we cannot help you. 
That is wrong. And the people who fit into that category, between 62 
and 64 and 65, ought to be helped. And people who are 55 and older, who 
are retired or laid off or unemployed, ought to be helped as well.
  You know, there are many, many people who retire after age 55 and 
their companies promise them that their health care coverage will 
continue once their retire. And then they retire and suddenly find out 
that the company revokes it or something happens, and the President's 
proposal would extend this COBRA coverage which would allow these 
people to again buy in with their own resources and to have a 
continuation of the health coverage that they had when they were 
working.
  Who could object to that? Especially if we can find innovative ways 
and people can pay the premiums so the cost to the government would be 
minimal. It would seem to me like apple pie and motherhood. It should 
be something that everybody supports.
  It is very disheartening to see that the same forces who opposed 
Medicare in the 1960s are the same ones who are now saying, no, no, we 
cannot expand it, we should not expand it, let it wither on the vine, 
or whatever the speeches are. Everybody should be embracing this 
Medicare expansion because it is good for people and it is good for 
America.
  And, after all, we are 435 of us here, Democrats and Republicans, we 
were all elected to do what is good for America. And I can think of 
nothing better that is good for America than to try to expand health 
care coverage to average people who have worked hard all their lives, 
who have played by the rules, who do not look for handouts, just look 
for fairness and equity.
  And I want to again say how proud I am of the Democrats in the House 
of Representatives for putting forward these proposals and the 
President of the United States for putting forward these proposals and 
for us to say we are going to make this health care coverage, these 
health care proposals our number one priority in this Congress, and let 
the American people decide what they want and let the American people 
see who is really acting in their interests.

  So, again, I am proud to stand with the Democrats in this House to 
say that we will not stop until we expand coverage for Americans, until 
we make sure that Americans get adequate health coverage and we make 
sure that decisions are made based on what is best for the patient, not 
what is best for the bottom line or the profit or the almighty dollar.
  We, again, understand people need to make profits, but the bottom 
line is health care for the sick, health care for all Americans, 
quality care. That is the most important thing.

[[Page H83]]

  Mr. PALLONE. I want to thank the gentleman, and while he was talking 
about the hearing that we both attended, where Secretary Shalala, the 
Secretary of Health and Human Services, spoke, I was just looking over 
a summary of what she outlined as to briefly why this near elderly 
proposal was necessary and the specifics, which is pretty basic, of who 
would be covered.
  If I could just mention it very briefly, what she said is that a lot 
of people in this age bracket lose their coverage because an older 
spouse becomes eligible for Medicare and retires, ending their work-
based coverage. That is one category. Then we have, of course, we 
mentioned others who lose their coverage because of downsizing or 
layoffs, which of course happens very frequently. And then the third 
are the people who lose their insurance when employers either 
unexpectedly drop their retirement health care plans or somehow change 
the plan. And as the gentleman knows, a lot of people expect that they 
will continue to have coverage but all of a sudden their employer 
decides to drop it or change it.
  There were three components that Secretary Shalala mentioned to the 
proposal. One is that Americans aged 62 to 65 can buy into Medicare by 
paying the full premium. Second, displaced workers over age 55, who 
have involuntarily lost their jobs and their health care coverage, can 
buy into Medicare by paying the full premium. And last, that Americans 
age 55 and older, whose companies reneged on their commitment to 
provide retiree health benefits, are given a new option through 
extending the COBRA.
  Now, the President's proposal does not get into this, but when the 
gentleman and I were at that hearing that day, we also mentioned the 
possibility, which I know the two of us would like to see, of probably 
providing some sort of sliding scale subsidy so that people who could 
not afford the full premium would still be able to buy into it. And I 
think that in the context of the tobacco settlement or other monies 
that might be available, we could probably do something like that and 
still keep the budget balanced.
  Mr. ENGEL. Let me say also, I think we could probably cut back on 
waste, fraud and abuse in the Medicare system and find the money to 
finance what the gentleman just described.
  Mr. PALLONE. True.
  Mr. ENGEL. I go to senior citizen centers in my district and I always 
get a lot of heads nodding when I say there is a problem with something 
with Medicare. And sometimes we have difficulty where we get, we are in 
a hospital stay and we get a printout afterwards and we see the monies 
that Medicare has spent. And we see listings sometimes of doctors' 
names, and we say who are these doctors I do not know who they are. I 
did not see them. And it is the doctor who pokes his head in the door 
and asks how you are feeling today and then leaves and bills Medicare. 
And when people say that, or when I say that, people nod all the time.
  I am sure all our colleagues have countless stories that constituents 
have told them about waste, fraud and abuse in the Medicare system, 
where people are told that they can get certain things, and they get 
them and they do not need them. I really believe if we crack down on 
waste, fraud and abuse we could save billions. And by saving that 
money, we could put it into ensuring that everybody gets expansion of 
health care coverage and that people that do not have it can get it.
  So I think where there is a will there is a way. We certainly are 
capable of looking at it. And we know there is waste, fraud and abuse, 
and we can get at it.
  So I again think that the President's proposal is something that has 
a lot of merit. I know the American people, I have seen polls, are all 
for it. I know my constituents in New York are for it. And I think, 
again, that those of us in Congress who understand the necessity for 
the expansion of Medicare, particularly on the Democratic side, and I 
hope again our colleagues on the Republican side will embrace it as 
well, but I know on the Democratic side we are embracing it and that we 
will continue to push for Medicare expansion in this Congress and 
hopefully get a bill that the President will sign into law.
  Mr. PALLONE. I want to thank the gentleman again, and I will yield to 
the gentlewoman from Connecticut.
  Ms. DeLAURO. Just two points. I think on the expansion of the 
Medicare coverage, while it is specific to the age groups of 55 to 64, 
there is not anyone who is 47, 48, 49, 50, 51 who is not thinking 
about, my gosh, if I get ill or if something happens to my family am I 
going to be wiped out by illness. These are people who are near that 
period of time.
  So there are a lot of people who are immediately facing the 
circumstance, but there are those who are fairly soon going to face the 
circumstance and they are scared. They are scared. And this seems like 
an equitable way, with the purpose of not draining Medicare funds, 
which no one wants to do, we want to make sure those funds are safe, 
and, at the same time, allowing people the opportunity to pay in. It is 
not getting something for nothing. We will pay in. In this way we are 
in some way protected.
  I think we have some very, very important health care issues that are 
critical in the lives of our families today, which is exciting to me 
and I think to my colleagues. We have a real challenge, we do, on the 
Medicare expansion issue and with the discussion, and we need to build 
that support. And I think that the support is out there for doing this, 
particularly in the country, but we have to build the support here.
  But there is, on the managed care side, a great deal of bipartisan 
support here. I think we have a perfect opportunity very quickly in 
this session of Congress to take advantage of that support and the 
external pressure to get something done in this area.
  And what it says ultimately, it says to middle class families in this 
country, we are there to help you. We are there for people in the 
country to say you need to have health care coverage, we want to make 
sure that you have it. We also want to keep the cost contained, but we 
can do that without somehow putting your health in jeopardy.
  And at the same time, a very, very important message to the insurance 
companies and to the providers; that, in fact, we are willing, we are 
willing and we are going to stand up to set limits on what they can do 
and what they cannot do when it regards the health and the safety of 
Americans in this country.

                              {time}  1530

  That needs to be what our obligation is. And the faster we get to it 
in this session of the Congress, the faster we are going to make 
Americans believe that what we do here in Washington is not focus on 
the problems we have here, but we are focusing on the problems that 
they have in their lives. That is what our obligation is. That is why 
we were elected to serve.
  Mr. PALLONE. Mr. Speaker, I appreciate the remarks of the 
gentlewoman. I think she is right on point.
  Mr. ENGEL. Mr. Speaker, will the gentleman yield?
  Mr. PALLONE. I yield to the gentleman from New York.
  Mr. ENGEL. Mr. Speaker, I just want to say that the gentlewoman from 
Connecticut (Ms. DeLauro) is so right that this is not an issue that 
people think about when they are 62. All of us down the line are 
thinking about it right now, and so many millions and millions of 
Americans are thinking about health care. It goes back to what I said 
when I opened my remarks, that health care is something that affects 
all Americans and it is really up there on the lists of concerns of 
people.
  The hearing we attended, if my colleagues remember those three people 
that were between 62 and 65, they all said that they could not afford 
to buy health coverage, that they desperately need it but they simply 
could not afford to buy it. If we could expand the Medicare program and 
allow them to buy in at a reasonable cost that they could afford, I 
mean, are we not then doing something meaningful for people's lives?
  Again, average Americans, middle-class people who work hard all their 
lives, play by the rules, something happens and they get a little older 
and they suddenly find themselves abandoned. So the gentlewoman from 
Connecticut is so right.
  I think we in Congress have to show that we are listening to our 
constituents, to the people out there in America, that in Washington, 
inside the

[[Page H84]]

Beltway, there are all kinds of things that come into play and there is 
politics and there is rumor mongering and everything else. The American 
people are not interested in that. The American people are interested 
in what is Congress, what is the President, what is Government in 
Washington doing to affect their lives, to help them in their lives.
  Again, I can think of nothing more that we can do to help the average 
American than to expand health care coverage and to make sure that 
every American has decent, quality health care; and that is what I 
think we ought to do in this Congress.
  Mr. PALLONE. Mr. Speaker, I want to thank both of my colleagues.
  I think that the President sent a very strong message last night on a 
number of issues, managed care reform, expansion of Medicare to the 
near elderly. These are common sense ideas that have the support of the 
American people; and so we are going to pledge, as Democrats in this 
House, that we are going to fight to make sure that these proposals get 
enacted. And if we have to drag along the Republican leadership, we 
will just drag them along.
  Mr. Speaker, I yield back the balance of my time.

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