[Congressional Record Volume 144, Number 15 (Wednesday, February 25, 1998)]
[House]
[Pages H624-H626]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentlewoman from Connecticut (Ms. DeLauro) is 
recognized for 60 minutes as the designee of the minority leader.
  Ms. DeLAURO. Mr. Speaker, I want to stand here and have the 
opportunity to have a discussion with some of my colleagues this 
evening, to talk about an issue that is near and dear to the hearts of 
the American people, and that is for those who are today in something 
called managed care for their health care, people who are looking at 
how they are going to afford health care, how in fact they can meet the 
rules and regulations that some of the HMOs have put upon them, how 
they can have the option of selecting their physician or specialist if 
they need one, how in fact they can get all of the information that 
they need in order to make good choices and good decisions about their 
medical treatment, and how, if they run into a difficulty with their 
provider, their HMO, their insurance company, that they have an appeal 
process that they can go to to see if this can be sorted out.

                              {time}  1730

  This is a topic that is going to be hotly debated in this Chamber in 
the next several months. The President talked about a patient's Bill of 
Rights, if you will. That sounds like a very elevated term. Essentially 
it is what I have talked about, having for individuals the opportunity 
to know what their best options are in order to get their health care.
  This patient's Bill of Rights is going to be debated. The President 
talked about it in his State of the Union Address. He wants to see 
something like this passed. There are a number of us on both sides of 
the aisle, and as a matter of fact it was one of those issues the night 
of the State of the Union where Democrats and Republicans were on their 
feet because it makes good sense. It makes good sense for people to 
have the adequate kind of health care, the adequate treatment that they 
need in order that they may survive, themselves and their families. 
What is at stake here is not just the bottom line, the profit motive in 
health care today, but in fact the health and safety of the American 
public.
  An issue that I have specifically focused on is the issue of 
mastectomies. I have found through a Dr. Sarfos in Connecticut, a 
surgeon, he came to me and told me that women were being treated as 
outpatients for mastectomies, and that they were getting a few hours' 
treatment, or less treatment than both their doctor and they thought 
they needed in order for them to be healthy, to be on that road to 
recovery both emotionally and physically.
  Together a number of us have written legislation that says in fact 
that the length of stay in a hospital needs to be determined by a 
doctor and by a patient, and not be the decision of the insurance 
company. In the case of this specific piece of legislation, it says 48 
hours for a mastectomy, 24 hours for a lymph node dissection, and that 
the individual, the woman can in fact have the luxury, if you will, of 
not having to stay for 48 hours if the doctor and patient make that 
determination that in fact it can be a shorter stay.
  These are commonsense kinds of decisions that we are talking about. 
What we want to do is to make sure, as I say, at the base of all of 
this, is that people's health is the first order of business, and not 
the profit motive of the insurance provider or of the HMOs.
  I am delighted to have with me tonight a colleague from Illinois, and 
I yield to the gentleman from Illinois (Mr. Davis).
  Mr. DAVIS of Illinois. Mr. Speaker, I thank the gentlewoman from 
Connecticut for yielding to me, and I also want to do more than that. I 
want to thank her for the kind of leadership that I think she displays 
and continues to display in this House of Representatives by bringing 
before the American people on a daily basis issue by issue, making the 
greatest use of herself to awaken the conscience of the American 
people; for putting before them positions that they need to be aware 
of, things that they need to understand, and then taking the lead in 
actually not only talking the talk but walking the walk, and voting her 
conscience and convictions. It is just a pleasure and an honor for me 
to serve in this body with her.
  Ms. DeLAURO. Mr. Speaker, I thank the gentleman very much.
  Mr. DAVIS of Illinois. Mr. Speaker, when we look at health care 
delivery and we look at what has happened in health care all over the 
place, there have been changes and changes and changes. We see in 
America right now thousands of individuals who are physicians who 
decided to go to medical school, learned their profession, because they 
wanted to be engaged in the practice of medicine. They wanted to work 
out with patients treatment plans and treatment patterns. They wanted 
to make use of the skills which they had acquired to provide the best 
possible care for their patients and their clients.
  Now we reach a point where many of these very same physicians, 
individuals who have spent years and years and years of study and 
training, are actually being told how they must practice. They are 
being told what it is they have to prescribe for certain illnesses, 
what it is that they have to do for certain patients, how long they can 
keep their patients in the hospital, what they have to do with them if 
they have to go home. It just seems to me that rather than making use 
of that training and skills, now we have health maintenance 
organizations, managed care organizations, HMOs, which are telling the 
physician how he or she must practice.
  I can understand when we first evolved to the point where managed 
care became a real part of the American scene, people were concerned 
about cost containment, lack of regulation. It appeared as though the 
health care industry was running wild, and in some instances people may 
have been staying in hospitals much longer than they actually needed 
to. There may have been a few physicians in some cases who may have 
been taking liberties with their prescriptions and what they were 
doing, or seeing patients when they were not needed to be seen. But 
that was not the majority. That was not even anything close to a 
majority.
  I think we have now given managed care, HMOs, a little too much 
action. I think we have given them too much leeway to set the pace, to 
make the decisions, to make the determinations. It is time to look at 
the needs of the patients. That is why, when the President talks about 
a patient's Bill of Rights, what he is really talking about is looking 
now at what the patient can logically and reasonably expect from a 
health care provider, from a health care institution that will meet his 
or her individual needs.
  I do not believe that you can practice medicine wholesale, when it 
gets down

[[Page H625]]

to the actual treatment. One person does not necessarily respond and 
react the same way as another. While you need to keep one person 3 
days, you may need to keep another one 5. There may be some special 
problems and some special needs that they have.
  I think we have to move to enact the Patient's Bill of Rights, and we 
have to give to the patients the greatest opportunity to interact with 
their doctor, to interact with their provider to determine what the 
health care is going to be.
  Mr. Speaker, I see that we have also been joined by a number of other 
colleagues, and I await what it is the gentleman is going to say.
  The SPEAKER pro tempore (Mr. Cooksey). The gentleman from New Jersey 
(Mr. Menendez) is recognized for the balance of the hour as the 
designee of the minority leader.
  Mr. MENENDEZ. Mr. Speaker, I yield to the distinguished gentleman 
from Texas (Mr. Green).
  (Mr. GREEN asked and was given permission to revise and extend his 
remarks.)
  Mr. GREEN. Mr. Speaker, I thank my colleague, the gentleman from New 
Jersey, for this special order, but also for the issue, managed care 
and managed health care. I was interested when my colleague, the 
gentleman from Chicago, was discussing the managed care issues in his 
community. I would like to talk about it in mine, not only in the State 
of Texas but in Houston.
  My concern is we need to be more concerned about the patients' rights 
and establishing some standards for managed health care plans. We all 
have to live by parameters. If you drive on the road, you have to live 
by the speed limits. You have to live by rules and regulations. That is 
what I would like to see this Congress address, is something that would 
protect the patients' rights, and establishing standards for managed 
health care plans, which a great many of them already comply with, Mr. 
Speaker. But I think we would like to see that as knowledgeable 
consumers, people would be able to know that, and know that they have 
certain rights and certain requirements on whatever managed care plan 
they have.
  Ever since their existence, managed care health plans have determined 
what medical procedures would and would not be covered for the 
patients. We need to guarantee patients will receive quality health 
care from their managed care plans. We need to hold managed care 
companies accountable for providing quality health care, instead of 
just being concerned about their bottom line.
  We are a free enterprise system in our country. All of us in business 
are interested in making a profit, but that is also why we have 
government regulations. If it is a State health plan, then you have a 
State agency. In Texas, our State Commission on Insurance is one that 
regulates health plans in the State of Texas. They set the guidelines 
for health plans in Texas, and now we need some guidelines on national 
plans.
  But more importantly, we need to be concerned. We need to protect 
that patient's rights. I am a cosponsor of the bill of the gentleman 
from Georgia (Mr. Norwood). It is a bipartisan piece of legislation to 
protect patients' rights and to establish standards for managed health 
care.
  I know there are other options. The gentleman from New Jersey (Mr. 
Pallone) also has a bill. There is a health care task force within the 
Democratic Caucus that is working on that. Our ranking member, the 
gentleman from Michigan (Mr. John Dingell) has been putting that 
together, and hopefully we will see it. So there are lots of options 
out here, and it is a bipartisan concern that we need to deal with.
  The legislation, whether it is the gentleman from Georgia (Mr. 
Norwood) or any other ``Woods'' should require employer health plans to 
allow employees to select their own personal physicians, for example. 
That is what Congressman Norwood's bill would do.
  Patients would have the rights to choose their own doctor, a doctor 
who meets their personal needs. It would eliminate preauthorization 
requirements for emergency room visits and pay for specialists' care 
recommended by a primary doctor.
  One of the concerns I have heard from my own constituents is that, 
oftentimes, for emergency room care, they really do not know what kind 
of illness they may be having. For example, I have used, and I heard 
this used to me from my constituents, if I have chest pains, I do not 
know whether it is a heart attack or it may be indigestion. And the 
only place to know that is to go to an emergency room. So that is why 
preauthorization for emergency room visits may not be practical in the 
real world.
  If you are badly injured or severely ill, you should not have to 
worry about your insurance. You should be more concerned, and 
rightfully so, about your health and getting the needed help you get. 
Your health should be your primary concern.
  According to a study from the American College of Emergency 
Physicians, 94 percent of emergency room visits have been allocated to 
an injured person. So 94 percent of those emergency room visits, they 
are not someone who thinks they have the flu or have a fever. They are 
actually to an injured person.
  In most cases of injury, there is not an ample enough amount of time 
to call or get approval for an emergency room visit. If there is a 24-
hour phone line for preauthorization for emergency room treatment, 
again, most of the time, the concern is for the health care need and 
not necessarily for the authorization.
  Congressman Norwood's legislation would also help patients who have 
been denied care to appeal their decisions to a mutual third party. 
Patients should be allowed the right to file a claim regarding their 
health coverage. And a third party neutral would ensure quality health 
care for patients unlike current managed care regulations oftentimes.
  It would also allow patients to sue health plans for damages under 
the State malpractice law. In other words, if a person's health care 
plan makes the medical decision, then that patient would then have the 
right, instead of suing their doctor or whatever provider, they can 
say, well, that health care was denied by my health plan.
  In fact, the State of Texas this last legislative session in 1997 
passed that legislation on a very bipartisan vote. And it was sponsored 
by a Republican State senator to make sure that where the decision 
making is at is also where the responsibility is at. And that is what's 
important.
  I would hope whatever bill, I know the gentleman from Georgia (Mr. 
Norwood's) bill has it and whatever bill we consider would also say we 
have responsibility for our decisions whether you are an individual or 
whether you are a health care plan.
  Current Federal law allows self-insured employers to exempt 
themselves from State regulation governing both pension and health 
benefit plans and often prevents individuals from having that 
opportunity to seek legal redress for their health care plans. That is 
under the ERISA preemption.
  We like the ERISA preemption. I have companies in my District who 
need to have ability to have a health care plan that covers, not only 
their employees in Houston, Texas, but also their employees in 
Louisiana or Seattle or anywhere else.
  That is why it is so important on a Federal level. This cannot be 
handled just on the State level. On the Federal level, we have to 
provide some guidelines for these plans that may not be licensed by the 
State but do business in the State, but they come under Federal law.
  Health care needs need to be held to a standard, a standard that 
provides that quality health care to patient at all times by providing 
quality health care such as in the Norwood legislation and again in 
other legislation that the House we hope we will consider will provide 
patients with medical options.
  One of the medical options is that any time there is a managed care 
plan, and I know this is in the Democratic Task Force plan that the 
gentleman from Michigan (Mr. John Dingell) has been working on, that 
will allow an individual that their employer may only be able to afford 
a managed care plan. But they would offer them at the employee's 
expense to be able to upgrade that to a different plan a point a 
service plan or something else.

                              {time}  1745

  That, again, just brings options into health care. And having been in 
a business where we oftentimes had trouble

[[Page H626]]

being able to justify the increasing in health care premiums, I know 
what has happened in the industry the last few years. Businesses want 
to try and cut their costs or cut the increasing costs in health care 
premiums. And so that is why managed care has been so successful. It 
has limited the cost, but in a lot of cases we are also seeing a limit 
in the ability of the service to the people that are supposed to be 
served, the employees or the patients.
  Hopefully, our managed care reform legislation will give patients a 
greater range of medical options instead of restricting them. Managed 
care originally was an ideal program to say patients will have other 
options, they will have wellness care, for example. Because, again, it 
is much better to provide immunizations and provide checkups on an 
annual basis before there is a need. Checkups catch things like 
diabetes, and that is what managed care was originally about.
  There are a lot of great managed care plans in our country. What we 
need to do, again on a congressional level, is provide some guidelines 
for managed care companies to live by. If they are licensed by the 
State with State regulations, then the State can take care of that. But 
also on the Federal level, and that is our job as Members of Congress. 
Let us provide patients with options to make the right choice for their 
health care, at the same time being mindful of the cost considerations 
of employers and people who have to pay those premiums.
  Mr. Speaker, I know that is the important part and I would hope 
tonight that during this managed care reform discussion in the Congress 
over the next few months, that will be one of the issues we deal with.

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