[Congressional Record Volume 144, Number 21 (Thursday, March 5, 1998)]
[Senate]
[Pages S1440-S1441]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. JEFFORDS (for himself and Mr. Lieberman):
  S. 1712. A bill to amend title XXVII of the Public Health Service Act 
and part 7 of subtitle B of title I of the Employee Retirement Income 
Security Act of 1974 to improve the quality of health plans and provide 
protections for consumers enrolled in such plans; to the Committee on 
Labor and Human Resources.


      the health care quality, education, security, and trust act

  Mr. JEFFORDS. Mr. President, today, I join with my good friend 
Senator Lieberman to introduce the Health Care Quality, Education, 
Security, and Trust Act--``The Health Care QUEST Act''--in order to 
improve the quality of our nation's health care system and provide 
necessary consumer protections without adding significant new costs; 
increasing litigation; or micro managing health plans.

  Over the past decade across the country, an extraordinary change has 
taken place in the delivery of health care. In 1996, over 67% of 
Americans received their health care through managed care--almost 
double the percentage that existed in 1990. However, this transition 
has not been problem-free. Many consumers worry that the quality of 
their health care is being sacrificed to cut costs. While the 
traditional fee-for-service health care system was guilty of over 
utilization and runaway costs, consumers did feel that they would get 
the necessary services, treatment, and information to recover from a 
serious illness or manage a chronic health problem. People are now 
worried that managed care only manages costs and, in effect, rations 
care. One consequence of this transformation is that Americans are 
losing confidence in the quality of care they receive from our health 
system.
  The American Association of Health Plans' voluntary initiative to 
respond to these concerns, ``Putting Patients First,'' is an important 
step and I urge that they continue to expand this effort. Businesses, 
such as General Motors and GTE, have also initiated programs to improve 
the quality of the health care received by their employees. In 
addition, a number of states have already passed legislative 
initiatives to address many of the problems consumers have experienced 
with their health plans. However, I believe that Federal legislation is 
necessary because the Employee Retirement Income Security Act of 1974 
(ERISA) prevents states from enforcing health care quality standards 
that relate to the employer-sponsored health benefits that 148 million 
Americans receive.
  The Health Care QUEST Act addresses these concerns through four 
provisions. First, it creates a Health Quality Council to set national 
goals for improving health and serve as a resource for Congress and the 
President regarding health care quality. Second, it expands the duties 
and responsibilities of the Agency for Health Care Policy and Research 
(AHCPR) in order to develop the tools needed to measure and report 
health care quality. The Act also requires that employers and health 
plans provide enrollees with health plan information such as measures 
of consumer satisfaction and their right to access speciality health 
services. Finally, the Act calls for the establishment of the ``prudent 
layperson'' standard of access to emergency room care, the right to use 
an impartial independent external appeals process and the guarantee 
that a patient's health care professional is able to recommend the best 
treatment options and to serve as their advocate.
  These provisions will help to restore consumers confidence in the 
quality of our nation's health care system and provide a level playing 
field--so that managed care plan compete on the basis of quality as 
well as cost. Based on an analysis by the Lewin Group, the added costs 
for information disclosure and external appeals requirements are 
extremely low. The estimated monthly cost per person for comparative 
information and for external appeals with a

[[Page S1441]]

three year phase-in is only $0.88. This cost estimate doesn't take into 
account the improved market efficiency and increased competition that 
the Lewin Group indicates will be achieved with these requirements.
  Much of the debate over this issue to date in Washington has been 
conducted from two very divergent viewpoints. Many House members, and 
some in the Senate, believe we should regulate health care very 
closely, on a disease-by-disease or procedure-by-procedure basis. 
Another sizable camp believes that there is nothing wrong with the 
health care marketplace that can't be be sorted out by its own 
operation.
  Obviously, I disagree. And Congress, too, disagreed when it 
confronted many of these issues in the Medicare program last year. Much 
of what I propose in the Health Care QUEST Act is contained in the 
``Balanced Budget Act of 1997'' and applies to plans that enroll 
Medicare beneficiaries. Extending the same standards to the private 
sector will ensure that all Americans have the same rights and 
protections.
  The states have developed comprehensive approaches that provide 
regulation for those components of the health care system under their 
jurisdiction. The challenge for the federal government is to define 
regulatory solutions for those sectors under federal control that 
advance the consumer choice health care market while recognizing the 
voluntary nature of our private system. These regulatory solutions, in 
my opinion, should not determine medical necessity, establish hospital 
lengths-of-stay, or impede private sector initiatives. Furthermore, we 
must not set into statute standards that would preclude efforts for 
continued quality improvement or fail to recognize the evolutionary 
nature of medical practice.
  The McCarran-Ferguson Act of 1945 granted states the authority to 
regulate the business of insurance. However, ERISA preempted state law 
with regard to the regulation of employee benefit plans. While ERISA 
provides detailed standards for employer provided pensions, it provides 
only minimal standards for health plans. Currently about 41 percent of 
those who receive their health coverage through employer-sponsored 
plans are in self-insured health plans. The Health Care Quest Act 
follows the framework established under the Health Insurance 
Portability and Accountability Act of 1996 (HIPAA) by setting national 
standards for employer sponsored plans under ERISA and a federal floor 
for insurance companies to follow that states can build upon.
  The Health Care QUEST Act will help to restore consumer confidence in 
our health care system and also promote market efficiency and 
accountability. I look forward to working with other Senators to enact 
legislation this year that establishes necessary consumer protections 
and sets national standards to guide our nation's market based health 
care reform efforts.
                                 ______