[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.

                          ____________________