[Congressional Record Volume 144, Number 22 (Friday, March 6, 1998)]
[Senate]
[Page S1538]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         ADDITIONAL STATEMENTS

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                         HEALTH CARE QUEST ACT

 Mr. LIEBERMAN. Mr. President, I am pleased to join with 
Senator Jeffords to announce the introduction of the Health Care Quest 
Act. Last year, he and I worked together on a bill to improve the 
quality of health care purchased by the federal government for 
Medicare, Medicaid, TRICARE, and VA beneficiaries. The Health Care 
Quest Act extends our effort to improve health care quality to the more 
than 100 million beneficiaries in private sector plans.
  For millions of these individuals, passage of the bill will bring for 
the first time rights for external appeals when their plan denies 
payment for medical treatments. The appeals process will be available 
to any person who thinks they were wrongly denied coverage, and gives 
them the right of appeal to an impartial body outside the health plan 
with a decision guaranteed on a timely basis. A timely decision is 
crucial to a sick person or parent of a child with an illness and this 
bill sets out very specific timeliness the health plan must meet for 
the appeal.
  The bill guarantees reimbursement for people who go to the emergency 
room thinking they are sick. Without enactment, a father who goes to 
the emergency room because he thinks that he is having a heart attack 
could be left with thousands of dollars of bills. I think that we can 
rely on the wisdom of people to decide when they need to go to the 
hospital. a person with a medical emergency should not have to wait to 
be buzzed in to the emergency room by a managed care bureaucrat 
hundreds of miles away. Medical care is more serious than admitting 
visitors to an apartment building.
  Patients should expect physicians to recommend the best treatment 
options and serve as their advocates. Protections from so-called ``gag 
clauses'' were included in last year's Balance Budget Act for Medicare 
beneficiaries. We are extending these protections to beneficiaries of 
private sector plans.
  One distinctive feature of the Health Care Quest Act is its focus on 
empowering purchasers, providers, and consumers with useful information 
about their health care. At the center of this effort is a new health 
care quality advisory body to follow up on the good work conducted by 
the President's Advisory Commission. The Health Quality Council will 
continuously update and expand the comparative measures of quality 
available to drive competition based on value. If the new grievance 
process in the bill provides a floor under quality, the new information 
requirements point consumers toward the best care available.
  I would like to end with a comment on the need for quality 
legislation. A recent poll by the Kaiser Family Foundation and Harvard 
University found that close to half of Americans--48 percent--report 
they personally, or someone they know, have experienced problems such 
as lack of information, problems with access to specialists, disputes 
over emergency room coverage, or no recourse to external grievance 
procedure.
  Low-quality health care's tragic result is sobering, 34.7% children 
in HMO's not immunized in 1996. 1,600 unnecessary cardiac deaths 
occurred among 57 million HMO enrollees because a common treatment for 
heart attacks (beta-blockers) was not used appropriately. 1,200 breast 
cancers undetected resulting in 1,800 years of life that could have 
been saved.
  Quality is often an issue of where you get your care with wide 
variations at sites within easy driving distance of each other. One of 
the premier hospitals in Connecticut, Yale-Haven, discharges over 92% 
of its heart attack victims alive--despite taking sicker patients with 
more health problems. Other hospitals within a thirty-minute drive have 
survival rates as much as 10 percent lower. Yet few patients know their 
choice of destination may be a life-and-death decision.
  The Health Care Quest Act attacks these deadly problems. After it is 
enacted, a Connecticut resident with an emergency can go to a hospital 
armed with information, and once there expect their care to be covered 
by their insurer. If they have a problem they will be get an appeal. 
And each day they are healthy, a Health Quality Council will be working 
to make sure the best possible health system is there when they need 
it.

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