[Congressional Record Volume 144, Number 59 (Tuesday, May 12, 1998)]
[Senate]
[Pages S4644-S4651]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  WOMEN'S HEALTH AND CANCER RIGHTS ACT

  Mr. D'AMATO. I yield 10 minutes to the Senator from California, 
Senator Feinstein.
  The PRESIDING OFFICER. Is there objection?
  Mr. BAUCUS addressed the Chair.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. D'AMATO. Regular order. I believe under the regular order I 
control up to an hour.
  The PRESIDING OFFICER. The Senator is correct.
  Mr. BAUCUS. Mr. President, I make a point of order.
  Mr. D'AMATO. Mr. President, I yield to the Senator from California, 
for up to 10 minutes, for a question.
  Mr. FORD. Mr. President, take charge and give direction to these 
Senators.
  The PRESIDING OFFICER. The Senator from New York has been recognized 
under the regular order. The Senator from New York does not control the 
floor. If he seeks to yield time, that requires a unanimous consent.
  Is there objection to yielding time?
  Mr. D'AMATO. Mr. President, my colleague from California has a 
question. I would like to yield for a question to the Senator from 
California.
  Mrs. FEINSTEIN addressed the Chair.
  The PRESIDING OFFICER. The Senator from New York has a right to yield 
for a question. The Senator from California.
  Mrs. FEINSTEIN. Mr. President, I would like to ask the Senator from 
New York a question.
  As I recall, we introduced this amendment as a bill on January 30, 
1997. That was 16 months ago. The Patients' Bill of Rights, I believe, 
was introduced on March 31st of this year. Is that not correct?
  Mr. D'AMATO. Would the Senator----
  Mrs. FEINSTEIN. My question about when we introduced this bill, a 
bill that would give a woman and her physician the right to determine 
the length of a hospital stay when she has a mastectomy, and quite 
possibly a radical mastectomy. The length of stay in the hospital would 
be the decision of her physician, not the HMO; we introduced this bill 
16 months ago. Correct? The Patients' Bill of Rights was introduced in 
March of this year. Is that not correct?
  Mr. D'AMATO. That is correct. The Senator is correct. We introduced 
this on January 30, 1997.
  Mrs. FEINSTEIN. And, am I correct in that the Senate Finance 
Committee held a hearing on our bill on November 5, 1997?
  Mr. D'AMATO. That is also correct. And the Senator testified--the 
Senator from California came and gave some very cohesive and forceful 
testimony as to the need for this legislation.
  Mrs. FEINSTEIN. Is it not true that we have filed this bill to be 
considered by the Senate two times and you offered it in the Finance 
Committee two times? On March 16, we filed it as an amendment to H.R. 
2646, the Parent and Students Savings Account Plus Act. Is that not 
correct?
  Mr. D'AMATO. Absolutely. The Senator is absolutely correct.
  Mrs. FEINSTEIN. On May 6, we filed it as an amendment to H.R. 2676, 
the IRS restructuring bill. Is that not correct?
  Mr. D'AMATO. That is absolutely correct.
  Mrs. FEINSTEIN. And on March 31 and on February 10 of this year, did 
my colleague not offer it as an amendment in the Finance Committee?
  Mr. D'AMATO. I did. I did. My colleague is right. We brought it to a 
vote.
  Mrs. FEINSTEIN. Is it not true that the Senator has been unable to 
get the Finance Committee to move this bill to the floor?
  Mr. D'AMATO. Absolutely true. Again, procedurally this is raised, 
just as an analogy, as is being done here--there they raised 
germaneness, and, unfortunately, they kept the women of America from 
having the opportunity to have this bill considered at that time. That 
is correct.
  Mrs. FEINSTEIN. Is it not true that the D'Amato-Feinstein mastectomy 
bill has 21 cosponsors, including a bipartisan group of women 
Senators--Senators Snowe, Moseley-Braun, Hutchison, Mikulski, and 
Boxer?
  Mr. D'AMATO. Absolutely. It is a bipartisan effort. It has been that 
way. I applaud my colleague from California for her leadership in this 
matter. We have done this and conducted this in a manner that has 
sought to eliminate politics and think about the women of America and 
the families of America, because we are talking about a disease and 
procedures that are hurting, harming the families of America.
  Mrs. FEINSTEIN. I would like the Senator from New York to know that I 
am a cosponsor, also, of the Patients' Bill of Rights Act. I understand 
the importance of this bill. I would very much welcome floor time to 
consider this bill as well.
  However, I did indicate in our Democratic caucus that absent that 
opportunity, and because women all across this Nation are going through 
some of the same events that two women who brought this to my attention 
3 years ago in California went through, and that is to show up to have 
a radical mastectomy at 7:30 in the morning, and then to be pushed out 
on the street at 4:30 that afternoon with drains in them, the effects 
of anesthetics still upon them, really unable even to walk--is it not 
true that what we strive to do is make a simple reform and say that no 
woman without the permission of her physician will be subject to this 
kind of treatment ever again in the United States of America?
  Mr. D'AMATO. The Senator from California is absolutely correct.
  Let me say that we worked long and hard on this. We have many of our 
colleagues who, because of their commitment to deal with this--it is 
tragic when it hits a family it has so much of an impact--said you have 
to have at least 48 hours. In other words, 72 hours. And we finally 
have been working with the people in the medical community, and I must 
say we built a consensus where we recognize that we should not put any 
time limitation whatsoever.
  If I might, Mr. President, we have the Senator from Montana who is 
waiting to make a statement. Might I propound a unanimous consent 
request that he be permitted to speak for up to 3 or 4 minutes as if in 
morning business, and that might we also have an additional 5 minutes 
then--we started late--so that he could make his statement, and then 
without my losing the right to continue and to hold the floor and 
continue our discussion with respect to this?
  Mr. KENNEDY. Reserving right to object, I don't want to object. I 
would like to have a very brief time to be able to respond. I think, as 
I understand it, at 11 o'clock under the consent agreement we are going 
to the agricultural matter.
  Mr. D'AMATO. That is why I asked for an additional 5 minutes.
  Mr. KENNEDY. I would like to see if we could have, say, 15 minutes to 
be able to respond to that time.
  Mr. D'AMATO. Unfortunately, I am not in a position to agree to that. 
Let me say this to Senator Kennedy. Let's say that in one-half hour we 
would yield to the Senator from New York 10 minutes. Is that fine?
  Mr. KENNEDY. That would be very generous.

[[Page S4645]]

  Mr. D'AMATO. Could Senator Baucus' remarks be contained in morning 
business without interrupting the debate for up to 5 minutes?
  The PRESIDING OFFICER. Is there objection? Without objection, it is 
so ordered.
  Mr. BAUCUS. Mr. President, I thank all Senators very much for 
accommodating me.
  First of all, I hope that the bill to be offered by the Senator from 
California and the Senator from New York will be brought up quickly and 
passed. I think every Member of the Senate does. I very much favor it. 
At the same time, I very strongly believe the Patients' Bill of Rights, 
the basic protection bill, we have to pass that. It is very 
regrettable, frankly, that we are at loggerheads. We need to get that 
bill passed. I think we should work that out fairly soon. Frankly, it 
is in the interest of the American people we get this passed very 
quickly. But it is not going to be resolved right now.
  By unanimous consent, the remarks of Mr. Baucus pertaining to 
``Montana Pole Vaulters'' are printed in today's Record under ``Morning 
Business.''
  Mr. D'AMATO. Mr. President, might I ask unanimous consent that 
Senator Johnson from South Dakota be given 3 minutes to speak on this 
issue?
  Mr. DORGAN. Mr. President, reserving the right to object, my 
understanding is that the order by unanimous consent at 10 o'clock 
required that Senator D'Amato be recognized to propound a unanimous 
consent request; not that Senator D'Amato be recognized between 10 and 
11 o'clock. I am wondering. Am I correct on that?
  Mr. D'AMATO addressed the Chair.
  The PRESIDING OFFICER. The order provides for the recognition of 
Senator D'Amato of New York.
  Mr. D'AMATO. I believe I was going to be recognized, and indeed I am 
attempting to accommodate this. I could speak for this 1 hour. I am 
attempting to accommodate the needs of my colleagues. That is why I 
yielded 10 minutes. I am prepared to yield 10 minutes to Senator 
Kennedy. The time is clicking off here.
  Mr. DORGAN. I will not object. But my understanding of the UC was 
that the Senator from New York would be recognized to propound a 
unanimous consent request at which point the floor would be open. I 
guess I understand the Senator from New York intends to retain the 
floor until 11 and simply by consent allow others to speak for a 
certain amount of time.
  Mr. D'AMATO. Yes.
  Mr. DORGAN. He certainly has that right. Under the unanimous consent 
agreement he has the right of recognition. So I will not object.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. JOHNSON. Mr. President, I thank the Senator from New York and the 
Senator from California for their extraordinary work on this important 
legislation.
  Mr. President, frankly, I have to share a great level of frustration, 
and to be candid, anger at where we find ourselves this morning: unable 
to move forward with the breast cancer legislation for which there is 
broad bipartisan support and little controversy. I have more than 
simply a public policy concern about this issue. I have a personal 
concern in my own family, having gone through my wife's breast cancer 
challenge over the past 2 years. She is doing very well. But we had a 
situation where she remained in the hospital for one night following 
surgery. She went home with the drains, and the other complications. We 
were able to do that all right because we don't have small children at 
home. We had no complications. But I know of other women in my State of 
South Dakota who have small children at home who cannot take a great 
amount of time from work, who have no extra help, who have extra 
complications, and who have all sorts of matters that are debilitating 
that cause complications. And 24 hours for many of them is simply not 
adequate. We have an opportunity here to correct that problem. This 
doesn't correct everything.
  I share the support of the Senator from California for the Patients' 
Bill of Rights. I am frustrated, as well, that we haven't made greater 
progress there. I hope that before this session is over we will in fact 
deal with the more comprehensive health care reform legislation.
  I applaud Senator Daschle's leadership on the Patients' Bill of 
Rights legislation. But I do not want to make the perfect the enemy of 
the good. What we have here is a piece of legislation which we should 
be able to pass this very day.
  It is certainly my hope, while we have the continued discussion about 
a more comprehensive approach to managed care and ensuring the rights 
of all patients, that before this session of the 105th Congress 
expires--and we are running out of time quickly--that, in fact, we get 
this breast cancer bill to the floor and deal with it in an expeditious 
fashion.
  Again, I simply want to applaud the leadership of the Senators from 
California and New York on this issue, one that we really should not 
allow to be delayed longer than it already has.
  I yield my time.
  Mr. D'AMATO addressed the Chair.
  The PRESIDING OFFICER. The Senator from New York.
  Mr. D'AMATO. Mr. President, I ask unanimous consent that the time be 
extended until 11:05, because we did not start nearly on time, and I 
further ask unanimous consent that Senator Kennedy be recognized now 
for up to 10 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. KENNEDY. Mr. President, I yield myself 7 minutes.
  Mr. President, let me be clear: I am all in favor of Senator 
D'Amato's bill. Its provisions are included in the Patients' Bill of 
Rights. I was an original cosponsor of Senator Daschle's legislation, 
which preceded the legislation authored by my colleague from New York, 
that guaranteed breast cancer patients a minimum length of stay in the 
hospital following a mastectomy. And I worked with the breast cancer 
community--patients and providers--to write and introduce a bill that 
would require plans that cover mastectomies to also cover 
reconstructive surgery, prostheses and treatment for lymphedema, a 
complication of the surgery. In fact, Senator D'Amato modified his 
original bill, which covered only reconstructive surgery, to conform it 
more closely to mine. We share a commitment to this legislation.
  But his proposal does not include other provisions that are in our 
bill and which are equally important to breast cancer patients, their 
families and their doctors. The following protections, all of which are 
in the Patients' Bill of Rights remain unaddressed in the legislation 
proposed by Senator D'Amato:
  It does not guarantee access to specialists--provisions that would 
allow an oncologist to act as a cancer patient's care coordinator, or 
would allow a patient to see an oncologist directly, without first 
making an unnecessary visit to a so-called ``gatekeeper.''
  It does not ensure for a smooth transition between new and existing 
doctors for breast cancer patients and survivors whose employers change 
plans or whose plans change providers in the network.
  It does not include access to and coverage of participation in 
clinical trials, which can so often mean the difference between life 
and death for patients with nowhere else to turn.
  It does not establish the right to an independent and timely appeal--
a critical feature for those times when coverage decisions fall into a 
grey area.
  It does not create access to prescription drugs that are not on the 
formulary, if they are medically indicated in the case at hand.
  It does not guarantee that emergency care will be covered, provided a 
layperson believed they were in an emergency.
  With the limited exception for post-mastectomy length-of-stay 
determinations, it does not fully restore the doctor-patient 
relationship by returning treatment decisions to the attending 
physician.
  Finally, it does not allow patients to hold health plans accountable 
for their medical decision-making.
  Clearly, the problems are not with what is in the bill, but with what 
is not in the bill.
  We are effectively precluded from including these particular 
provisions in the D'Amato proposal. And that is why these matters are 
linked, Mr. President. The items contained in our Patient Protection 
Act are critically important to breast cancer patients and

[[Page S4646]]

survivors. Our bill has the broad support from virtually all the 
various cancer groups and breast cancer groups. But, if we move forward 
on only those included in the D'Amato proposal, we effectively preclude 
movement on the rest of the provisions.
  One can say, ``Well, we are still making some progress.'' I 
understand, but there is no reason in the world--none, no reason--that 
we cannot include these particular provisions for women today--none, 
make no mistake about it.
  We have had eight hearings on the issues relating to the Patients' 
Bill of Rights. I introduced the original legislation on this issue 
more than a year ago--over a year ago. The President's advisory 
commission, which included among its members representation from the 
business community and insurance industry, reported unanimously last 
November about what ought to be included in a patients' bill of rights. 
We have incorporated their recommendations in our bill. They are needed 
today by women across this country.
  All we are asking is for the opportunity to have the Senate debate 
and go on record with regard to these kinds of protections. But we are 
foreclosed from acting today. We are denied doing it. We cannot even 
get a reasonable period of time. The Republican leadership is sitting 
somewhere in this building. They could have listened to the exchange 
that was done by the Democratic leader and the Senator from New York. 
They know what is going on on the floor of the U.S. Senate. They can 
just come out here and say, ``All right, you got it, you are going to 
have an opportunity to debate this issue; we won't have a time 
limitation, call the roll and let's have a debate on what is the No. 1 
issue before American families.'' But, no, we are precluded from that.
  You don't have to be around here a great deal of time to understand 
what is going on. We are effectively excluded because of the power of 
the insurance industry. Do you hear that? We are excluded from having 
an opportunity to debate this because of the power of the insurance 
industry. That is what is going on here. That is the issue this morning 
on the floor of the U.S. Senate.
  The industry does not want to provide patients with the protections 
to which they are entitled and have paid for, and their allies in the 
Senate are holding this up, Mr. President, by using parliamentary 
techniques to deny us the chance to consider this legislation. We 
cannot get a report out of our Labor and Human Resources Committee. We 
cannot take it up on the floor of the U.S. Senate. It is time for 
action, and we are denied an opportunity, not just today, not just 
tomorrow, not just June, but anytime whatsoever--whatsoever.
  We are asking the Republican leadership to give us a time. Call the 
Democratic leader. Bring it up in 2 days. Bring it up in 2 weeks. Bring 
it up in a month. But give us a time to bring this up. That is what 
this issue is all about, and that is where we are going, Mr. President. 
We will bring this issue up time in and time out, again and again. We 
may be foreclosed now, but the American people are going to demand it. 
Those women who have or have had breast cancer are going to understand 
it and demand it as well.
  I yield the remaining time to the Senator from California.
  I thank the Senator from New York for granting the time.
  Mrs. BOXER. Mr. President, how much time remains?
  The PRESIDING OFFICER. Four minutes 15 seconds.
  Mrs. BOXER. Mr. President, I say to my colleague, I will reserve 2 
minutes for him.
  Sometimes we set up false fights, and it is a real false fight 
between those who want to ban drive-through mastectomies, which I would 
guess is every single Senator in this Chamber, and those who want to go 
even further and grant patients protections across the board for breast 
cancer patients, prostate cancer patients, children, the elderly, 
anyone who gets sick. There is no fight. Why are we having a fight? We 
are having a fight because, as the Senator from Massachusetts has said, 
we are unable to make this a broader bill.

  I am very proud to be a sponsor of the D'Amato-Feinstein bill, and I 
am going to be very excited when this bill becomes law, and it will 
become law.
  We need to do more, and there is no reason why the leadership of the 
Senate won't give us that opportunity, except that there are many 
special interests who don't want us to do more, who are pocketing--into 
deep pockets--profits on a HMO system that shortchanges patients, and 
that is wrong.
  I was visited by a man named Harry Christie. I have told his story on 
the Senate floor before. His daughter was diagnosed with a rare tumor 
in her kidney. She was 9 years old. There were two doctors who had 
experience operating on that type of tumor. His HMO said, ``That's too 
bad, you have to go with a general surgeon.''
  He said, ``This is my only child.''
  And they said, ``You're out of luck.''
  Fortunately, Mr. Christie was able to come up with the $50,000 he 
needed, and he saved his daughter's life. Six years later, she is alive 
and, yes, the HMO was fined a hefty sum by the State of California. If 
Mr. Christie had listened to the HMO, he might not have his daughter 
today.
  All the Senator from Massachusetts and the Democratic leader are 
saying is we love this mastectomy bill, we want to help you get this 
bill through, but help us, help us do more. We can stop a woman from 
having to go through a horrific, outrageous, demeaning, dangerous 
drive-through mastectomy, and we will with this bill. But what happens 
when she is out of hope a couple of years later, and she needs to get 
into a clinical trial where she can have access to certain drugs 
because nothing else is working? The mastectomy bill is narrow, it 
doesn't address that. The broader patient rights bill addresses it.
  I want to speak to the issue of the dates when these various bills 
were put into the hopper, because Senator Feinstein made a good point 
on that. However, Senator Kennedy had a bill that was offered before 
the drive-through mastectomy bill. Others had bills that were offered 
before as well. We don't need to have this argument which pits one 
against the other. We should be able to pass this bill banning drive-
through mastectomies, and allow it to be amended to take up these 
broader issues, so that if someone has chest pains and goes to the 
emergency room, they are not going to be told by their HMO that they 
can't qualify for a payment because, guess what, they didn't actually 
die and have a heart attack, they actually lived. But it was a prudent 
person who made that decision to walk into that emergency room. Why 
should they be penalized?
  I am very hopeful we will pass this drive-through mastectomy bill, 
but also a broader Patients' Bill of Rights for breast cancer patients, 
for prostate cancer patients, for Alzheimer's patients, for all the 
patients, and let's not set up a false argument here. We can do both. 
Somebody once said you should be able to walk and chew gum at the same 
time. Well, we should be able to do this very narrow bill and then 
debate a broader bill and give all of our patients the protection they 
so richly deserve.
  I yield the remaining time to Senator Kennedy.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. D'AMATO. Mr. President, I ask unanimous consent that my colleague 
from California, Senator Feinstein, be recognized for 5 minutes.
  The PRESIDING OFFICER. The Senator from California.
  Mrs. FEINSTEIN. I thank the Senator from New York.
  I must say that I think what is happening here is unfortunate. I 
think what we are seeing overwhelmingly all across the United States is 
a state of medical care and health insurance in this country that is 
becoming much more oriented toward business and much less oriented 
toward medicine. And this is prompting, I think, all across this land a 
terrible situation for physicians and for patients.
  What prompted me to introduce this bill was two California women who 
wrote to me. I want to read them to you and enter their full statements 
in the Record.
  One was from a woman in Newark, CA. And she wrote--and this was 
almost 2\1/2\ years ago--that she had a modified radical mastectomy as 
an outpatient at the Fremont Kaiser outpatient clinic. She was operated 
on at

[[Page S4647]]

11:30 in the morning and was released at 4:30 that afternoon, with no 
attempt made to see if she could even walk to the bathroom. She was 60 
years old. And the discovery of cancer and the subsequent surgery were 
extremely draining both emotionally and psychologically.
  That is one case. Same day. Let me read you about another case.

       My mastectomy and lymph node removal took place at 7:30 
     a.m., November 13. I was released at 2:30 p.m. that same day. 
     I received notice, the day before surgery, from my doctor 
     that mastectomy was an outpatient procedure at Kaiser and I'd 
     be released the same day. Shocked by this news, I told my 
     surgeon of my previous complications with anesthesia and the 
     fact that I have a cervical spine condition, which adds an 
     additional consideration for any surgery.

  Then she goes on and she says:

       While in a groggy, postoperative daze, swimming in pain and 
     nausea, I was given some perfunctory instructions on how to 
     empty the two bloody drains attached to my body. I was told 
     to dress myself and go home. My doctor's written chart 
     instructions for a room assignment, if I developed acute 
     nausea or pain, were ignored by the nursing staff.

  This is the problem we are trying to stop right here and now. I 
frankly am sorry that the bill isn't broader. But this is something 
whose cost is small--$100 million. We know it can be accommodated. We 
know we can get the job done.
  This bill is simple. It requires every insurance plan in the United 
States of America to cover the hospital length of stay determined by 
the physician to be medically necessary. It does not prescribe a fixed 
number of days. It does not set a minimum. It leaves the length of the 
hospital stay for the mastectomy up to the treating physician.
  Secondly, it requires health insurance plans to cover breast 
reconstruction following a mastectomy.
  Thirdly, it requires insurance plans to cover breast prostheses and 
complications of mastectomy, including lymphedema.
  And, finally, it prohibits insurance plans from financially 
penalizing or rewarding a physician for providing medically necessary 
care or for referring a patient for a second opinion.
  This is a simple bill. It is a direct bill. It is going to directly 
benefit the lives of tens of thousands of women. I regret that it isn't 
more comprehensive. But we know it is doable, we know what it does, and 
we know women will immediately be better off because of it.
  So I am very proud to stand here with my colleague from New York and 
with others in the Senate. The great bulk of women Senators are 
supporting this. This is tangible; it is doable. We believe it can 
become law quickly. And we say, let us seize the moment and let us 
accomplish at least this for women of America.
  So I thank my colleague from New York for his authorship. I was very 
proud to be an original sponsor on this bill. We did have a hearing. We 
have tried to get the job done before, but hopefully it will get done 
this morning.
  As an original cosponsor of S. 249, the Women's Health and Cancer 
Rights Act, I am pleased to sponsor the amendment on mastectomy 
hospital length of stay that Senator D'Amato is urging the Senate to 
consider. It is time to pass it.
  Senator D'Amato and I introduced this amendment as a bill on January 
30, 1997, 16 months ago. The Senate Finance Committee held a hearing on 
the bill, S. 249, on November 5, 1997. We have filed this as an 
amendment, to be considered by the Senate, three times:
  On March 16, we filed it as an amendment to H.R. 2646, the Parent and 
Student Savings Account PLUS Act.
  On May 6, we filed it as an amendment to H. R. 2676, the IRS 
restructuring bill.
  On March 31 and on February 10 of this year, Senator D'Amato offered 
it as an amendment in the Finance Committee.
  In sum, we have made numerous efforts to get the Senate to consider 
this bill.
  The D'Amato-Feinstein mastectomy bill has 21 cosponsors, including a 
bipartisan group of women Senators: Senators Snowe, Moseley-Braun, Kay 
Bailey Hutchison, Mikulski and Boxer.
  This amendment has four important provisions: For treatment of breast 
cancer:

       1. It requires insurance plans to cover the hospital length 
     of stay determined by the physician to be medically 
     necessary. Importantly, our bill does not prescribe a fixed 
     number of days or set a minimum. It leaves the length of 
     hospital stay up to the treating physician.
       2. It requires health insurance plans to cover breast 
     reconstruction following a mastectomy.
       3. It requires insurance plans to cover breast prostheses 
     and complications of mastectomy, including lymphodemas. For 
     treatment of all cancers:
       4. It prohibits insurance plans from financially penalizing 
     or rewarding a physician for providing medically necessary 
     care or for referring a patient for a second opinion

  Let me share with you two firsthand experiences, two California women 
describing their treatment by insurance companies in having a 
mastectomy.
  Nancy Couchot, age 60, of Newark, California, wrote me that she had a 
modified radical mastectomy on November 4, 1996, at 11:30 a.m. and was 
released by 4:30 p.m. She could not walk and the hospital staff did not 
help her ``even walk to the bathroom.'' She says, ``Any woman, under 
these circumstances, should be able to opt for an overnight stay to 
receive professional help and strong pain relief.''
  Victoria Berck, of Los Angeles, wrote that she had a mastectomy and 
lymph node removal at 7:30 a.m. on November 13, 1996, and was released 
from the hospital 7 hours later, at 2:30 p.m. Ms. Berck was given 
instructions on how to empty two drains attached to her body and sent 
home. She concludes, ``No civilized country in the world has mastectomy 
as an outpatient procedure.''
  These are but two examples of what, unfortunately, is symptomatic of 
a growing trend and a national nightmare--insurance plans interfering 
with professional medical judgment and arbitrarily reducing care 
without a medical basis.
  Premature discharges for mastectomy, with insurance plans strong-
arming physicians to send women home, are one glaring example of the 
growing torrent of abuses faced by patients and physicians who have to 
``battle'' with their HMOs to get coverage of the care that physicians 
believe is medically necessary.
  Increasingly, insurance companies are reducing inpatient hospital 
coverage and pressuring physicians to discharge patients who have had 
mastectomies. This is beyond the pale. It is unconscionable.
  The Wall Street Journal on November 6, 1996, reported that ``some 
health maintenance organizations are creating an uproar by ordering 
that mastectomies be performed on an outpatient basis. At a growing 
number of HMOs, surgeons must document `medical necessity' to justify 
even a one-night hospital admission.''
  A July 7, 1997 study by the Connecticut Office of Health Care Access 
found the average hospital length of stay for breast cancer patients 
undergoing mastectomies decreased from three days in 1991 and 1993 to 
two days in 1994 and 1995. This study said, ``The percentage of 
mastectomy patients discharged after one-day stays grew about 700 
percent from 1991 to 1996.''
  In the last ten years, the length of overnight hospital stays for 
mastectomies has declined from 4 to 6 days to 2 to 3 days to, in some 
cases, ``no days.'' The average cost of one day in a community hospital 
in 1995 nationwide was $968.00. In California, in 1997, the average 
cost for one day was $1,329.77. When insurance plans refuse to cover a 
hospital stay, most Californians have difficulty coughing up $1,300.00. 
They are forced to go home.

  In 1997, over 180,000 women (or one in every 8 American women) were 
diagnosed with invasive breast cancer and 44,000 women died from breast 
cancer. Only lung cancer causes more cancer deaths in American women. 
2.6 million American women are living with breast cancer today.
  In my state, this year, 19,399 women will be diagnosed with breast 
cancer and 4,585 will die. The San Francisco Bay Area has some of the 
highest rates of breast cancer in the world. According to the Northern 
California Cancer Center, San Francisco's 9-county area's rate of 
breast cancer in 1994 was 50 percent higher than most European 
countries and 5 times higher than Japan. In September 1997, the 
Northern California Cancer Center gave us some mixed news: ``The good 
news is we're seeing the rates go down. The bad news is we don't know 
why,'' said Angela Witt

[[Page S4648]]

Prehn. But officials there say, the bottom line is that incidence rates 
are still higher than national rates.
  After a mastectomy, patients must cope with pain from the surgery, 
with drainage tubes and with psychological loss--the trauma of an 
amputation. These patients need medical care from trained 
professionals, medical care that they cannot provide themselves at 
home.
  A woman fighting for her life and her dignity should not also be 
saddled with a battle with her health insurance plan. A physician 
trying to provide medically necessary care
  As the National Breast Cancer Coalition wrote me on March 12, 1998: 
``The NBCC applauds this effort and believes this compromise will put 
an end to the dangerous health insurance practices that allow cost and 
not medical evidence to determine when a woman leaves a hospital after 
breast cancer surgery.''
  Insurance plans also refuse to cover breast reconstruction and breast 
prostheses. Our bill requires coverage.
  Joseph Aita, Executive Vice President and Medical Director of 
LifeGuard, was quoted in the San Jose, California, Mercury News, as 
saying ``Looking normal is not medically necessary.''
  Let me contradict Mr. Aita. Looking normal is medically necessary. 
Breast reconstruction is important to recovery. According to Dr. Ronald 
Iverson, a Stanford University surgeon, ``Breast reconstruction is a 
reconstructive and not a cosmetic procedure.''
  He cites a study which found that 84 percent of plastic surgeons 
reported up to 10 patients each who were denied insurance coverage for 
reconstruction of the removed breast. This could mean 40,000 cases per 
year.
  Commendably, my state has enacted a law requiring coverage of breast 
reconstruction after a mastectomy. We need a national standard, 
covering all insurance policies. Let's follow California's need.
  Finally, our amendment prohibits insurance plans from including 
financial or other incentives to influence the care a doctor's 
provides, similar to a law passed by the California legislature last 
year. Many physicians have complained that insurance plans include 
financial bonuses or other incentives for cutting patient visits or for 
not referring patients to specialists. Our bill bans financial 
incentives linked to how a doctor provides care. Our intent is to 
restore medical decision-making to health care.
  For example, a California physician wrote me, ``Financial incentives 
under managed care plans often remove access to pediatric specialty 
care.'' A June 1995 report in the Journal of the National Cancer 
Institute cited the suit filed by the husband of a 34-year old 
California woman who died from colon cancer, claiming that HMO 
incentives encouraged her physicians not to order additional tests that 
could have saved her life.
  Our amendment today tries to restore professional medical 
decisionmaking to medical doctors, those whom we trust to take care of 
us. It should not take an act of Congress to guarantee good health 
care, but unfortunately that is where we are today. As the National 
Breast Cancer Coalition wrote us on March 12, ''. . . until guaranteed 
access to quality health care coverage and service is available for all 
women and their families, there are some very serious patient concerns 
that must be met. Without meaningful health care reform, market forces 
propel the changes in the health care system and women are at risk of 
being forced to pay the price by having inappropriate limits placed on 
their access to quality health care.''
  This amendment is an important protection for millions of Americans 
who face the fear, the reality and the costs of cancer every day. When 
any cancer strikes, it is not just the victim who suffers. It becomes a 
family matter.
  Today I say, enough is enough. It is time for this Senate, for this 
Congress to send a strong message to insurance companies that we must 
put care back into health care. Medical decisions must be made by 
medical professionals, not anonymous insurance clerks.
  I ask unanimous consent to have items I referred to previously 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                    Newark, CA, November 16, 1996.
     Senator Feinstein.
     Senator Boxer.
       I recently called your office to express my anger at having 
     been forced on Nov. 4 to have a modified radical mastectomy 
     as an outpatient at the Fremont Kaiser Outpatient Clinic. I 
     was operated on at 11:30 am and was released by 4:30 with no 
     attempt made to see if I could even walk to the bathroom.
       I am 60 years old and the discovery of cancer and the 
     subsequent surgery was extremely draining both emotionally 
     and psychologically. I feel that Kaiser completely 
     disregarded these feelings, along with my fear of coming home 
     so soon with no professional help. We received a call from 
     Kaiser the following morning but visit by a home health 
     nurse.
       Any woman, under these circumstances, should be able to opt 
     for an overnight stay to receive professional help and strong 
     pain relief.
       I am interested in your view of this issue. Contact me if 
     you want further details.
                                                    Nancy Couchot.

       Sorry I am still wobbly writing.
                                  ____


              [From the Los Angeles Times, Nov. 21, 1996]

                     Outpatient Mastectomy Surgery

       My thanks to Ellen Goodman for ``The Latest HMO Outrage: 
     Drive-Thru Mastectomy'' (Commentary, Nov. 18). Last week I 
     became an uninformed victim of this inhumane practice at 
     Kaiser-Permanente, Los Angeles.
       I want to acquaint women with my firsthand experience of 
     this degradation and urge my fellow HMO patients to contact 
     their Washington legislators.
       My mastectomy and lymph node removal took place at 7:30 
     a.m., Nov. 13. I was released at 2:30 p.m. that same day. I 
     received notice, the day before surgery, from my doctor that 
     mastectomy was an outpatient procedure at Kaiser and I'd be 
     released the same day. Shocked by this news, I told my 
     surgeon of my previous complications with anesthesia and the 
     fact that I have a cervical spine condition, which adds an 
     additional consideration for any surgery. The pleasant doctor 
     assured me that I'd be admitted, for the night, if I 
     experienced excessive pain or nausea. This was noted in my 
     chart.
       In the recovery room and the holding area, I felt like a 
     wounded soldier in a hospital tent during the Civil War. I 
     was surrounded by moaning patients and placed directly next 
     to a screaming infant. When I finally found a voice, I 
     shouted, ``Get me out of here!'' A nurse flitted by, shot me 
     a disapproving glance, and commented, ``Some folks just don't 
     know when to be grateful.'' This was the ultimate 
     humiliation.
       While in a groggy, postoperative daze, swimming in pain and 
     nausea, I was given some perfunctory instructions on how to 
     empty the two bloody drains attached to my body. I was told 
     to dress myself and go home. My doctor's written chart 
     instructions for a room assignment, if I developed acute 
     nausea or pain, were ignored by the nursing staff. Obviously, 
     the reassurance had been given to placate me at the time of 
     my discussion with the doctor but everyone knew an overnight 
     stay was against Kaiser hospital rules. Everyone knew, except 
     me. I had no time to mourn the loss of my breast or regain a 
     sense of composure.
       This experience was especially shocking because four years 
     previously, I had undergone a hysterectomy and received 
     excellent treatment and a four-night stay at the very same 
     Kaiser facility.
       We women can allow ourselves to be discounted or we can 
     demand more from the HMOs. No civilized country in the world 
     has mastectomy as an outpatient procedure.
                                                   Victoria Berck.

  Mrs. FEINSTEIN. I yield the floor.
  Mr. D'AMATO. Mr. President, I ask unanimous consent that the Senator 
from Maine, Senator Snowe, be recognized to speak for up to 5 minutes.
  The PRESIDING OFFICER. The Senator from Maine is recognized.
  Ms. SNOWE. Thank you.
  Mr. President, I thank Senator D'Amato for yielding me such time. I 
want to applaud him for his leadership on this very important issue for 
women in America. And I thank my colleague, Senator Feinstein, for her 
leadership as well and commitment that she has demonstrated on this 
issue.
  Mr. President, I regret that we have reached a point here where we 
cannot pass one bill because it is being held hostage to another. No 
one disagrees with the Senator from Massachusetts in terms of the 
importance of some of the issues that he has raised with respect to a 
Patients' bill of rights. But this legislation should not be held 
hostage to that legislation.
  We all know that there are many questions with respect to the 
approach that he has taken--relevant questions, understandable 
concerns--that should be appropriately discussed and explored in the 
committee process and then ultimately here on the floor. But this 
should not hold up this particular bill. And Senator D'Amato is 
absolutely correct, we should move forward, because this has strong 
bipartisan support.

[[Page S4649]]

  There is not a Senator on the floor who would not support this 
legislation. So the women of America should not be held hostage because 
of internal divisions, because of parliamentary maneuvers, because of 
legislative gridlock.
  This legislation has the support of Democrats as well as Republicans. 
We have 180,000 women every year who are diagnosed with breast cancer. 
One in eight women in their lifetime will be detected with breast 
cancer. We have now discovered that, in many instances, mastectomies 
are being performed on an outpatient basis, and we need to take action 
to prevent that. Mastectomies are very complicated surgical procedures.
  There is no way that that is a decision that should be made by a 
bureaucrat; but rather, the length of a woman's stay in a hospital, how 
that procedure will be handled, should be determined by her as well as 
her doctor. Those are the only two individuals who ought to be making 
that decision. It should not be a bureaucrat's bottom line.
  We have found time and time again women who have had to endure this 
procedure on an outpatient basis. The physical scars left by 
mastectomy, which can be complicated and difficult to care for, often 
require supervision. Women prematurely released may not have the 
information they need, let alone the care. And dangerous complications 
have arisen hours after the operation. And all of this is occurring 
within the context of a traumatic circumstance, and that is having a 
mastectomy. We want to make sure that this decision is made 
appropriately within the confines of medical supervision and medical 
providers.
  We have also found that breast reconstructive surgery is considered 
cosmetic surgery. Well, it is not. Forty-three percent of women who 
want to undergo breast reconstructive surgery cannot because it is 
deemed cosmetic. And that is wrong. Breast reconstructive surgery is 
designed to restore a woman's wholeness. Fortunately, my State has 
passed legislation to guard against that and to require health 
insurance companies to consider it as breast reconstructive surgery. 
But unfortunately for those who are employed by those who are self-
insured, they do not receive this kind of coverage.
  That is why this legislation that is offered by Senator D'Amato is so 
essential. We cannot allow women to have to endure this kind of 
decisionmaking under the most arduous circumstances because of the 
indecision and the difficulties that have arisen here.
  This legislation had a hearing back in November of 1997 before the 
Senate Finance Committee. We are entitled to get this legislation 
through the legislative process. In fact, the President, during his 
State of the Union Address in January of 1997, had a physician in the 
gallery who drew attention to the need to change the guidelines that 
had encouraged outpatient masectomies. Therefore, he called on Congress 
in January of 1997 to pass this legislation.
  The PRESIDING OFFICER. The time of the Senator has expired.
  Ms. SNOWE. I thank Senator D'Amato for his leadership. I urge the 
Senate to move this legislation forward. We will have another day to 
raise the issues raised by the Senator from Massachusetts.
  Mr. D'AMATO. Mr. President, I ask unanimous consent that the Senator 
from Alaska be recognized for 2 minutes.
  The PRESIDING OFFICER. The Senator from Alaska is recognized.
  Mr. MURKOWSKI. Let me commend the chairman on his efforts to bring 
this to the floor. This is the second or third time he has done it. I 
am certainly pleased to be a cosponsor of the Women's Health and Cancer 
Rights Act.
  In our State of Alaska, we have an effort relative to awareness being 
put on by the Breast Cancer Detection Center of Alaska, which has 
provided 25,000 women in 81 villages throughout the State an 
opportunity for free mammograms. This has been done not with government 
support but with private support. We have raised about $830,000 through 
a series of fishing tournaments each year, which some Senators have 
been a party to.
  Mr. President, I think that the significance of this bill, which 
means so much to so many, is that it would put an end to the ``drive-
through'' mastectomies, as we know them today. Many of my colleagues 
have already spoken on this issue. The bill ensures that mastectomy 
patients would have access to reconstruction surgery. Scores of women 
have been denied this procedure because insurers have deemed this 
procedure to be ``cosmetic.'' Far too often, breast cancer victims who 
believe they have adequate health coverage have become horrified when 
they learn that reconstruction is not covered.
  In my State of Alaska, of the 324 mastectomies and lumpectomies 
performed in Alaska in 1996, reconstruction only occurred on 11 of the 
patients. That means that only 3.4 percent of the women who have a 
breast removed have reconstructive surgery, compared to the national 
average of 23 percent.
  The reason is cost, Mr. President. And if we look at one of the 
physicians in my State, Dr. Troxel, of Providence Hospital in 
Anchorage, who states:

       Women who are not able to receive reconstructive surgery 
     suffer from depression, a sense of loss, and need more cancer 
     survivor counseling. . . .Additionally, reconstructive 
     surgery can be preventive medicine--women who don't have 
     reconstructive surgery often develop back problems and other 
     difficulties.

  Mr. President, one out of nine American women will suffer the tragedy 
of breast cancer. It is today the leading cause of death for women 
between the ages of 35 to 54.
  Alaskan women are particularly vulnerable to this disease. We have 
the second highest rate of breast cancer in the nation: 1 in 7 Alaska 
women will get breast cancer and tragically it is the Number One cause 
of death among Native Alaskan women.
  Mr. President, these tragic Alaska deaths are not inevitable. Health 
experts agree that the best hope for lowering the death rate is early 
detection and treatment. It is estimated that breast cancer deaths can 
be reduced by 30 percent if all women avail themselves of regular 
clinical breast examination and mammography.
  But for many Alaska women, especially native women living in one of 
our 230 remote villages, regular screening and early detection are 
often hopeless dreams.
  For more than 20 years, my wife Nancy has recognized this problem and 
tried to do something about it. In 1974, she and a group of Fairbanks' 
women created the Breast Cancer Detection Center, for the purpose of 
offering mammographies to women in remote areas of Alaska--regardless 
of a woman's ability to pay.
  Now, the Center uses a small portable mammography unit which can be 
flown to remote areas of Alaska, offering women in the most rural of 
areas easy access to mammographies at no cost. Additionally, the Center 
uses a 43-foot-long, 14-foot-high and 26,000-pound mobile mammography 
van to travel through rural areas of Alaska. The van makes regular 
trips, usually by river barge, to remote areas in Interior Alaska such 
as Tanana.
  Julie Roberts, a 42-year-old woman of Tanana, who receives regular 
mammographies from the mobile mammography van, knows the importance of 
early screening:

       There's a lot of cancer here (in Tanana)--a lot of cancer. 
     That's why it's important to have the mobile van here . . . I 
     know that if I get checked, I can catch it early and can 
     probably save my life. I have three children and I want to 
     see my grandchildren.

  I am proud to say that the Fairbanks Center now serves about 2,200 
women a year and has provided screenings to more than 25,000 Alaska 
women in 81 villages throughout the state. To help fund the efforts of 
the Fairbanks Center, each year Nancy and I sponsor a fishing 
tournament to raise money for the operation of the van and mobile 
mammography unit. After just three years, donations from the tournament 
have totalled $830,000.
  Mr. President, Nancy and I are committed to raising more funds for 
this important program so that every women in Alaska can benefit from 
the advances of modern technology and reduce their risk of facing this 
killer disease.
  The importance of mammography and screening cannot be stressed 
enough--however, there has long been a tragic result of the disease 
that Congress has either ignored or failed to recognize--and that is 
the so-called ``drive-through'' mastectomy.

[[Page S4650]]

  Currently victims of breast cancer who receive mastectomies are being 
forced to get out of their surgery bed and vacate the hospital only 
hours after their surgery. The reason? Because far too often it is the 
practice of insurance companies to treat the procedure of a mastectomy 
as merely an ``out-patient service.''
  Here's the horror that many insurance companies cause:
  Nancy Couchot, a 60-year-old woman had a radical mastectomy at 11:30 
a.m. She was released from the hospital only hours later at 4:30 p.m.--
even though she was not able to walk or use the rest room without 
assistance.
  Victoria Berck, had a mastectomy and lymph node removal at 7:30 a.m. 
and was released at 2:30 p.m. She was given instructions on how to 
empty two drains attached to her body and sent home. Ms. Berck 
concludes, ``No civilized country in the world has a mastectomy as an 
out-patient service.''
  Mr. President that is why I am proud to co-sponsor of S. 249, the 
Women's Health and Cancer Rights Act. This bill would put an end to the 
drive-through mastectomies.
  Specifically, the Act will require health insurance companies to 
allow physicians to determine the length of a mastectomy patient's 
hospital stay according to medical necessity. In other words, the bill 
makes it illegal to punish a doctor for following good medical judgment 
and sound medical treatment.
  Another important provision of this bill ensures that mastectomy 
patients will have access to reconstructive surgery. Scores of women 
have been denied reconstructive surgery following mastectomies because 
insurers have deemed the procedure to be ``cosmetic'' and, therefore, 
not medically necessary.
  Mr. President, far too often breast cancer victims, who believe that 
they have adequate health care coverage, become horrified when the 
learn that reconstruction is not covered in their health plan.
  In Alaska, the problem is even more tragic. Of the 324 mastectomies 
and lumpectomies performed in Alaska in 1996, reconstruction only 
occurred on 11 of the patients. That means that only 3.4% of women who 
have their breast removed have reconstructive surgery, compared to the 
national average of 23 percent.
  The simple reason for this tragically low figure is simple: women 
can't afford the procedure.
  Breast reconstruction costs average about $5,000 for just the 
procedure. If hospital, physician and other costs are included--the 
cost averages around $15,000.
  Dr. Sarah Troxel, of Providence hospital in Anchorage, states the 
importance of reconstruction:

       Women who are not able to receive reconstructive surgery 
     suffer from depression, a sense of loss, and need more cancer 
     survivor counseling . . . Additionally, reconstructive 
     surgery can be preventative medicine--women who don't have 
     reconstructive surgery often develop back problems and other 
     difficulties.

  Mr. President, insurance companies commonly provide reconstructive 
surgery for other types of cancers that alter or disfigure the surface 
of the skin--such as melanomas and all skin cancers.
  Here is why federal legislation is needed: Thirty-four states, 
including Alaska have no state law requiring breast reconstruction 
after surgery. And in addition, 70 million Americans receive health 
benefits through federally regulated self-funded ERISA plans which are 
not covered by state insurance requirements.
  These issues are not partisan issues. We may have our differences 
regarding managing and financing health reform, but I think we all 
endorse accessible and affordable health care that preserves patient 
choice and physician discretion. Cancer does not look to see the 
politics of its victims.
  Mr. President, I urge my colleagues to support this important 
legislation.
  Mr. FAIRCLOTH. Mr. President, I rise to support the efforts of my 
good friend Senator D'Amato in his efforts to assure that women who 
need surgery for breast cancer will be able to do so in the hospital if 
that's what they desire.
  I'm disturbed by the recent trend that takes choice away from 
patients and their doctors in the name of cost savings.
  There are some things we just can't sacrifice. Patient's rights to 
seek care from specialty doctors and have access to cherished healers 
is a basic right we need to protect.
  Breast cancer is a traumatic enough experience for a woman and her 
family to suffer through. These families need our help in gaining as 
much support from our medical care system as they can get to bring them 
through this terrible time in their lives.
  This bill is simple. It simply guarantees a woman's right to a proper 
length of time in the hospital following her surgery. It guarantees the 
right to have a complete reconstruction of her breast to restore her 
body and sense of self-esteem.
  The bill gives every person diagnosed with cancer the right to a 
second opinion, and would direct the HMO to pay for this second 
opinion. Also, the bill directs HMO's to pay for a specialist even if 
that doctor happens to be outside the plan.
  Lastly, and most importantly, this bill prohibits HMO's from paying 
doctors to reduce or limit their patient care.
  This is managed care's dirty little secret. They pay doctors to limit 
the time spent with their patients and pay doctors not to provide care.
  I've heard from many, many, many constituents and doctors who are 
frustrated with this situation. If a doctor needs to spend time with a 
patient--time essential to healing--if a woman needs to be supported as 
she decides what to do for her breast cancer, I say give them all the 
time they need!
  I rise to support Senator D'Amato's bill today. We need to support 
our doctors and our women and their families.
  Mr. D'AMATO. Mr. President, I believe my colleague from California 
has a question.
  Mrs. FEINSTEIN. Mr. President, I have a question for the author, the 
Senator from New York. I believe this bill has strong support and a low 
cost. Its cause is just and correct, and it would be passed by this 
body overwhelmingly. When might we expect a vote on this bill?
  Mr. D'AMATO. Mr. President, I am glad my colleague raised that 
question. Let me say this: It is disingenuous to say that the women of 
America are being denied proper health care here when something so 
basic and elementary is being tied up by procedures. That is exactly 
what is taking place. This legislation would stop the kind of abuse we 
see taking place every day. I have women calling and saying they are 
being denied reconstructive surgery, being denied the kind of health 
care that everybody agrees on. We have found a methodology of paying 
for this, and it is not right to tie it to something so comprehensive 
and say, ``unless we get this one, we are not going to get the other.''
  The women of America are being denied this. I intend to hold hostage, 
with my colleagues, important legislation that moves through until we 
get a vote on this--whether it is on a defense bill, a tobacco bill, 
appropriations bills. When we come down to the floor and--
  The PRESIDING OFFICER. The time of the Senator has expired.
  Mr. D'AMATO. I ask unanimous consent for an additional 5 minutes.
  The PRESIDING OFFICER (Mr. Roberts). Is there objection?
  Mr. HARKIN. Reserving the right to object, Mr. President. By 
unanimous consent, yesterday, we were supposed to come up with the 
research bill at 11 o'clock. We are up against kind of a time problem 
here. I would like to have some idea as to how soon that will happen. I 
see the chairman of the Agriculture Committee is here. We are here to 
begin our debate. I wonder how much longer can we expect to wait.
  Mr. D'AMATO. Mr. President, I will withdraw my request and ask that I 
be given just 2 minutes, because I have yielded more time to more 
people. I want to set the stage.
  The PRESIDING OFFICER. Is there objection to the Senator's request?
  Mr. KENNEDY. For 2 minutes?
  The PRESIDING OFFICER. Yes.
  Mr. KENNEDY. No.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. D'AMATO. Mr. President, let me say that we have been thwarted 
time and time again, procedurally--by both sides, I might say. But now 
I find what

[[Page S4651]]

took place today absolutely horrendous.
  Again, it is disingenuous to suggest that we would have to consider 
both when one is so clear cut, and the need is so necessary, and women 
are being denied. That is what is going on here. It is wrong. So when 
we have a bill that is going to be acted on, I will come to the floor--
I hope with a number of my colleagues--to offer this legislation as an 
amendment and get a vote. Let the people of America see this. The 
people are going to be so full of pride that we will not allow 
something that is so obviously necessary that they are going to hold it 
hostage, because that is what is taking place with this legislation. It 
has been held hostage, and it is disingenuous to come down here and say 
you have to take this great big piece of legislation or we can't even 
let the women of America have freedom from the fear that they will be 
denied that which they should have--reconstructive surgery and to stay 
in the hospital until their doctor says now is the time to go home, not 
a bean counter, someone who limits you to 24 or 48 hours.

  I hope my colleagues will join with me in this endeavor, making it a 
bipartisan fight to see that the women and families of America get 
justice.
  Mrs. FEINSTEIN. Mr. President, I certainly will. I thank the Senator 
for his leadership and commitment to this issue.

                          ____________________