[Congressional Record Volume 144, Number 55 (Wednesday, May 6, 1998)]
[Senate]
[Pages S4405-S4406]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MANAGED CARE
Mr. REED. Mr. President, today we are engaged in a very important
debate about the reform of the IRS, but there is another very crucial
debate that we also must consider and recognize, and that is the debate
about the future of our health care system in the United States--
particularly the managed care health care system, which is becoming so
prominent in America today.
I am particularly concerned that children should also be part of this
debate and that they deserve the same consumer protections that many
have talked about in the context of adult health care plans. Managed
care, as we all recognize, plays a very important and critical role in
our health care delivery system and has provided many benefits. But we
also hear repeatedly about instances in which patients--particularly
children--are not served as well as they should be by managed care.
I recall one child who was brought to my attention in Rhode Island. A
young child, Morgan Smith, was born in Rhode Island November of 1993.
Shortly after her fourth birthday, Morgan was diagnosed with
Rhabdomyosarcoma, a cancer that attacks any smooth muscle in the body,
including blood vessels. They detected this cancer in Morgan's brain.
She was indeed faced with a critical, life-threatening brain tumor.
We are fortunate in Rhode Island because we have an excellent
children's hospital, Hasbro Children's Hospital in Providence, which is
the hospital where Morgan was diagnosed. The pediatric oncologists
there determined that the best treatment for Morgan would be to go to
the New England Regional Medical Center in Boston for specialized
chemotherapy. Now, her mother, obviously, was willing to do anything to
treat her child and have the best benefits for her child.
At that point, the insurance company denied her the ability to bring
her child to Boston and requested that they get a second opinion. They
got that second opinion; it was the same as the first opinion. However,
the HMO still refused to authorize the treatment necessary for that 4-
year-old child to receive life-saving therapy in Boston.
Mrs. Smith literally had to wage war against the HMO to make her
point. At the time, she was absolutely crushed by the prospect of her
young child being stricken with a life-threatening brain tumor. She
determined on her own to go to Boston regardless of the consequences,
risking her financial future, risking all of the resources that she
had, while also having to provide for her other children. Nevertheless,
she was bound and determined to provide for Morgan.
Fortunately, this story has a happy ending. About a month after
pleading by Mrs. Smith, and by others, the insurance company relented
and she was granted permission to have the treatment conducted in
Boston. And the child is doing very well.
That is merely one example of the stories we are hearing constantly
about managed care and its inability at times to provide the kind of
care that most parents think they should get when they pay good money,
or their employer pays good money, for these managed care plans.
There have been studies in parts of the country suggesting that the
managed care plans are not best suited, in many cases, for children. A
study in California by Elizabeth Jameson at the University of
California compared managed care plans with the State's Medicaid plan
for children. Medicaid plans are sometimes stereotyped as the low-cost
and, by inference, low-quality health care. This study, however, found
that in many respects children in California's Medicaid Program were
getting better pediatric care than those enrolled in managed care plans
in the State.
The study found, for example, that some of the managed care plans
imposed restrictions on referrals to pediatric specialists. They also
found that many plan providers were attempting to deal with very
complicated pediatric conditions with which they had little experience.
As a result of the anecdotal evidence, as a result of the statistical
studies and surveys that have been done in parts of the country, I have
introduced S. 1808, the Children's Health Insurance Accountability Act.
It is designed to provide an opportunity for children's health to be
considered and focused on in a managed care plan. This act would
provide common sense protections for children in managed care plans--
protections, for example, that would ensure that a family has access to
necessary pediatric services; that they would have appeal rights and
special conditions with respect to children; that they would have
quality programs that measure outcomes with respect to children and not
just to adults; that there would be utilization review rules that be
geared toward children and not just to adults; that there would be
child-specific information in terms of the sale of these plans on care
provided to children.
There are so many parents who buy plans and think they have coverage
for their kid, only to discover in a time of crisis that the coverage
is not what they thought it was. My legislation would put that
information up front.
What I have done with respect to children is consistent with a much
broader class of legislation that is attempting to reform managed care
for
[[Page S4406]]
the entire population of patients. The Health Care Bill of Rights, for
example, introduced by my Democratic colleagues, is one such plan. My
legislation is consistent with this overall thrust to ensure that
managed care continues to operate for the benefit of patients, that
operates by allowing physicians to provide advice, and not accountants,
to control the diagnosis and the application of health care.
With respect to children, again, the American people are strongly
supportive of proposals to give better access through managed care for
pediatric services. In a February 1998 poll by the firm of Lake, Sosin,
Snell, Perry and Associates and the Tarrance Group--two pollsters, one
Democrat and one Republican--it was found that 89 percent of adults
surveyed favored having ``Congress require HMOs and other insurance
companies to allow parents to choose a pediatrician as their child's
primary care physician.'' And 90 percent favored having ``Congress
require HMOs and other insurance companies to allow parents of children
with special care needs, like cerebral palsy, cystic fibrosis, or
severe asthma, to choose a pediatric specialist to be their child's
primary care physician.''
There is overwhelming public support for these provisions that will
allow parents to truly and wisely choose coverage for their children
and have the ability to have pediatric specialists care for their
children.
Again, this is consistent with a theme, a message, and a
responsibility that we all have; that is, to move in this time
decisively, with determination, to ensure that we reform the managed
care system, that we provide the benefits of managed care in terms of
preventive services; in terms of access to physicians, that we do it in
a way that physicians know they are providing the best care for their
patients and that the consumers of health care know that they can have
access to good-quality care.
The time to act is now. I join many of my colleagues on an almost
daily basis in urging that we take up this matter quickly and that we
move forward decisively and pass comprehensive managed care for all of
our citizens, but particularly for our children.
I thank you, Mr. President. I yield my time.
Mr. ROTH. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. GRAHAM. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
____________________