[Congressional Record Volume 144, Number 36 (Thursday, March 26, 1998)]
[House]
[Pages H1636-H1640]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HMO CARE
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 7, 1997, the gentleman from Iowa (Mr. Ganske) is recognized for
60 minutes.
Mr. GANSKE. Mr. Speaker, 2 years ago I met a woman who killed a man.
I did not meet her in prison. She was not on parole. She had never even
been investigated by the police. In fact, for causing the death of a
man, she received congratulations from her colleagues and she moved up
the corporate ladder. This woman, Dr. Linda Peeno, was working as a
medical reviewer at an HMO.
In testimony before the Committee on Commerce on May 30, 1996, she
confessed that her decision as an HMO reviewer to deny payment for a
life-saving operation led to the preventable
[[Page H1637]]
death of a man she had never seen. Dr. Peeno then exposed the ways that
HMOs denied payment for health services. She showed how plans draft
contract language to restrict access to benefits. She showed how HMOs
cherry-pick healthy patients. She showed how HMOs use technicalities to
deny necessary medical care.
Dr. Peeno also told Congress about the most powerful weapon in an
HMO's arsenal to hold down costs. HMOs generally agree to cover all
services that are deemed medically necessary. But because that decision
is made by HMO bureaucrats, not by the treating physician, Dr. Peeno
called it the ``smart bomb'' of cost containment.
Hailed initially as a great breakthrough in holding down health
costs, the painful consequences of the managed care revolution are
being revealed. Stories from the inside, like those told by Dr. Peeno,
are shaking the public's confidence in managed care. We can now read
about some of Dr. Peeno's experiences in the March 9 edition of U.S.
News and World Report.
The HMO revelations have gotten so bad that health plans themselves
are running ads touting the fact that they are different from the bad
HMOs that do not allow their subscribers a choice of doctors or
interfere with their doctors practicing good medicine.
Here in Washington one ad says, ``We don't put unreasonable
restrictions on our doctors. We don't tell them that they cannot send
you to a specialist.'' This Chicago Blue Cross ad proclaims, ``We want
to be your health plan, not your doctor.'' In Baltimore, the Preferred
Health Network ad states, ``At your average health plan, cost controls
are regulated by administrators. APHN doctors are responsible for
controlling costs.''
This goes to prove that even HMOs know that there are more than a few
rotten apples in the barrel. The HMO industry has earned a reputation
with the public that is so bad that only tobacco companies are held in
lower esteem. Let me cite a few statistics.
A national survey shows that far more Americans have a negative view
of managed care than a positive view. By more than 2-to-1, Americans
support more government regulation of HMOs. The survey shows that only
44 percent of Americans think managed care is a good thing.
Do my colleagues want proof? Well, recently I saw the movie ``As Good
As It Gets.'' When Academy Award winner Helen Hunt expressed an
expletive about the lack of care her asthmatic son gets from their HMO,
people clapped and cheered. It was by far the biggest applause line of
the movie. No doubt the audience's reaction has been fueled by dozens
of articles and news stories highly critical of managed care and also
by real-life experiences.
In September 1997, the Des Moines Register ran an op-ed piece
entitled ``The Chilly Bedside Manner of HMOs'' by Robert Reno, a
Newsweek writer. Citing a study on the end-of-life care, he wrote,
``This would seem to prove the popular suspicion that HMO operators are
heartless swine.''
The New York Post ran a week-long series on managed care; headlines
included. ``HMOs Cruel Rules Leave Her Dying for the Doc She Needs.''
Another headline blared out, ``Ex-New Yorker Is Told, Get Castrated
In Order To Save.'' Or this one: ``What His Parents Didn't Know About
HMOs May Have Killed This Baby.'' Or how about the 29-year-old cancer
patient whose HMO would not pay for his treatments? Instead, the HMO
case manager told the patient to ``hold a fund-raiser,'' a fund-raiser.
Mr. Speaker, I certainly hope that campaign finance reform will not
stymie this man's chance to get his cancer treatment.
To save money, some HMOs have erected increasingly steep barriers to
proper medical care. These include complex utilization preview
procedures, computer programs that are stingy about approving care,
medical directors willing to play fast and loose with the term
``medically necessary.''
Consumers who disagree with these decisions are forced to work their
way through Byzantine appeals processes which usually excel at
complexity, but generally fall short of fairness; and these appeals,
unfortunately, Mr. Speaker, can last longer than the patient. The
public understands the kind of barriers they face in getting needed
care.
Republican pollster Frank Luntz recently held a focus group in
Maryland. Here is what some consumers said. One participant complained,
``I have a new doctor every year.'' Another said she is afraid that if
something major happened ``I wouldn't be covered.'' A third attendee
griped that he had to take off work twice because the plan requires
people to see the primary care doctor before seeing a specialist.
Those fears are vividly reflected in editorial page cartoons. Here is
one that reflects what the focus group was talking about. It shows a
woman working in a cubicle in a claims department of an HMO. In talking
with the customer she remarks, ``No, we don't authorize that
specialist. No, we don't cover that operation. No, we don't pay for
that medication. No, we don't consider this assisted suicide.'' These
HMO rules create ethical dilemmas.
A California internist had a patient who needed emergency treatment
because of fluid buildup in her lungs. Under the rules of the patient's
plan, the service would come at a hefty cost to the patient. She told
the doctor that she could not have the treatment because she did not
have the money. However, if she was admitted to the hospital, she would
have no charges. So her doctor bent the rules. He admitted her and then
he immediately discharged her.
Now, Mr. Speaker, are HMOs now forcing doctors to lie for their
patients? HMOs have pared back benefits to the point of forcing
Congress to get into the business of making medical decisions. Take,
for example, the uproar over the so-called drive-through deliveries.
This cartoon shows that some folks thought health plans were turning
their maternity wards into fast food restaurants. As the woman is
handed her new child, the gate keeper at the drive-through window asks,
``Would you like fries with that?''
Well, in a case that is not so funny, in 1995 Michelle and Steve
Bauman testified before the Senate about their daughter, Michelina, who
died two days after she was born. Their words were powerful and
eloquent. Let me quote from Michelle and Steve's statement. ``Baby
Michelina and her mother were sent home 28 hours after delivery. This
was not enough time for doctors to discover that Michelina was born
with streptococcus, a common and treatable condition. Had she remained
in the hospital an additional 24 hours, her symptoms would have
surfaced and professional trained staff would have taken the proper
steps so that we could have planned a christening rather than a
funeral. Her death certificate listed the cause of death as
meningitis.'' Michelle and Steve went on to say, ``when it should have
read, death by the system.''
In the face of scathing media criticism and public outrage, health
plans insisted that nothing was wrong, that most plans allowed women to
stay at least 48 hours and that babies discharged the day of delivery
were just as healthy as others.
Mr. Speaker, that line of defense sounds a lot like the man who was
sued for causing an auto accident. ``Your Honor, he says, I was not in
the car that night. But even if I was, the other guy was speeding and
swerved into my lane.''
{time} 2245
For expectant parents, however, the bottom line was fear and
confusion. There is nothing more important to a couple than the health
and safety of their child. Because managed care failed to condemn
drive-through deliveries, all of us are left to wonder whether our
plans place profits ahead of care. The drive-through delivery issue is
hardly the only example of the managed care industry fighting to derail
any consumer protection legislation. What makes this strategy so
curious is that most plans had already taken steps to guarantee new
moms and infants 2 days in the hospital. Sure, there were some fly-by-
night plans that might not have measured up, but most responsible plans
had already reacted to the issue by guaranteeing longer lengths of
stay. The HMOs' efforts to reassure the public that responsible plans
do not force new mothers and babies out of the hospital in less than 24
hours, however, were completely undermined by their opposition to a law
ensuring this protection to all Americans. That was a missed
[[Page H1638]]
opportunity for the responsible HMOs to get out front, to proactively
work for legislation that reflected the way they already operated. Not
only would it have improved managed care's public image, but it would
have given them some credibility.
Why then did managed care oppose legislation on this issue? Because
the HMO industry is Chicken Little. Every time Congress or the States
propose some regulation of the industry, they cry, ``The sky is
falling, the sky is falling.'' I would suggest that by endorsing some
common sense patient protections, managed care would be more believable
when they oppose other legislation.
Mr. Speaker, today's managed care market is highly competitive.
Strong market rivalry can be good for consumers. When one airline cuts
fares, others generally match the lower prices. In health care when one
plan offers improved preventive care or expanded coverage, other market
participants may follow suit. But the competitive nature of the market
also poses a danger for consumers. In an effort to bolster profits,
plans may deny coverage of care that is medically necessary. Or they
may gag their doctors to cut costs. Some health plans have used gag
rules to keep their subscribers from getting care that may save their
lives.
During congressional hearings 2 years ago, we heard testimony from
Alan DeMeurers who lost his wife Christy to breast cancer. They are
pictured here with their children. When a specialist at UCLA
recommended that Christy undergo bone marrow transplant surgery, her
HMO leaned on UCLA to change its medical opinion. Who knows whether
Christy would be with her two children today had her HMO not interfered
with her doctor-patient relationship. HMO gag rules have even made
their way onto the editorial pages. Here is one such cartoon. A doctor
sits across the desk from a patient and remarks, ``I'll have to check
my contract before I answer that.'' Dr. Michael Haugh is a real life
example of this problem. He testified before the Committee on Commerce
and told how one of his patients was suffering from severe headaches.
He asked her HMO to approve a specific diagnostic procedure. They
declined to cover it, claiming that magnetic resonance arteriogram was
experimental. Remember, Dr. Peeno testified about the clever ways that
health plans decide not to cover requested care. So Dr. Haugh explained
the situation in a letter to his patient. In it he wrote, ``The
alternative to the MRA is to do a test called a cerebral arteriogram
which requires injecting dye into the arteries and carries a much
higher risk to it than MRA. It is because of this risk that I am
writing to tell you that I still consider that an MRA is medically
necessary in your case.'' Two weeks later, the medical director of
BlueLines HMO wrote to Dr. Haugh. He said, ``I consider your letter to
the member to be significantly inflammatory. You should be aware that a
persistent pattern of pitting the HMO against its member may place your
relationship with BlueLines HMO in jeopardy. In the future I trust you
will choose to direct your concerns to my office rather than in this
manner.''
Amazing. The HMO was telling this doctor that he could not express
his professional medical judgment to his patient. Cases like these and
others demonstrate why Congress needs to pass legislation like the
Patient Right to Know Act to prevent health plans from censoring exam
room discussions. This gag rule cartoon is even more pointed. Once
again a doctor sits behind a desk talking to a patient. Behind the
doctor is an eye chart saying ``ENUF IZ ENUF.'' The doctor looks at a
piece of paper and tells his patient, ``Your best option is cremation,
$359, fully covered,'' and the patient says, ``This is one of those HMO
gag rules, isn't it, Doctor?''
The HMO industry continues to fight Federal legislation to ban gag
rules. The HMOs and their minions in Congress still keep the Patient
Right to Know Act from coming to the floor, despite the fact that it
has been cosponsored by 299 Members of this House, endorsed by over 300
consumer and health profession organizations and has already been
enacted to protect those receiving services under Medicare and
Medicaid, but not for those of you who are not poor or elderly. Even
some executives of managed care plans have privately told me that they
are not opposed to a ban on gag rules, because they know that
competition can result in a race to the bottom in which basic consumer
protections are undermined.
My bill to ban gag rules presents managed care with an opportunity to
be on the vanguard of good health care. Instead, they are frittering
away another opportunity just like they did with drive-through
deliveries. In opposing a ban on gag rules, HMOs have only fueled
bipartisan support for broader, more comprehensive reform legislation.
In recognition of problems in managed care, last September three
managed care plans joined with consumer groups to announce their
support of an 18-point agenda. Here is a sample of the issues that the
groups felt required nationally enforceable standards, things like
guaranteeing access to appropriate services, providing people with a
choice of health plans, ensuring the confidentiality of medical
records, protecting the continuity of care, providing consumers with
relevant information, covering emergency care, disclosing loss ratios,
banning gag rules. These health plans and consumer groups wrote,
``Together we are seeking to address problems that have led to a
decline in consumer confidence and trust in health plans. We believe
that thoughtfully designed health plan standards will help to restore
confidence and ensure needed protection.'' Mr. Speaker, I could not
have said it better myself. These plans, including Kaiser Permanente,
HIP, the Group Health of Puget Sound probably already provide patients
with these safeguards. So it would not be a big challenge for them to
comply with nationally enforceable standards. By advocating national
standards, these HMOs distinguish themselves in the market as being
truly concerned with the health of their enrollees. Noting that they
already make extensive efforts to improve their quality of care, the
chief executive officer of Health Insurance Plan, known as HIP said,
quote, ``Nevertheless, we intend to insist on even higher standards of
behavior within our industry and we are more than willing to see laws
enacted to ensure that result.'' Let me repeat that. ``We are more than
willing to see laws enacted to ensure that result.''
One of the most important pieces of their 18-point agenda is a
requirement that plans use a lay person's definition of emergency. Too
often health plans have refused to pay for care that was delivered in
an emergency room. The American Heart Association tells us that if we
have crushing chest pain, we should go immediately to the emergency
room because this could be a warning sign of a heart attack. But
sometimes HMOs refuse to pay if the patient tests normal. If the HMO
only pays when the tests are positive, I guarantee you, Mr. Speaker,
people will delay getting proper treatment for fear of a big bill and
they could die if they delay diagnosis and treatment. Another excuse
HMOs use to deny payment for ER care is the patient's failure to get
preauthorization. This cartoon vividly makes the point.
Kuddlycare HMO. My name is Bambi. How may I help you?
You're at the emergency room and your husband needs approval for
treatment?
Gasping, writhing, eyes rolled back in his head? Doesn't sound all
that serious to me.
Clutching his throat? Turning purple? Um-huh. Have you tried an
inhaler?
He's dead? Well, then he certainly doesn't need treatment, does he?
Gee, people are always trying to rip us off.
Does this cartoon seem too harsh? Ask Jacqueline Lee. In the summer
of 1996, she was hiking in the Shenandoah Mountains when she fell off a
40-foot cliff, fracturing her skull, her arm and her pelvis. She was
airlifted to a local hospital and treated. You will not believe this.
Her HMO refused to pay for the services because she failed to get
preauthorization. I ask you, what was she supposed to do with broken
bones lying at the base of the cliff? Call her HMO for
preauthorization? I am sad to say that despite strong public support to
correct problems like these, managed care regulations still seem
stalled here in Washington. Some opponents of legislation insist that
health insurance regulation, if there is to be any at all, should be
done by the States.
[[Page H1639]]
Other critics worship at the altar of the free market and insist its
invisible hand can cure the ills of managed care. As a strong supporter
of the free market, I wish we could rely on Adam Smith's invisible hand
to steer plans into offering the services consumers want. And while
historically State insurance commissions have done an excellent job of
monitoring the performance of health plans, Federal law puts most HMOs
beyond the reach of State regulations. Let me repeat that. Federal law
puts most HMOs beyond the reach of State regulations. How is this
possible? More than two decades ago, Congress passed the Employee
Retirement Income Security Act, which I will refer to as ERISA, to
provide some uniformity for pension plans in dealing with different
State laws. Health plans were included in ERISA, almost as an
afterthought. The result has been a gaping regulatory loophole for
self-insured plans under ERISA. Even more alarming is the fact that
this lack of effective regulation is coupled with an immunity from
liability for negligent actions. Mr. Speaker, personal responsibility
has been a watchword for this Republican Congress. This issue is no
different. I have worked with the gentleman from Georgia (Mr. Norwood)
and others to pass legislation that would make health plans responsible
for their conduct. Health plans that recklessly deny needed medical
service should be made to answer for their conduct. Laws that shield
them from their responsibility only encourage HMOs to cut corners.
Take this cartoon, for instance. With no threat of a suit for medical
malpractice, an HMO bean counter stands elbow to elbow with the doctor
in the operating room. When the doctor calls for a scalpel, the bean
counter says, ``pocket knife.'' When the doctor asks for a suture, the
bean counter says, ``Band-Aid.'' When the doctor says, ``Let's get him
to the intensive care unit,'' the bean counter says, ``Call a cab.''
Texas has responded to HMO abuses by passing legislation that would
make ERISA plans accountable for improper denials of care. But that law
is being challenged in court and a Federal standard is needed to
protect all consumers. The lack of legal redress for an ERISA plan's
act of medical malpractice is hardly its only shortcoming. Let me
describe a few of ERISA's other weaknesses.
{time} 2300
ERISA does not impose any quality assurance standards or other
standards for utilization review. Except as provided in Kassebaum-
Kennedy, ERISA does not prevent plans from changing, reducing or
terminating benefits. With a few exceptions, ERISA does not regulate a
plan's design or content, such as covered services or cost sharing.
ERISA does not specify any requirements for maintaining plan solvency.
ERISA does not provide the standards that a State insurance
commissioner would.
It seems to me that we can take one of three approaches in reforming
the way health plans are regulated by ERISA. The first would be to do
nothing, but I think I have already demonstrated why that is not
acceptable.
The second option would be to ask the States to reassume the
responsibility of regulating these plans. This was the traditional role
of the States, and they continue to supervise other parts of the health
insurance market. But I will tell you why that will not work.
Turning regulation of ERISA plans over to the States will be fought
tooth and nail by big business and by HMOs, and it will not happen.
That leaves only one viable option: some minimal reasonable Federal
consumer health protections for patients enrolled in ERISA plans.
Now there are many proposals on the table, including the Patient
Access to Responsible Care Act, the Patients' Bill of Rights, the 18-
point agenda released by Kaiser HIP and AARP. Whether we enact one of
these options or some other yet to be drafted, Congress created the
ERISA loophole and Congress should fix it.
Now, defenders of the status quo sometimes say that making plans
subject to increased State or Federal regulations is not the answer.
They insist that like any other consumer good, managed care will
respond to the demands of the market. I would note that other
industries are liable for their acts of misconduct.
So the shield from liability provided by ERISA by itself distorts the
health care market. It differs from a traditional market in other ways
as well. For example, the person consuming health care is generally not
paying for it. Most Americans get their health care through their
employer because the primary customer, the one paying the bills, is the
employer. HMOs have to satisfy their needs before they satisfy the
needs of their patients. And the employer's focus on the cost of the
plan may draw the HMO's attention away from the employee's desire for a
decent health plan.
As Stan Evans noted in Human Events, many HMOs operate on a capitated
basis. This means that plans are paid a flat monthly fee for taking
care of you. This translates to the less they spend on medical
services, the more profit they make.
Now, how many markets function on the premise of succeeding by giving
consumers less of what they want?
Take a look at this cartoon which illustrates perfectly the problem
of health plans focusing on the bottom line. The patient is in
traction. This is the HMO bedside manner. And the doctor standing next
to him says, ``After consulting my colleagues in accounting we have
concluded you are well enough. Now go home.''
Are HMOs paying attention to their patients' health or to their
stockholders' portfolios?
Stan Evans again hit the nail on the head when he noted:
Paid a fixed amount of money per patient regardless of the
care delivered, HMOs have a powerful motive to deliver a
minimum of treatment. Care denial, pushing people out of
hospitals as fast as possible, blocking access to specialists
and the like are not mistakes or aberrations. They stem
directly from the nature of the setup in which HMOs make more
money by delivering less care, thus pitting the financial
interests of the provider against the medical interests of
the patient.
His comment raises an important issue. Presented with tragedies like
those of the Baumans or Mrs. DeMeurers, managed care defenders argue
those are just anecdotes. What Mr. Evans points out is that cases like
these are not mistakes or aberrations or anecdotes. They are exactly
the outcomes we would expect in a system that rewards those who
undertreat patients.
Finally, markets only function when consumers have real choices.
Dissatisfied consumers have limited options. Most employers offer
employees very few health plans. For many, the choice of their health
plan is simple: Take it or leave it. Freedom in the health insurance
market now means quitting your job if you do not like your HMO. There
is not a free market when consumers cannot switch to a different health
plan.
But even if we were to put aside all these arguments and assume that
health insurance was a free market, there is still a need for
legislation to guard patients from abuses. The notion of consumer
protections is consistent and supportive in our concept of free
markets. In his book, Everything for Sale, Robert Kuttner points out
the problems of imperfect markets. He says:
Industries such as telecommunications, electric power and
health care retain public purposes that free market forces
cannot achieve. For example, as a society we remain committed
to universal access for certain goods. Left to its own
devices the free market might decide that delivering
electricity and phone service to rural areas and poor city
neighborhoods is just not profitable, just as the private
market brands cancer patients as ``uninsurable.''
Think for a moment about buying a car. Federal laws ensure that cars
have horns and brakes and headlights. Yet despite these minimum
standards, we do not have a nationalized auto industry. Instead,
consumers have lots of choices. But they know that whatever car they
buy will meet certain minimum safety standards. You do not buy safety a
la carte.
The same notion of basic protections and standards should apply to
health plans. Consumer protections will not lead to socialized medicine
any more than requiring seat belts has led to a nationalized auto
industry. In a free market, these minimum standards set a level playing
field that allows competition to flourish.
Critics of regulating managed care also complain that new regulations
will drive up the costs of health insurance. In criticizing the Patient
Access
[[Page H1640]]
to Responsible Care Act, they cite a study showing that certain
provisions could increase health insurance premiums from 3 to 90
percent. Three to 90 percent. I mean, that is a joke. Such a wide range
is meaningless. It must be an accountant's way of saying I do not know.
Other studies have said that costs may go up slightly, but nothing
near the doomsday figures suggested by opponents of this legislation. A
study by the accounting firm Muse and Associates shows that premiums
will increase between seven-tenths of 1 percent and 2.6 percent if the
Patient Access to Responsible Care Act is enacted.
And do not let the HMOs tell you that the rising premiums we are
seeing this year are the result of Federal legislation. HMOs have been
charging below cost premiums for a long time. As a result, we are now
seeing premium increases long before passage of any Federal consumer
protection legislation.
And keep in mind also the shareholder's philosophy of making money
can come into conflict with the patient's philosophy of wanting good
medical care. To save money, many plans have nonphysician reviewers to
determine if callers requesting approval for care really need it. Using
medical care cookbooks, they walk patients through their symptoms and
then reach a medical conclusion.
These cookbooks do not have a recipe for every circumstance. Like the
woman who called to complain about pain caused by the cast on her
wrist. The telephone triage worker asked the woman to press down on her
fingernail to see how long it took for the color to return.
Unfortunately, the patient had polish on her nails.
How far can this go? Like this cartoon shows, pretty soon we could
all be logging on to the Internet and using the mouse as a stethoscope.
This trend should trouble every one of us. Medicine is part science,
part art. Computer operators cannot consider the subtleties of a
patient's condition. Sometimes you can know the answer by reading a
chart, but sometimes doctors reach their judgments by a sixth sense
that this patient really is sick. There are certain things that
computers just cannot comprehend.
Now doctors are expected to be professional, to adhere to standards
and to undergo peer review. Most of all, they are expected to serve as
advocates for their patients' needs, not to be government or insurance
apologists. It is in the interests of our citizens that their doctor
fights for them and not be ``the company doc.''
Like a majority of my colleagues, I am a cosponsor of H.R. 1415, the
Patient Access to Responsible Care Act, otherwise known as PARCA. In an
attempt to derail this legislation, the managed care community has made
a number of false statements about this bill. For example, they
repeatedly state that PARCA would force health plans to contract with
any provider who wanted to join its network. That is clearly a false
statement. In two separate places in the bill, it states that it should
not be considered an ``any willing provider'' bill.
PARCA simply includes a provider nondiscrimination provision similar
to what was enacted in Medicare last year. Provider nondiscrimination
and ``any willing provider'' are no more the same than equal
opportunity and affirmative action.
Similarly, some opponents have suggested that the bill would force
health insurance to be offered on a guaranteed issue or a community
rated basis. This is a nonissue. Congressman Norwood and I oppose
community rating and guaranteed issue and will not support any bill
coming to the floor that would result in community rating or guaranteed
issue.
{time} 2115
Our goals should be passage of comprehensive patient protection
legislation. I am committed to seeing legislation enacted before the
close of the 105th Congress. I am open to working with all interested
Members, Republican, and Democrat, to develop a bipartisan patient
protection bill.
In the meantime, H.R. 586, the Patient Right to Know Act, which would
ban gag rules, should be brought to the floor for a vote.
Mr. Speaker, just last week, a pediatrician told me about a 6-year-
old child who had nearly drowned. The child was brought to the hospital
and placed on a ventilator. The child's condition was serious. It did
not appear that he would survive.
As the doctors and the family prayed for signs that he would live,
the hospital got a call from the boy's insurance company. Home
ventilation, explained the HMO reviewer, is cheaper than in-patient
care. I was wondering if you had thought about sending the boy home.
Or consider the death of Joyce Ching, a 34-year-old mother from
Fremont, California. Mrs. Ching waited nearly 3 months for an HMO
referral to a specialist despite her continued rectal bleeding and
severe pain. She was 35 years old when she died from a delay in the
diagnosis of her colon cancer.
Joyce Ching, Christy DeMeurers, Michelina Baumann, Dr. Peeno's
patient, Mr. Speaker, these are not just anecdotes. These are real
people who are victims of HMOs.
Let us fix this problem. The people we serve are demanding it. Let us
act now to pass meaningful patient protections. Lives, Mr. Speaker, are
in the balance.
____________________