[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.

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