[Congressional Record Volume 144, Number 6 (Wednesday, February 4, 1998)]
[House]
[Pages H307-H312]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         HEALTH CARE IN AMERICA

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentlewoman from Texas (Ms. Sheila Jackson-Lee) is 
recognized for 60 minutes as the designee of the minority leader.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I am pleased to be able to 
discuss what I believe is a very important issue and need in this 
country, and I could first start speaking generally about the value of 
good health care and how health care touches all Americans, how health 
care is bipartisan, not a respective race or agenda or region. It 
really is the desire of all people to have good health care, good and 
safe and viable and, yes, reasonable health care.
  But even as we talk about reasonable health care, I think it is 
important that that word be put in the context of the right kind of 
medical professional-patient relationship and interaction. Just a few 
hours ago there was an extensive debate on the floor of the House 
regarding attorneys' fees for the White House Task Force on Health. 
During that debate I indicated that I thought my colleagues were moving 
in the wrong direction, a punitive direction rather than a helpful 
direction, and, in fact, the question of who should pay attorneys' fees 
for a challenge to that task force really begs the question and really 
took up the time of the American people in the wrong way.
  We passed no effective health legislation by that vote. And I voted 
against it because I thought that it simply missed the point of the 
House Health Task Force that, in fact, did not conclude with a decision 
as to which type of health care this whole Nation would buy into, but 
they did do something very important. They put in the minds of the 
American people that we had a health system that needed repair and, in 
fact, all was not well and there were other options that we might look 
at.
  Whether it was universal service or access universally to health 
care, or whether or not it had to do with physician assisted plans, or 
whether or not it had to do with the professional health maintenance 
organizations, which have now about taken over the country, it still 
raised the debate. And, yes, it talked about the importance of making 
sure that all aspects of our community, our children, our infants, our 
senior citizens, our working families had access to health care. And 
today we find that we do have and still have a broken system.
  Many of us can rise to the floor of the House and share personal 
stories. For example, my father, who suffered from cancer, not unlike 
many families in America, a senior citizen who, in fact, had been 
healthy every day of his life and was shocked that there was now 
something wrong with him. In the family's eyes there was nothing wrong 
with him. He was ill and we wanted him to be better. But in his mind 
there was something wrong, and we needed a sensitive and responsive 
health maintenance organization. I am sorry to say we did not get that.
  How many times I have heard from constituents who indicate that it 
seems like the question of cost was more the priority of their health 
maintenance organization than it was quality of service and the 
wellness of the patient.
  I do not believe Congress can proceed any further without assessing 
the need for better health care and good health care. We already have 
noted that 88 percent of the American public supports a consumer Bill 
of Rights as it relates to HMOs. Eighty-two percent support tax breaks 
and grants and subsidies for child care that also has an impact on 
how our children are cared for and also a better quality of life. But 
always the health care rises to the level of importance.

  The attractiveness of a tobacco settlement focuses on opportunities 
to improve the health of Americans, to ensure that we diminish the 
opportunity for Americans to suffer through smoking and the illnesses 
that come about. But no matter how much we tell Americans to be healthy 
and to participate in wellness programs, if we have a broken health 
system, if we have HMOs that are governing and controlling all of the 
health systems around this Nation with little sensitivity to the 
importance and the sacredness of the patient-physician relationship, or 
the patient-professional medical practitioner relationship, then we do 
not have a system.
  So Americans are very interested in this consumer protection Bill of 
Rights, and I believe we must drive this to the end and it must be 
passed. And so I call upon my colleagues and the leadership of this 
House, the Republican leadership, to let us stop dividing along the 
lines of party when it comes to health care. No one in America goes to 
their physician and asks for their voting card. They want a good 
physician. They want the kind of physicians who carefully guided into 
this world those wonderful septuplets in our Midwest now, as we watch 
each healthy baby leave the hospital.
  Those two young physicians, young women, in fact, might I say, cared 
enough about those lives and the good health of both the mother and 
those babies to meticulously and carefully and without any question of 
cost to proceed to bring and to help as God's creations were being 
born.
  And so it is important that we understand what Americans want. No, 
they do not want fraud and abuse. But if there had to be a question of 
whether or not they could readily and carefully and with expertise help 
bring those septuplets into this world, help them be born, help create 
a unique time in history, I do not think Americans would want HMOs 
standing outside the door of that young couple saying, well, you know, 
you have to make a decision.

                              {time}  1945

  The cost is too much to get and to have septuplets. What an 
outrageous thought. But that is what many Americans are feeling with 
the kind of HMOs we have in America. Calls being made to corporate 
institutions by physicians and physicians saying, ``No, they cannot 
have that transplant. How old are they? There is not enough money in 
their coverage. How old are they?'' And as the decision is being 
deliberated and the arguments are being made long distance, someone, 
your loved one, is dying. Americans are saying, enough is enough.
  I am gratified that we have this opportunity to fix this system, that 
we have not gone too far. Coming from an area that has the Texas 
Medical Center and premier hospitals, in particular one that I happen 
to serve on the advisory committee for prostate cancer, M.D. Anderson, 
I know that most of the health officials want to do their job 
efficiently, effectively, with great recognition of cost; and they want 
to save lives; and they want to go to any length to save lives. We must 
give them that opportunity. Our HMOs are stifling good health care in 
America.
  Oh, yes, there are some that provide easy access by way of the cost 
that one pays for an office visit. But, in many

[[Page H308]]

instances, the physicians are overloaded, having to match a certain 
number of visits per day, having to move patients out in a certain 
period of time, some tell me 15 minutes or less, sort of a factory type 
sense, being penalized if they take a longer period of time to ask 
questions of that senior citizen who may have a difficult time 
communicating, that person who does not speak English, that child who 
is younger and has a difficult time explaining to the physician and to 
mommy or daddy where the pain is. I have heard these stories.
  My colleague from Tennessee has said that we even have some 
difficulties in administrative regulations relating to home health 
care. We find that these agencies are proliferating, but we understand 
as well that there is a need.
  Many of our health needs revolve around home-bound patients who need 
to be with family and in warm surroundings, as opposed to the 
possibility of a sterile hospital; and they need these visits from home 
health care officials. Yet we are creating hassles, if you will, for 
those businesses to survive, many of them small businesses; and we are 
creating financial hurdles for them to jump through, so that they 
cannot have that kind of care.
  If I may personalize this again, at the time of the height of my 
father's illness, he needed around-the-clock, 24-hour care. It was much 
better for him to be at home than it was for him to stay at a hospital 
of which there was at that time, very sadly, not much to be done. But 
yet, we find ourselves in controversy because these kinds of 
opportunities and choices are being denied.
  So I am delighted to be able to support the Democratic Health Task 
Force proposal for a patient bill of rights, to have been able to work 
through this and work with the task force as it looked first at child 
health care. We saw in the last budget fiscal year 1998 $24 billion 
that was allotted for children's health, to see the numbers of 
immunization rise and the numbers of preventable diseases that would, 
in fact, be destructive of our children's health, to see those diseases 
go down because our children are being immunized.
  So we see what can happen when we turn our attention effectively to 
the whole question of good health care.
  What does the patients bill of rights, the access to care, what does 
it really mean for America? Well, let me tell my colleagues what it 
means.
  And I can simply say that it means a smile on every American's face. 
It means a comfort level for some daughter who is worried about her 
elderly mother in another State and where she only has the ability to 
consult with that mother's medical professionals by telephone and is 
not really aware of what kind of care that mom is getting or whether or 
not she is being shortchanged.
  It means a choice of plans. We have found that giving consumers 
choice, allowing them to pick what fits their needs, enhances consumer 
satisfaction.
  So, we, as Democrats, would allow a limited point of service option 
for employees who were only offered one health plan and that health 
plan was a closed panel HMO. The health plan, not the employer, would 
be required to make available another point of service option for those 
beneficiaries who wanted it. Being released, unshackled, if you will, 
taking a breath of relief that they would actually be able to express 
dissatisfaction with their HMO and still have good health care. They 
are not boxed in.
  I just want us to think for a moment. Maybe the American public is 
not familiar with how far we have come and how low we sunk in health 
care in America.
  Just a year or so ago, we had the drive-by maternity hospitalization. 
Mothers were being dispatched out of the hospital in 24 hours, and 
those who had what we call a Caesarian section were cast out in 4 
hours. Drive-by deliveries. It took Congressional legislation, working 
with the Senate, that time Senator Bradley and others, working with the 
Women's Caucus and many others.
  I remember cosponsoring and working on that legislative plan to 
extend the time that mothers who were delivering their precious baby to 
be cared for with the right kind of care in the hospital that they were 
in.
  Only those of us who may have firsthand experienced all of the 
excitement and the doubt and the needs of care of giving birth would be 
able to fully appreciate, along with, of course, the father and 
relatives, the need for care.
  I heard terrible stories from constituents of their fear and 
apprehension of that moment of delivery and then the next moment when 
they barely have had a chance to be able to be cared for, to be able to 
be stabilized, the baby stabilized and because of their HMO they were 
dispatched, turned away if you will, out of the hospital.
  Have any of my colleagues heard of postpartum depression? Most 
females will be able to share that with you, a serious condition. Is 
anyone able to detect that in a 24-hour time period? Well, that is what 
we had just a short period of time.
  What about the story of this daughter whose elderly father was 
delivered home in a taxicab from a hip replacement surgery to a mobile 
home in Florida and left at the doorsteps with a walker, no home health 
care, no training as to how to use the walker, no one to help him use 
the bathroom facilities, no knowledge of how he would fix his food, 
because he had to be removed from the hospital because of his HMO?
  These are just the tip of the iceberg of the stories that you have 
heard because cost has been the ultimate decider of health care rather 
than the care, nurturing and then the eventual wellness of the patient. 
So choice of plans. Because, ``If your HMO cannot provide you with the 
guidance and necessary physician care, then go somewhere else.''
  What about the quality and the expansiveness of the providers? We say 
plans must have a sufficient number, distribution and variety of 
providers to ensure that all enrollees receive covered services on a 
timely basis. This way, again, you are not confined or boxed in; and 
you do not have a sense that you are not able to get the breadth of 
diversity that one might need.
  I would probably give it away if I talked about my admiration for 
that TV doctor that used to carry the little black bag and visit people 
in their homes. I would really be dating myself if I said that my first 
doctor visited us in the home. What a special privilege to be home sick 
from school, warmed in a bed, and to have your physician travel all the 
way to your house.
  Those were, in fact, the good old days of which we will not return. 
But I think Americans want the old-fashioned medicine, that their care 
and their nurturing is the first priority, not some bottom-line figure 
where someone is arguing that the red ink overcomes the need for the 
care of your loved one.
  So we are looking to have specialty care. Patients with special 
conditions should have access to providers who have the records and 
expertise to treat their problems.
  Our particular proposal of the patients bill of rights allows those 
patients with special needs, diabetes, MS, special forms of cancer, to 
be treated, liver disease, to be treated at the level that they have 
need. Those who need various specialists with relation to allergies, 
something very unique and isolated sometimes. But if they suffer from 
that and their HMO says, no, you cannot go to a specialist, it is not 
life-threatening, or let me say to them that it may not be life-
threatening to someone in corporate America in a cubicle in New York, 
but certainly I would say to them that it totally damages and takes 
away the quality of life and the kind of health care that we have come 
to appreciate.
  So that specialty care is something that I frequently heard from 
constituents, ``I have been denied the right to see a specialist. They 
told me I could not do it. My HMO refused. I could not get a second 
opinion.'' You develop a relationship with that physician, and you 
certainly develop a relationship if you have a chronic illness.
  In many instances, chronic is not terminal. But it does mean that 
they need to be under constant care. They are seriously ill. They 
require continued care. So we are saying that if that is the case and 
they require continued care by a specialist, the plan must have a 
process for selecting a specialist as the primary-care provider and 
assessing necessary specialty care without impediments.
  What that means is that, rather than them going to a general 
practitioner,

[[Page H309]]

who certainly does an enormous job in our community, and I encourage 
the further training of general practitioners, but if they have such a 
degree of chronic illnesses that they need a specialist more than they 
need the general practitioner, they should be able to utilize that as 
their primary physician, and there should not be, again, the hoops and 
the wagons and the races that they would have to run to get that done.
  I have heard in many cases as we have made progress in the detection 
of breast cancer and other women-related illnesses that part of the 
success of that has been early detection. Yet, in many instances, women 
have not been able to, under the present HMO provisions and what HMOs 
have been willing to pay for, they have not been able to get OB-GYN 
services. So it is extremely important and we think it is vital that 
women have the ability to designate an OB-GYN as a primary-care 
provider.
  Why should that be outside the loop of medical care? Might I say, in 
this day and time, what a blatant form of discrimination that necessary 
health care services had to be argued for rather than automatic. How 
many times we have heard our surgeon generals preach wellness 
prevention; and, in essence, without a complementary system to be able 
to provide for that, there is no wellness, there is no care.

                              {time}  2000

  So we have a provision that deals with women's protections, and that 
is extremely important.
  Continuity of care. There is nothing more frightening than to have 
care and to lose it and to need it, and that has come about to many of 
us because of a change in a plan or a change in a provider's network 
status. So we thought it was extremely important in our task force to 
lay out guidelines for the continuation of treatment in these 
instances, and particular protections for pregnancy, terminal 
illnesses, and institutionalization.
  It is a horrific impact on families when all of a sudden someone 
loses their job, and they have a child or a loved one who is suffering 
and has a terminal illness or some other condition that needs constant 
medical care. What an overwhelming burden on the family.
  Already many of us have heard of situations in our community where 
there are barbecues or fish fries or fire departments and police 
departments and communities rallying around families who need 
transplants. I frankly am outraged about that process. Those are 
particular incidents where there is a great need to be able to have the 
money, where money is not, and communities rally.
  Well, imagine yourself caring for a very ill loved one and you lose 
your job. How many of us have had the experience of some bad times or 
hard times come in the midst of the caring for a loved one who needs a 
great deal of care?
  We think it is imperative that there are guidelines that will carry 
you as a bridge over troubled waters so there is never a point where 
you come to the flat Earth theory, you get to the edge, and you 
completely fall off the edge; no hope, no safety net, no ability to 
carry that care forward. Believe me, my friends, that is not an 
isolated set of circumstances.
  So that is why I am moved to say debates like who is paying the White 
House health task force attorneys' fees is tomfoolery to a certain 
extent, when we have Americans who are without good health care, and we 
have really got to get on the ground working on this consumer 
protection bill, this patient bill of rights, because as I listened to 
those who are seeking help from the government to make health care 
accessible, but the best it can be, these are the kind of hard issues 
that these providers face every day.
  When I say that, the health professionals in our public hospital 
system, the health professionals in our private hospital system, every 
day they are dealing with life-or-death issues, questions of how do you 
pay for health care, how do you utilize Medicaid in the best way it 
possibly can be used.
  So as we balance HMOs, we must also look at making sure that Medicaid 
is effectively utilized, and that it, too, reaches the necessary 
patient base that goes without health care if they do not have coverage 
under Medicaid. Frankly, that is many of our children.
  So I would like us to look both at those of the very poor, those who 
are in need of coverage of Medicaid, as well as those individuals who 
are operating under HMOs.
  Another point that we want to see HMOs improve on is emergency 
services. Individuals should be assured that if they have an emergency, 
those services will be serviced by the plan.
  Let me give you an example of just some problems that sort of relate 
to emergency services. It is the question, one, of denial. That means 
you are not covered. You think it is an emergency, you are driven to 
the emergency room, but in fact your HMO will not allow that. I guess 
tragically, unless you come with a bullet wound and unable to speak, 
that is not always the kind of emergency that occurs.
  I heard tell of tragic stories where patients have driven themselves 
to the emergency room with a near heart attack, needing immediate 
assistance, and the first thing that the emergency room is forced to 
ask is, do you have health insurance. Might I say that I have heard of 
tragedies that have resulted in death because hospital emergency rooms 
had to be too engaged in finding out whether this patient, who has come 
into the emergency room, has the necessary health coverage.
  Part of that certainly is the way our whole system has been 
structured. Part of it is the overwhelming fear that HMOs instill in 
all kinds of health providers, we are not going to pay for this. And in 
many instances it originally started with good intentions,. The whole 
idea is to make more cost-effective our managed care system, but in 
actuality it became the death knell for many who needed good health 
care.
  There is a big debate about research and clinical trials. Not when 
you go to the National Institutes of Health, and many of our research 
hospitals. Talk to the community that suffers extensively, any 
community, from HIV, those both infected and affected. They realize how 
important clinical trials are and the fact that many people could not 
participate if they did not have such participation covered or allowed 
by their health insurance.
  So they should be able to engage in clinical trials because that 
treatment may be the only treatment that is possibly able to cure their 
tragic illness, and certain approved clinical trials we believe should 
be allowed under the HMOs. And right now you are more than climbing 
through hurdles, you are swimming rivers, climbing mountains, and then 
jumping off and flying like an eagle to even think of getting the 
approval of an HMO for clinical trials.
  We believe that drug formulas, prescription medication, should not be 
one size fits all. There should be plans that allow beneficiaries to 
access medication that is not formulary when the medical necessity 
dictates.
  We also think that there should be nondiscrimination against other 
health care services. We should not be discriminating against our 
enrollees on a variety of factors, including genetic information, 
sexual identity and disability.
  Very serious point that raises a great deal of consternation is 
preexisting disease. That has always been a problem, and I believe that 
the patient bill of rights has to rein in this whole issue of 
preexisting disease and any bar that it gives to the whole idea of not 
being able to get good health care.
  We want this to be an encompassing package. We want to be able to 
take away the aura around health care, the fear. In the early stages, 
or the good old days, as I have mentioned, it was merely the respect 
that most Americans had for their physicians and the great belief that 
they did all they could for them, so it was sort of an accepted 
posture, if you will, where there was sort of this great, great 
elevation of our physicians.
  That is all right, that is voluntary. That came about through 
competence and trust. Now, however, much of the relationship is out of 
absolute fear, fear of losing your health insurance, fear of being told 
you cannot get this surgery, fear of waiting long periods of time for 
approval to come from some corporate office, some insensitive, 
nonknowing analyst that has to respond to the HMO's criteria of 
selection.

  This is not an indictment of those professionals who work in the 
corporate structure. They are guided by

[[Page H310]]

the numbers that have come down that they must respond to.
  So we want to make sure that we break the aura of fear, devastating 
fear, and provide health plan information so that you can have and make 
informed decisions about your health care options and know what is in 
your plan, and not have pages and pages of small print that someone 
passes out to you in your corporate mail and you have no knowledge of 
what you are accepting or rejecting.
  Medical records need to be kept confidential, and that has to be a 
key element of the patient bill of rights. Patients should be able to 
accept the fact that their medical records are confidential so that 
they cannot be used against them by their HMOs. Many times there must 
be that link, that ombudsman, or woman, that you can comfortably go and 
show your confusion as a consumer of health care and be able to have 
answers being given to you.
  We will not get a health system that works if we act in fear. We will 
not get one that works if we do not act. We simply will not have the 
kind of health care that all Americans can be proud of if we do not 
take a stand on behalf of the millions of patients, far more than the 
numbers of HMO organizations that dominate our country.
  We are told that some States have nothing but HMOs. We have seen our 
physicians hover in fear because of HMOs. I have had physicians from 
certain communities, in particular the Indian community, that have 
acknowledged seemingly the lack of cultural understanding, the needs of 
their patients, the intrusion of the HMO into the kind of care that 
they need to give.
  The one thing we pride ourselves about here in this country is 
freedom, freedom of choice, the ability to go where you feel most 
comfortable; certainly not to do damage to anyone else, not to tread on 
anyone else's freedom, but certainly the freedom to get what you desire 
and need.
  We think it is important that as we break this aura of fear, that we 
assure the American public that they have quality health insurance, 
that the plans are working the way they should, doing what they should, 
that the caliber of physicians are at the level that they should be, so 
we support quality assurance, monitoring the HMOs and their service 
over a period of time. We think it is important to collect data, to be 
able to see how many success stories, how many cure stories, if we 
might, what are the surgeries and their success rate. Are we looking at 
the kind of plans that have the kind of health professionals and 
hospitals that provide the best care.
  I think it is very important that we have HMOs that reflect the 
community. I have been very much a strong advocate in my own district, 
in Houston, of encouraging Hispanic and African American physicians, 
Asian physicians, to organize and serve those inner-city populations, 
or populations that will be inclined to feel comfortable with the 
service that these particular physicians are rendering.
  Does it limit the service to one community over another? Absolutely 
not. But what it does say is that these kinds of PPOs in particular 
give comfort level to the consumer, if you will, and reinforces the key 
element of good service.
  We must also be fiscally responsible, and I think a utilization 
review. Which our patient bill of rights agrees to, is worth having so 
that we can review the medical decisions of practitioners. What do they 
need most? What helps them serve their patients best?
  I think it is extremely important that we give the consumer a right 
to a process of grievance. Patients voice their concerns about the 
quality of care, and an outside process that allows that matter to be 
handled even before any court action is necessary. Sometimes these 
processes need to be done so that they are working internally and 
without a court structure.

                              {time}  2015

  Certainly, we would want to have what I call the antigag and provider 
incentive plans. Consumers have a right to know all of their treatment 
options. Again, that goes back to the key element of a sense of 
confidence, breaking the fear, not having a zip mouth in the 
physician's office, because I do not want to ask this question. He or 
she said I only have 15 minutes, and maybe they will cancel my health 
insurance if I ask too many questions. We need to lay down the options. 
There should be no bell ringing, to say now your time is up and one 
certainly cannot be engaged in this decision of wanting to know more 
treatment options, and that is it. Take it or leave it.
  So I believe that it is now time that we have the right kind of HMOs 
and therefore, it is extremely important that we get off the dime, if 
you will, and really respond to what Americans are talking about, is an 
unentangled, caring health system that allows the best and the 
brightest of our health professionals to do their thing.
  As I see my colleague who has joined me who has been a real leader on 
these issues; in fact, he might be called Mr. Health Care, because it 
has not just been reforming this HMO revolution. Whenever there is a 
revolution, we get excited and it is a new toy to play with, but 
sometimes we have to go in and direct the revolution. But my colleague 
was there on the Medicare fight when we thought a number of our seniors 
would be denied care, he was there on the Medicaid fight, and each step 
of the way we have seen a better system come about.
  So for all of those people now hovering in the corner on the 
patient's Bill of Rights, hold your calmness and listen to what we are 
saying, that it is of great necessity that we open the doors to 
patients so that patients might feel that the system works for them.
  With that, I would like to say to the gentleman from New Jersey (Mr. 
Pallone) let me thank him for organizing this Special Order and 
allowing me to share with you what I think has to be one of the most 
important issues that we really need to face in the next 30 to 60 days. 
Somebody might say this year or over the next 2 years. I think we have 
a crisis that we have to deal with, and we need to pass the patient 
Bill of Rights that deals with HMO reform. I yield to the gentleman 
from New Jersey.
  Mr. PALLONE. Mr. Speaker, I wanted to thank the gentlewoman for being 
here tonight. I think the gentlewoman is the one that organized this 
Special Order, but I thank my colleague for saying that.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, we shared in it.
  Mr. PALLONE. Mr. Speaker, I know that the gentlewoman has been on the 
floor before talking about this issue and many other health issues that 
the Democrats have tried very hard to bring forth in the House of 
Representatives.
  One of the concerns that I expressed today earlier in the day when 
there was a resolution that the Republicans brought up with regard to 
President Clinton's health care task force, and they were criticizing 
that, and they brought up some procedural matter related to it. I took 
to the floor at the time because I wanted to express my concern that we 
not waste our time here in the House of Representatives dealing with 
procedural matters about who had a task force and who paid for the task 
force and what happened with the task force, but rather, we spend our 
time on substantive ways to try to achieve health care reform.
  We know that there are about 40 million Americans now that have no 
health insurance, and we know that there are problems with managed care 
and with HMOs, quality problems, which the gentlewoman talked about 
when she talked about the Patient Protection Act and the consumer 
protections that we all feel should be addressed with regard to HMOs 
and managed care reform.
  All I wanted to say today, and I will say it again this evening, and 
I am sure both of us are going to be saying it a lot more over the next 
few months to the Republican leadership, because they control the floor 
and what measures come up and what bills pass, and let us bring up 
these health care reform issues, let us bring up the patient Bill of 
Rights so we can reform managed care and HMOs. The President, when he 
spoke in his State of the Union address the other night, was very clear 
that a major priority for him was managed care reform and the patient 
protection concerns that the gentlewoman talked about. The public 
overwhelmingly, not only the Congressmen and women in the room, but the 
public in general overwhelmingly said that that was a high priority for

[[Page H311]]

them. But it is not going to come up and be debated on this floor 
unless the Republican leadership allows that to take place.
  One of the concerns I had today, and that is what this chart is, and 
I am not going to dwell on it, because we talked about it a lot today, 
but there is a concerted effort now by certain special interests to 
fight against the Patient Protection Act, to fight against these 
managed care reforms and not allow them to come forward, to move 
forward here in the House of Representatives. Today, the National 
Association of Manufacturers was actually here lobbying Members and 
telling the Republican leadership and getting them to go along with 
this idea of fighting against managed care reform.
  What we have up here, I will just mention it briefly, this is a blow-
up of a memo from the staff person at the Health Insurance Association 
of America, the for-profit health insurance lobby, and it talks about 
the Speaker's aides calling up lobbyists to Capitol Hill and giving 
them marching orders to trash the bill providing consumer protections 
in HMOs. I think one of the most egregious things that I see where it 
says here the message we are getting here from House and Senate 
leadership is that we are in a war and need to start fighting like we 
are in a war. Well, the reason we are in a war is because we know and 
the President knows and the Democrats know that people want managed 
care reform, they want these patient protections, so the war is to 
fight against that. They are talking about the war because they know 
that there is so much support for it.
  Then later on, I think it is Senator Lott, who is the majority leader 
in the Senate, he said that the Senate Republicans need a lot of help 
from their friends on the outside, and he says that they should get off 
their butts, I hate to use that expression, and get off their wallets, 
reference obviously to the need to finance and provide money, if you 
will, for campaigns and special interest money, if you will, to support 
those who fight against the health care and the patient protection 
reforms.
  So we have a battle here. I think the gentlewoman and I said the 
other day that this is going to be a battle. Well, the Republican 
leadership claims it is a war. Whether it is a battle or a war, I do 
not know, but we have our work cut out for us.
  But I wanted to mention very briefly if I could, there were a group 
of family and health care advocates, organizations that are in favor of 
these patient protections and the managed care reform.
  Ms. JACKSON-LEE of Texas. Absolutely.
  Mr. PALLONE. And they sent a letter to Members today, Members of 
Congress, because they knew that the National Association of 
Manufacturers was coming down here and lobbying against this managed 
care reform. So they sent a letter, and this is from Families USA, 
American Federation of Teachers, United Church of Christ, Women's Legal 
Defense Fund, AFL-CIO, a number of groups that are involved in this.
  They said to the Members in their letter, when these people come that 
are against these managed care reforms and they come to your office 
today, why do you not just go through the checklist that we will 
provide you of what this managed care reform does and ask them whether 
or not--why these are bad things, why they are against these things. If 
I could just briefly, I have the other chart here, go through this. I 
know the gentlewoman mentioned a lot of these things earlier today. But 
I think it is very interesting to sort of pose the question in that 
way.
  Ms. JACKSON-LEE of Texas. Absolutely. If the gentleman will yield 
just for a moment, it is interesting, and the checklist is important, 
that this group would want to go up against 88 percent of the American 
public that wants a consumer protection bill as it relates to health 
care. They want a patient Bill of Rights.
  So the war is on. I think the clarion call is for the 88 percent of 
the American public to stand up and say what they want loudly and 
clearly. I think they can overcome any of those who would want to 
detract away from what they need, and of course that checklist will be 
the real test as to whether or not these folks who are opposed to it 
even know what they are opposed to: Simple, basic assurances, if you 
will, that we in this country believe that everyone should have access 
to good health care. I yield to the gentleman.
  Mr. PALLONE. Mr. Speaker, the reason I would like to go through it 
quickly together, if the gentlewoman would like, is because a lot of 
times I worry that we deal in abstracts. Even when we talk about 
patient Bill of Rights, I am not sure that the public necessarily 
understands what we are talking about.
  The great thing about debating this issue of managed care reform and 
the patient Bill of Rights is that when one sees what we are actually 
talking about, and then one hears the stories about people who do not 
have these benefits, then the public becomes even more aware of why it 
is necessary.
  The first one says that health care consumers can appeal denials or 
limitations of care to an external, independent entity. I have had a 
lot of my constituents, in other words, they seek certain care, they 
want to stay in the hospital a couple of extra days, they want to see a 
certain specialist, they want to use a certain kind of equipment for a 
particular medical procedure, and they are either denied or they are 
told well, we have to go and it has to be reviewed by a certain party. 
What we are saying here is that if it is denied or limitations are put 
on a procedure or access to a doctor, that there has to be some way of 
externally independently reviewing that decision and overturning it in 
a quick fashion. Obviously, that is very important.
  The second thing is, consumers can see specialists when needed. 
Again, I think one of the biggest problems with HMOs is the fact that 
increasingly, the gatekeeper, whoever it is, whether it is the primary 
care physician or more often some bureaucrat with the insurance company 
that says that one cannot see a specialist, and people need that type 
of specialty care, so this is an issue.
  The third thing is that women have direct access to OB-GYN services. 
Another one is the physician decides how long patients stay in the 
hospital after surgery. That I think is so crucial. We had this with 
the drive-through deliveries where women were released from the 
hospital the same day that they had a child; people that had C-sections 
were allowed to stay only 2 days in the hospital, and the bottom line 
is that that decision about how long one stays in the hospital at a 
particular time after surgery, that should be made by the physician, in 
cooperation with the patient, not by the insurance company.
  Health care professionals are not financially rewarded for limiting 
care. This is the biggest problem that we face. Increasingly, the 
doctors and the method of payment they receive is dependent on them 
putting limits on how they care for patients and what kind of care 
patients receive. How could one possibly have quality health care with 
those kinds of limitations? It is okay to say, for a doctor to say, 
okay, this is the number of days that you should have for this 
particular activity, or this particular surgery, but to have there be a 
financial incentive for the doctor to do that I think opens the door to 
abuse, and this is what we keep hearing over and over again is 
occurring.
  Then, consumers can see my provider if the providers in their plan do 
not meet their needs. Again, in many cases where the HMO does not have 
the specialist or even does not have certain types of hospital 
facilities that are covered by the plan, well, if they are not covered 
by the plan, if someone needs a certain type of care or a certain type 
of specialization, they should be able to have access to it if the plan 
does not cover it as part of their network. That is essentially what we 
are saying.
  Then, consumers have access to an independent consumer assistance 
program to help them choose plans and understand programs. This is the 
ombudsman concept. What I find more and more is that the average person 
does not even know what their plan consists of. They do not know what 
is in it, they do not know what is covered, they do not know what care 
they are allowed to have, because there is no requirement in many 
States for any kind of disclosure when one enters into one of these 
networks, one of these HMOs,

[[Page H312]]

and obviously, it would be a good idea to have someone to go to to 
provide that kind of assistance.
  Then we have health plans demonstrate that they have inadequate 
number mix and distribution of health care providers to meet consumer 
needs. Consumers get information on plans including how many people 
drop out of the program each year, amounts of premium dollars spent on 
medical care and how providers are paid, just basic disclosure. People 
should know what they are getting into.
  Finally, this is just of course the most important aspects, is that 
doctors, nurses and other health care workers can speak freely to their 
patients about treatment options and quality problems without 
retaliation from HMOs, insurance companies, hospitals, and others. I 
think the gentlewoman mentioned before about the gag rule and how we 
have to eliminate that as well.
  This is what we are talking about. This is not any abstract science 
here. It is just simple things that I think most people probably think 
that they are getting until they actually find out that the HMO or the 
managed care plan does not provide it and has these limitations. We get 
this out to the American public, people understand this. That is why 
better than 80 percent of the people support these kinds of managed 
care reforms.

                              {time}  2030

  Ms. JACKSON-LEE. Mr. Speaker, I keep raising the 88 percent, because 
the gentleman is right. If we get the message out as to the Patient 
Bill of Rights, it is not even out the way it should be, because, as 
the gentleman has said, the Republican leadership has not yet seen the 
wisdom of getting it on the floor of the House.
  Can my colleague imagine if the American public saw the value of what 
we were offering and realized in many instances that they did not have 
those privileges if they had a crisis or real health need? The good 
thing about what happens in this country is that as many sick people as 
we have, we have a lot of well people who pay for health insurance and 
never have the real opportunity, which is very fortunate, to maybe have 
a serious illness.
  Of course, as we age, there are times when we do have, through age, 
serious illnesses. But, in fact, these persons who are in their prime 
of working do not have major illnesses and, therefore, are not even 
aware that there are limits on the kind of treatment that they might be 
able to get that maybe someone who has children who are all 10 and 12 
did not come through the time when in 24 hours you had to be out.
  Just think as we educated individuals how they would want the numbers 
or the numbers would show 100 percent supporting this. If we emphasized 
the drama of what occurred today. Leader Gephardt indicated a ``fly-
in'' of the friends of our colleagues to swat down any kind of interest 
in the Patient Bill of Rights. If we could just have the American 
public see a swarm of bees swarming in to just stop it in its tracks, I 
would say we would have 120 percent because health is such a sacred 
part of the quality of life and what we have come to expect in this 
country.
  I cannot imagine why this would not be a bipartisan effort to really 
run to support the Patient Bill of Rights, because, in doing so, we 
would be responding to what all of America would want, irrespective of 
whether or not they are Democrat, Republican, Independent. They clearly 
want to be able to count on their health plan.
  So the gentleman has highlighted several of the major points. I had 
the opportunity to emphasize some of the other aspects. And it is quite 
extensive, but it is not redundant, it is not costly, it is certainly 
recognizing that what we have is a broken system.
  We started out with it. It was new. We organized it in a manner that 
had more of a dominance of the insurance companies as opposed to the 
health care providers. We see that is wrong; and so we are now going 
back to fixing, which is a good concept. But the wrong direction. The 
head is not leading. The tail is leading. I think we need to get it in 
order so that the health care of this country can be what we would like 
it to be.
  Mr. PALLONE. Mr. Speaker, and I know we only have a couple of minutes 
left, and I just wanted to say that I know what some of the arguments 
are that are coming from the opponents. They are saying that it will 
cost too much. Well, most of these things do not cost anything; and if 
there is a slight cost from some of them, it is so slight in terms of 
the benefits that a person is receiving that I think overwhelmingly 
people would support these patient protections.
  The other thing, of course, we hear is that the Democrats, they are 
trying to move towards national health insurance or socialism. The 
reason HMOs have become so predominant in the insurance market is 
basically through the capitalist system. This is not the government. 
They have actually worked and they have competed and a lot of people 
have joined them, a majority of people have joined them, but we know 
that there are times when the system gets out of hand and the 
government has to step in with some modest restrictions.
  These are modest restrictions. That is all we are talking about. This 
is not major tinkering with the system. HMOs will still be out there, 
and managed care will still be out there. They can still compete, but 
we are saying that these basic provisions have to be met to provide 
some semblance of quality health care.
  Mr. Speaker, I yield back to the gentlewoman, because she, in fact, 
organized this special order this evening. But I thank the gentlewoman 
for having me participate in it.
  Ms. JACKSON LEE. Mr. Speaker, it was certainly my pleasure. And, as 
we close, I certainly want to thank the Speaker for this time. I think 
this was an important discussion on the floor of the House, and I am 
delighted to have the gentleman from New Jersey join on the kinds of 
issues that we will be facing. We have a plan. Our task force has a 
plan. It is certainly appropriate for the leadership to move forward on 
this issue of good health care.

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