[Congressional Record Volume 144, Number 79 (Wednesday, June 17, 1998)]
[House]
[Pages H4705-H4709]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          HEALTH CARE REFORM AND THE PATIENTS' BILL OF RIGHTS

  The SPEAKER pro tempore (Mr. Peterson of Pennsylvania). Under the 
Speaker's announced policy of January 7, 1997, the gentleman from New 
Jersey (Mr. Pallone) is recognized for 60 minutes as the designee of 
the minority leader.
  Mr. PALLONE. Mr. Speaker, tonight, once again, I want to talk about 
the issue of managed care reform, and particularly the Democrats' 
proposal called the Patients' Bill of Rights.
  Before I do so, though, I would like to mention that my colleague 
from Texas (Mr. Green) is here to join me in this debate about managed 
care reform or patient protections.

                              {time}  2100

  But I would like to yield to the gentleman at this point, because I 
know he would like to address some of the comments that were made by 
the previous speakers.
  Mr. GREEN. Mr. Speaker, I thank my colleague for yielding, and the 
gentleman from New Jersey understands, we have waited here for our hour 
to be able to talk about managed care, and I think that is much more 
important. But I need to respond after listening to some of the debate.
  We are in a long-term debate, I guess, on campaign finance reform. We 
call it ``death by amendment,'' because the seriousness of the campaign 
reform issue is so important, and yet our colleagues on the Republican 
side are the ones that have 300 amendments they want to bring up and 
they are really delaying it.
  In real life out there, Republicans outspend Democrats two, three, 
four and five to one in campaigns. We need campaign finance reform to 
get the money out of politics. They are too busy attacking working 
people and not really talking about campaign finance reform.
  But I want to talk about managed care and how important it is to the 
people that we represent. Maybe they will be serious about managed care 
reform, because that is something that affects people every day. I will 
be glad to work with the gentleman from New Jersey for the next 30 
minutes or hour to talk about how important health care reform and 
managed care reform are to our constituents and all Americans.
  Mr. PALLONE. Mr. Speaker, let me just say, because I came in at the 
tail end of the comments by our Republican colleagues, and I am just 
frustrated, as I know the gentleman from Texas is, because the 
Republican leadership continues to stall on this issue of campaign 
finance reform.
  There is no doubt in my mind that the Democrats have been appealing 
to the Republican leadership for months now to simply allow an up-or-
down vote on what we consider the most significant campaign finance 
reform that is likely to come up this session, and that is the Meehan-
Shays bill.
  I believe very strongly that if the Republican leadership allowed us 
to bring the Meehan-Shays bill to the floor today or tomorrow, any day, 
it would overwhelmingly pass, and we would have some significant 
campaign finance reform. But as the gentleman knows and mentioned, they 
do not want to do that. They just want to keep bringing up amendments, 
making it impossible for us to get to the Meehan-Shays bill.
  My understanding is that today they were talking about a rule, which 
I guess ultimately they did not bring up, that would have allowed 
something like between 200 and 300 amendments, what we call nongermane 
amendments, to the campaign finance reform. Amendments that were not 
even relevant to the issue in an effort to try to stall a final vote on 
the Meehan-Shays bill.
  So we are getting from the other side this constant effort by the 
Republican leadership to stall and stall and bring up amendments, as 
the gentleman mentioned, ``death by amendment'' on this issue; and I 
think they are going to try to let the clock run so that we never get 
to the Meehan-Shays bill and have some real campaign finance reform. We 
will have to hope that is not the case and keep at it and make it clear 
that we want this bill to come forward.
  Mr. Speaker, the same is true for the issue that I would like to 
address now, and that is managed care reform. We know that this issue, 
without question, is one of the most important issues, I would say the 
most important issue, on the minds of Americans today.
  I keep saying that when I have a town meeting or a forum, or when I 
see my constituents on the street, the most common concern that they 
have is about the quality of care or the lack of proper care that they 
may have because they are in an HMO or some kind of managed care system 
that limits their ability to receive quality care.

[[Page H4706]]

  We, as Democrats, came up with a proposal, we have had it for some 
time now, called the Patients' Bill of Rights, H.R. 3605, which 
provides a number of patient protections to deal with the problem, some 
of the problems that managed care organizations have presented.
  The problem though is that the supporters of managed care reform and 
the Republican leadership and the insurance industry are basically on a 
collision course. The Republican leadership, along with the insurance 
industry, is fighting tooth and nail to undermine the various managed 
care reform proposals that have been introduced. They basically again 
are trying to run the clock out, because with so few legislative days 
left in this Congress, those who support patient protections believe it 
is increasingly important that everyone come together on a bipartisan 
basis and allow us, demand even, that the Republican leadership allow 
us to bring the Patients' Bill of Rights to the floor for a vote.
  Mr. Speaker, I would bet again, just like campaign finance reform 
legislation, that if the Republican leadership allowed this managed 
care reform or Patients' Bill of Rights to come to the floor, it would 
pass overwhelmingly. That is why they do not want to let it come to the 
floor.
  There is widespread agreement in Congress for ensuring that medical 
decisions are made by doctors based on medical need and not by company 
bureaucrats whose primary concern is the company margin. We are all too 
familiar with the Republican leadership's preference for shortchanging 
the American people by cutting comprehensive health care initiatives.
  Mr. Speaker, we tried to bring up expanding kids' health insurance 
and we got opposition from the Republican leadership. Gradually, we got 
Republican Members to join with the Democrats and eventually we had a 
majority. The leadership was forced to bring the kids' health care 
initiative to the floor and it passed overwhelmingly.
  We had it with the Kennedy-Kassebaum bill. This was to deal with the 
problem for people who have health insurance, but have a preexisting 
medical condition and could not get health insurance or wanted to take 
their health insurance with them from job to job, the so-called 
portability issue. These were encompassed in the Kennedy-Kassebaum 
bill. These were addressed.
  We could not get the Republican leadership to bring the bill to the 
floor. We finally got some Republican colleagues to join with us and it 
was brought to the floor and it was voted on and it passed.
  This same precedent applies here today. What we are trying to do is 
to get more and more of our Republican colleagues to join with the 
Democrats to pass the Patients' Bill of Rights.
  Let me just, if I could, because I do not want to talk about the 
Patients' Bill of Rights in an abstract way or managed care reform in 
an abstract way, I want to give a few concrete examples of the type of 
patient protections that we are talking about in our Democratic bill, 
H.R. 3605. Let me run through some of the main points to give an idea 
of the kind of patient protections that we are talking about.
  Access to emergency services. This is very important. Because of the 
fear of denial of coverage, managed care patients have died in many 
cases, delayed seeking emergency care or been injured when driving past 
nearby emergency rooms to more distant network emergency rooms. What 
happens is a lot of times the managed care organizations require 
patients not to go to the hospital or emergency room close by, but to 
another one further away.

  Mr. Speaker, what our bill does is to remove these major barriers to 
emergency care by prohibiting prior authorization for emergency care. 
Coverage of emergency care, including out-of-network care, is based 
upon what we call a ``prudent layperson'' standard, which means that a 
health plan is required to cover emergency visits based on the symptoms 
rather than the final diagnosis.
  This prevents health care plans from being able to deny coverage for 
an emergency visit for a suspected heart attack that turns out to be 
severe indigestion. So if the prudent layperson, if the average person 
would assume that because of the condition they have to go to a local 
emergency room, if they go, the insurance company has to reimburse for 
it.
  Let me give another example of the types of things, the patient 
protections that are in our bill. Under the bill, if an employer offers 
only one health plan and that health plan is a closed panel HMO, that 
plan is required to offer their employees the opportunity to purchase a 
point-of-service option in addition to the basic plan offered through 
the employer. So that means that my employer has to give me the option 
of having an HMO or a managed care plan that allows me to go to a 
doctor outside the network and choose any doctor, if I wish, and has to 
give me that option when I sign up for my health insurance. I may have 
to pay a little more, but nonetheless I have that choice.
  Then I will give a third example with regard to specialty care and 
then I will yield to my colleague from Texas. This is access to 
specialty care. The bill establishes certain standards to ensure 
hassle-free access to appropriate specialty care. A lot of times when 
people want to see a specialist, they are not allowed to or they have 
difficulty doing it because of their managed care organization and the 
way that it sets forth access to specialty care.
  But in our bill, women are able to select their OB/GYN as their 
primary care provider. If the plan does not have an appropriate 
specialist in network, it must provide a referral to a specialist. For 
example, if a child needed a pediatric neurologist but the plan only 
had an adult neurologist, that plan would refer the child to the 
outside specialist at no extra cost to the family than if the care had 
been provided in network.
  Patients with serious ongoing medical conditions are able to choose a 
specialist to coordinate their primary and specialty care. So if the 
insureds have a chronic illness, their specialist can actually be, in 
effect, their primary care provider.
  Mr. Speaker, I do not think we are really talking here about anything 
outlandish. I think most of these patient protections are very common 
sense. Most people probably think that they have these kind of 
protections, but they do not in many cases.
  So we are really not asking for much. We are asking basically for a 
floor, that managed care organizations or HMOs have to provide certain 
patient protections at a minimum, regardless of the particular type of 
plan that an individual signs up for.
  There is a lot more that we can talk about, but at this point I will 
yield to my colleague from Texas who has been someone who has really 
been outspoken on this issue and is very concerned about the need for 
patient protections and has joined with me and others from our 
Committee on Commerce, which has jurisdiction over this legislation, to 
make the case why this bill should be brought to the floor.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Green).
  Mr. GREEN. Mr. Speaker, I thank the gentleman from New Jersey (Mr. 
Pallone) for yielding and I appreciate his request for this special 
order this evening so we can talk about managed care and bring it to 
the attention of the American people, although they know about it even 
better than we do because they are the ones who are being subjected to 
the harsh decisions being made every day. They brought it to our 
attention. That is our job as Members of Congress and elected 
officials, to respond to our constituents' problems.
  The gentleman mentioned that we are not doing things that are 
outlandish or outrageous. There is an article that I would like to show 
that was in the Wichita Falls Times newspaper in Texas, and it said, 
``Texas leads the way as States tackle HMOs.''
  Mr. Speaker, our Texas legislature last year passed an HMO reform 
bill in 1997. They passed the bill in 1995, but the governor at that 
time vetoed them. But in 1997, he saw the error of his ways, I guess, 
like we all learn, and he let them become law. But Texas and New 
Jersey, the gentleman's home State, have passed legislation for HMO 
reform.
  The reason we are having to do it in Washington, because I would love 
to be able to let the States take care of their own problems and our 
States are doing that, Texas, New Jersey, 40 States across the country, 
the reason we have to do something in Congress and why it

[[Page H4707]]

is so important is that so many of the insurance policies that are in 
effect for group insurance are covered by Federal law and not State 
law.
  So no matter what the State law in Texas says or New Jersey says or 
anywhere else, if it is under ERISA exemptions and under Federal law, 
no amount of protections in State law will help them. We have to have 
those protections on a national scale to be able to supplement what the 
States are already doing.
  So we are not talking about earthshaking legislation here. We are 
just talking about reforms that the States have done over the last few 
years. We have learned from both the success and also some of the 
errors in the States to be able to come up with the bills that are 
being considered. I know the Democratic Task Force, that the gentleman 
from New Jersey is a leader in, has legislation that we have worked on.
  Mr. Speaker, I am concerned about this issue because the quality of 
medical care that our citizens are receiving has declined considerably. 
Some patients are not getting the best medical care that they have 
become accustomed to in our country. Medical decisions are being made 
by insurance company bureaucrats as opposed to their medical providers.
  If we are badly injured or seriously ill, we should not have to worry 
about our insurance coverage. Our first concern should be our health 
care or, particularly if it is for a parent or a child, our first 
concern should be to get them to the health care that they need. These 
are just two of the examples of problems that patients are facing when 
they need medical care.
  We owe it in our responsibility as elected officials to respond to 
the American people to give them access to top quality medical care. 
They should be able to obtain quality health care, whether or not they 
are required preauthorization for emergency room treatment.
  One of the other problems, and I have used the example before and we 
have heard it, if I right tonight begin having chest pains, how do I 
know it is not a heart attack? It might be the pizza we had this 
evening waiting for our special order, but I cannot diagnose myself. I 
need to go to an emergency room. And yet we have had cases where the 
HMO has said, ``No, you had indigestion and not a heart attack. You 
should have called in first.''

                              {time}  2115

  Health care delayed can also be health care denied. So that is the 
worry that we have that is affecting all of our constituents. As a 
member of the Democratic Health Care Task Force, I have worked with the 
gentleman and a lot of Members on trying to establish guidelines and 
direction to improve managed care.
  I currently cosponsor three proposals. One of them is the Patient's 
Access To Responsible Care Act, the Patient's Bill of Rights that the 
Democratic Task Force has put together, and also the Patient's Choice 
and Access to Quality Health Care.
  These bills are all bipartisan bills. They are cosponsored by 
Republicans and Democrats, although predominantly Democrats on some of 
them, but we do have Republican Members who are leading in trying to 
get these bills passed, members of our Committee on Commerce on both 
sides of the aisle.
  Each of these bills provides varying degrees of access to 
specialists, improved quality, and accountability of managed care and 
timely internal and external appeals process when a consumer feels a 
claim was denied inappropriately.
  The focus of these bills, and we have developed five key concepts, 
that whatever bill we pass, it does not have to have Gene Green's name 
on it. I would be glad to have my colleagues on the Republican side 
have these concepts in their bill, and I will speak for it and vote for 
it. So there is no pride of authorship in needing to have these bills 
passed and the President sign it.
  One is the antigag rule which would allow physicians to discuss with 
their patients the most appropriate course of treatment even if it is 
not covered by that HMO. A doctor or provider ought to be able to have 
a two-way conversation with their patients. That is just right.
  Mr. PALLONE. Mr. Speaker, if I can just interrupt the gentleman, the 
gag rule to me, and what you pointed out was such an excellent example 
of the kind of common sense approach that I think most Americans would 
believe they already have.
  I mean, I do not think most people could imagine that their doctor is 
not allowed to tell them something about their medical condition or 
possible treatment. It seems to go against the First Amendment, which 
it probably does if it ever went to court or ever traveled to the 
Supreme Court for an opinion on it.
  To imagine that HMOs now are allowed to gag the doctors into telling 
their patients what they should know, it is inconceivable to me. That 
is the kind of common sense approach that we are talking about that the 
gentleman brings up.
  Mr. GREEN. Mr. Speaker, that is so important just to open the lines 
of communication. Again, HMOs have cut the cost of medical care, and 
they have done a great job. But we can have some guidelines for them to 
where we can have better quality care and still have the cost controls 
that are there.
  Another one of the five concepts is the internal and external appeals 
process. A lot of the HMOs already provide this. But that would be a 
reasonably timed appeals process, reasonably timed so you do not have 
to, again, have medical care delayed is medical care denied, both 
internal and external appeals process; the opportunities for the 
employee choice which would provide employees with the opportunity to 
get health care coverage outside their managed care system for an 
additional cost.
  The gentleman and I know that the reason managed care is popular with 
a lot of our companies who pay for the insurance is that they have also 
placed cost controls on it. But if an employee in a company says, okay, 
the company says I can pay X amount of dollars per month, and that will 
buy you this HMO, a lot of employees, both government employees and 
private employees, private employers will do that.
  But there ought to be a requirement that a health care provider would 
offer a little better plan. So that employee could say, yeah, the HMO 
is great, but I would really like to have a little better plan, and I 
will pay $10, $20, $30, $50 a month more to make sure that I can have 
more flexibility in my plan, a requirement that gives that choice to 
the patient and to the employee.
  We are not asking for businesses to pay more money, we are just 
asking for insurance companies to be able to say, hey, I can sell you a 
better Ford and actually maybe make more money.
  One of the other important parts of it is access to specialty care 
which guaranties the patient's right to see a specialist who can 
diagnosis and treat a patient's specific medical needs.
  Again, I have some great examples of medical care delayed and denied 
in my own district and with my own family. They went to a doctor in 
February; that doctor, for example, in this one case drained the knee. 
There was a knee injury. Drained the knee and shot cortisone in it, did 
not request an MRI under a managed care plan until finally this 
constituent actually went back to the doctor at the end of May and had 
to wait 2 weeks for an appointment because there were only two doctors 
on the plan that were orthopedic, and finally got an MRI that said we 
need to have surgery.
  So that constituent is having surgery this Friday morning to be able 
to correct that torn cartilage in the knee that could have been done in 
February if they would have taken the time and been able to have to go 
to a specialist.
  The fifth important decision I think, and this is one that is very 
controversial, but, again, States have already done it, and 
particularly Texas, decision-maker responsibility. Make managed care 
plans that authorizes or fail to authorize medical procedures 
accountable as much as the health care providers.
  So if my doctor or my provider is subject to a lawsuit because they 
do something wrong, then if a health care insurance company or an HMO 
denies coverage, then they ought to also be subject to the same 
responsibility that that health care provider is.
  Again, this is not something that is a major change. The State of 
Texas, again, in 1997 passed that as part of the bill. Liability 
legislation is made. They

[[Page H4708]]

call it in this article the Doomsday Weapon because it makes the 
responsibility go with the person who is ultimately responsible. If 
someone says no to a procedure, then they may have to answer in a court 
of law just like a health care provider would have to.
  Mr. PALLONE. Mr. Speaker, if the gentleman would yield, what we do in 
our bill is to basically leave that up to the States. So it would be up 
to the State.
  If the State decides that they think that the HMO or the managed care 
organization should be liable in the circumstance, then they can. So we 
are not actually dictating to the States what they do in that respect, 
but we are leaving it up to States to make that decision. Right now, 
there is no liability under Federal law.
  Mr. GREEN. Mr. Speaker, I think that is ironic, because the gentleman 
and I know, as Democratic Members of Congress, oftentimes we have been 
accused of not trusting the States and local control.

  I bring to Congress 20 years of service in the Texas legislature, and 
I know that these halls do not have infinite wisdom, although there is 
not infinite wisdom in the halls of the legislature either, but I also 
like the idea of 50 States being able to make that decision on lots of 
things and particularly in this area.
  Let us let the State liability law provide for the people that are 
covered by ERISA. Doctors and health care providers should be in charge 
of medical care decisions. When patients need immediate care, doctors 
need to be able to provide that quality health care.
  I believe that these basic protections are fundamental to maintain a 
high quality medical care in our country. I do not believe that managed 
care is inherently bad. In fact, I think it has reduced a cost 
increase, as we have seen over the last few years, but I believe that, 
like any other system, you have to provide some protections, patient 
protections, so managed care does not just throw out the baby with the 
bath water, so to speak; that we have the benefits of managed care with 
the cost containment, but we also have the benefits of quality health 
care and physician and health care provider contact with their 
patients.
  Let me give another example, and sometimes I know we are accused of 
passing legislation by analogy. But, again, as a Member of Congress or 
any elected official, you try and solve problems. That is our job is to 
solve problems.
  We have a constituent like earlier, the knee problem, we have our 
constituents write us letters. I have a Houston police officer who, 
again, is under a managed care system, and let me just read his letter.
  I want to thank you for your concern over the managed care issue, to 
many of us, the term NYL-Care, if it is appropriate. I worked for the 
City of Houston for over 30 years as a police officer and walked in 
harm's way more than once and I have not missed a day of work due to 
illness for over 20 years. I never worried about health care.
  When the city took away any choice of doctors, I was concerned, but 
not too alarmed. Last August, my worst fears became a reality. I went 
for a routine screening, was told by a doctor at Baylor that I needed 
additional tests for cancer.
  At this point, I found out what my HMO was really about. My very 
first attempt in getting medical help was a fiasco. My primary care 
doctor was out of town. My very first visit to a specialist was 
rejected because the referral was not the correct color.
  I did get to see the doctor after several buck-passing phone calls 
and more trips to the primary doctor. I found that the toughest battle 
was not with the disease, but with the HMO. As I am writing this 
letter, I have been trying for 2 weeks to see another specialist. The 
mental strain is tremendous.
  I offer you my experience and will testify and write letters to 
anyone that support your legislation.
  That is by a 30-year Houston police officer. We can come up with lots 
of examples of how people are being denied health care today. A Houston 
police officer, a teacher at the Houston independent school district, 
these are people who are serving our children and making our community 
safer. Yet, he needed that specialist for cancer care.
  The gentleman and I know that when you are diagnosed with cancer, you 
need to see that specialist immediately because the quicker the better. 
You need the treatment, but you do not need to wait another week or 2 
weeks or 6 weeks or a month to be able to see that specialist or 
quality specialist.
  That is why it is imperative that this Congress pass managed care 
reform, and it is imperative that my Republican colleagues quit denying 
that there is a need out there, the majority of them, because we have a 
great many of them who are really working and trying to pass 
legislation, but we need a majority of them to say, if we have to, let 
us take the discharge petition, let us get a bill here on the floor and 
pass it before this Congress leaves in early October, because it is so 
important for this Houston police officer and it is important for all 
our constituents who are being denied care right now.
  Mr. PALLONE. Mr. Speaker, I agree with the gentleman. I am glad he 
brought up this issue of the discharge petition, because I think that 
that, in fact, is what we may have to resort to.
  Our colleagues, of course, are aware of it, but the American people 
may not be aware of the fact that the way the House works, the Speaker 
and the majority, which is the Republicans, have the right to decide 
whether or not a bill comes up for a vote in committee and whether it 
comes to the floor.
  What we are seeing with the managed care reform and our Patient's 
Bill of Rights is that we are not even being given the opportunity of a 
hearing in the committee let alone having it come up for a vote in the 
committee and come to the floor.
  So our only recourse at this point is the discharge petition, where a 
majority of us sign this petition, and the bill is brought to the floor 
in effect by getting around the Republican leadership. I think we may 
be forced to that over the next few days, because time is running out 
in this Congress.
  Following up on what my colleague from Texas said, I think it is 
important that we give examples. Over time I get up lately and do a 
special order like this. I try to give some examples of how the patient 
protections that we have in our bill would correct the situation.
  I just wanted to give a few this evening if I could about some of the 
patient protections that I mentioned and what my colleague has 
mentioned.
  With regard to access to a specialist, this is a good example that 
was in the New York Post in September of 1995 where a 12-year-old girl 
had to wait a half a year for a back operation to correct severe 
scoliosis.
  The reason was that the HMO rejected the parents' bid to have a 
specialist perform the procedure, insisting instead on an in-network 
surgeon. After taking 6 months to determine that no one in its own 
network was capable, the HMO eventually relented and let her go to the 
specialist outside the network.
  Of course, when we were talking before about the Patient's Bill of 
Rights, H.R. 3605, one of the provisions says that, if there is no 
specialist within the network, then the outside referral is mandated. 
So we would address the problem that this particular 12-year-old girl 
had to face a few years ago.
  The other example, I think, with regard to emergency care, we have a 
couple of examples of that, and here is one example. This is from the 
Los Angeles Times on August 30, 1995.
  A pregnant woman was rushed to a hospital emergency room in the 
throes of a miscarriage and bleeding profusely. After a quick exam, the 
ER staff put in an urgent call to her HMO with the question, ``How do 
you want us to treat her?'' It took nearly 3 hours for the HMO to call 
back and say it wouldn't cover the care because none of its doctors 
were available to treat the woman. After 6 hours of arguing, the HMO 
eventually relented.
  Again, under the prudent layperson patient protection in our bill, 
that would not happen because if the average person would expect that 
when you go to the emergency room with a miscarriage and bleeding, 
profuse bleeding, that you would immediately receive care, you would 
receive it, and you would not have to give prior authorization or have 
the HMO approve it.
  I mean, some of these cases that I have are really horrific cases. 
Here is another emergency room case, a New York man. This is from Long 
Island

[[Page H4709]]

Newsday, February of 1996. A New York man slipped as he was getting out 
of a taxi, falling and cracking his skull. The taxi driver called 911, 
and the victim was rushed to an emergency room where he was given 
stitches, had a fracture set, and received treatment for a possible 
concussion. The episode was not a preauthorized emergency, so the 
patient's HMO refused to pay the bill. Incredible.

                              {time}  2130

  This is another one from Long Island News Day, actually the same day. 
A 5-year-old boy, who fell from a balcony and hit his head on the 
concrete, was brought to an emergency room on a backboard. As hospital 
workers rushed to give him a spinal x-ray and CAT scan, the HMO 
requested he be put in a taxi and driven to its own medical center. In 
that case the emergency doctors ignored the request. Thank God they 
ignored the request.
  So the cases go on and on. But, again, sometimes I think that when I 
read these patient protections they sound so simplistic that people 
say, well, of course, we have that right. But we do not, and that is 
why I think it is important to raise these examples. Because people are 
dying. People are being seriously injured. And it is not a common sense 
approach that the HMOs or the managed care organizations in many cases 
are making. They are not looking at things rationally from a common 
sense point of view.
  Mr. GREEN. Let me give the gentleman another example. One of the 
concerns I have as to why we need to put these into law is oftentimes, 
as a Member of Congress, we have constituents call us and explain to us 
situations, and we treat them like constituent work and the staff calls 
the hospital or the HMO, and oftentimes we can get that decision 
changed. But we represent 600,000 people, and not everyone is going to 
call their Member of Congress to get it corrected. That is why these 
reforms needs to be in place for everyone.
  I have an example of an elderly gentleman who was in a hospital in 
Pasadena, Texas, part of my district, and the doctor came around that 
the family did not know, and the patient was terminally ill with 
cancer. And the doctor said, you will have to be checked out and you 
cannot come back to this hospital. So the family checked with the other 
medical staff there and they called this person the HMO doctor.
  And so the family called our office and I talked with them and I 
said, well, we will check and see. And this was within 2 days, and he 
was not out of the hospital yet. And in working through the 
bureaucracy, that HMO said, sure, that is not a problem; that they 
wanted him to go to a different facility but they actually worked out 
an agreement to where the facilities were the same cost. And that ``HMO 
doctor'' came in and apologized 3 days later.
  This gentleman has since passed away. But to put a family through 
that, who already has a terminally ill father, or husband, and to say, 
no, you have to be checked out of here and go somewhere else, it is 
just inhuman. And not everyone will think to call their Member of 
Congress, and that is why these reforms are so important, so we can put 
a human face on managed care and make some rational decisions instead 
of what we are seeing out there in the marketplace now.
  So that is why I would hope that this session of Congress that we 
would not only be able to vote this bill out of the House but also the 
Senate and be able to have it signed by the President so we can put 
these reforms into place for the benefit of the people we represent and 
people all across the country. This is one of the most important bills 
that we can consider this year.
  And I want it to be a strong piece of legislation, too. I worry that 
because of the 80 percent support that the polls are showing for this, 
we might just see lip service paid to it and pass one or two. Let us 
make sure we do the job thoroughly and not just a partial job.
  So I would hope that my colleagues on the Republican side would 
cosign some of the bills and ultimately make the decision, if we have 
to, to sign that discharge petition to bring that bill here to the 
floor. I do not like to do that, because I believe in the committee 
process. But we have seen time after time during this session of 
Congress bills coming immediately to the floor without the committee 
hearings anyway, brought by the leadership. So let us do something 
right for the American people and pass this legislation. It is a strong 
piece of legislation.
  Mr. PALLONE. I appreciate my colleague's comments, and I would just 
like to say one more thing, too, before we close today, and that is 
that I believe, as the gentleman stated, that the support for these 
patient protections, this managed care reform, is overwhelming with the 
American people. And it does not matter whether you are a Democrat, a 
Republican, an independent, or whether you are from Texas or New Jersey 
or what part of the country. I know from talking to our colleagues that 
everyone is hearing from their constituents that we need to pass this 
patient bill of rights, or something like this bill we have been 
talking about this evening.
  My fear is what we may see from the Republican leadership, which so 
far has been stalwart in its opposition to this and its refusal to 
bring this up, primarily because of the insurance companies and because 
of the special interest money that comes from the insurance companies 
that is backing the Republican leadership, what I am fearful of is that 
as the Republican leadership keeps hearing how much support there is 
for this legislation, that they will try to come up with what I call a 
cosmetic fix; that they will try to come up with a very watered down 
version of our patient's bill of rights that really does not address 
most of the concerns that we have raised this evening. I think we have 
to be very careful of that.
  As the gentleman knows, the Republican leadership set up a task 
force, a Republican task force, to look into this issue. And some of 
our Republican colleagues who support our patient bill of rights, and 
have even cosponsored our patient bill of rights, are on that task 
force. And they were about ready, before the Memorial Day recess, to 
come forward with a proposal that included many of the patient 
protections we talked about tonight and that are in the Democratic 
bill. And what the Speaker did was basically pull the rug and say, no, 
no, go back to the drawing board and look at this some more.
  So, now, the second or third week has passed since that time, and 
still this Republican task force has not come forward with a bill. And 
what we are hearing is that the Speaker and the Republican leadership 
are putting pressure on them either to not put forward a bill or to put 
something forward that is basically a very watered down version of what 
we are talking about, a sort of cosmetic fix that does not really 
accomplish the goals that we set out to accomplish.
  So I think the worst thing that could happen, in many ways, is with 
all this impetus for a real managed care reform bill, if they were to 
just try on the other side of the aisle to bring something forward that 
looks like managed care reform but really is not. We have to be wary of 
that as well because we want to take this opportunity to pass something 
that really makes a difference for the average American; that really 
ensures quality health care. Nothing less will do.
  I know the gentleman shares my concern about that and my view on 
that. So we are going to continue to be here on a regular basis doing 
these special orders, constantly bringing this issue up, giving more 
examples, getting more of our colleagues to join with us, because we 
demand and we will insist that Speaker Gingrich and the Republican 
leadership bring the patient bill of rights up for a vote before this 
session ends.
  I want to thank my colleague again for joining me this evening.

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