[Congressional Record Volume 144, Number 94 (Wednesday, July 15, 1998)]
[House]
[Pages H5585-H5586]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          MANAGED CARE REFORM

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Michigan (Mr. Stupak) is recognized for 5 minutes.
  Mr. STUPAK. Mr. Speaker, I would like to pick up a little bit on 
where the gentleman from New Jersey (Mr. Pallone) was talking about on 
managed care.
  The leadership of the majority in both the House and the Senate have 
now finally entered into public discussions on trying to adopt a 
Patients' Bill of Rights. And I think that is great, because I think, 
as a country, American families are demanding that we begin to deal 
with the inequities that we find in health maintenance organizations 
organizations and managed care plan.

[[Page H5586]]

  So I also think it is an important step that the Republican majority 
is starting to engage finally in this conversation. And I think, as 
America has the chance to look at the different plans that are out 
there, they will clearly see that there is a choice. They can choose 
the Republican majority plan, which really affirms the right of a 
patient to appeal to the health maintenance organization which denied 
them their coverage.
  So I think that is an internal appeal which falls really on deaf 
ears. I am afraid that the majority plan does not have any real 
enforcement provisions and simply moves the appeal, if you will, 
internally within the HMO. And as I said earlier today, the denial of 
coverage would be moved up the management ladder to a more fancier 
waste paper basket.
  Now if we take a look at the Democratic plan, the plan that has been 
out there for a number of months, what we see is the Democratic plan 
does provide for real enforcement of all the provisions of the HMO that 
the consumer pay for will be entitled to receive. It gives the patient 
the right to enforce all the provisions of their manage the care plan.
  That is why we need the Democratic Patients' Bill of Rights 
legislation. The Democratic proposal reaches beyond the quick fix that 
is put forth by the Republican majority, and the Democratic plan will 
give consumers a real power in dealing with their HMO and managed care 
plan.
  And when we think about it, in managed care and HMOs, we have the 
insurance executives determining what their coverage will be or what 
they are going to pay for, what will be covered underneath the plan, 
what will not be covered.

  Well, we Democrats happen to think that is wrong. We believe in a 
doctor-patient relationship, and that is why the American Medical 
Association and most of the medical and consumer groups have endorsed 
our plan. We believe, as Democrats, that the doctor and the patient 
should make the decision, not what is in the fiscal interests of the 
managed care plan.
  Some of the other very positive aspects of the Democratic plan also 
makes for women, the OB/GYN can be your primary care physician; not a 
specialist, but could be your primary care physician and would be 
covered underneath your HMO. In the Democratic plan, when you have a 
true emergency, when you have an emergency, the closest emergency room, 
whether they come underneath that HMO or not, must treat you.
  Of course, the enforcement that I have been speaking of, as the 
gentleman from New Jersey (Mr. Pallone) mentioned, gives you, the 
patient, the right to make the enforcement process, and if that 
enforcement process says that you are denied coverage, you have a right 
to then go into court and not sue the hospital or the doctor who are 
trying to give you the care, but sue the insurance executive that 
denied you the coverage for whatever treatment or specialist you may 
need.
  What we try to do in the Democratic plan is put back medicine where 
it belongs, back with the doctor/patient. The decisions on your health 
care should be what is medically necessary to help you overcome your 
illness or disease, and that is where the doctor and the patient should 
make the decisions.
  And in the Democratic plan, all specialists that are needed, that are 
medically necessary, are going to be covered underneath your managed 
care plan. Unfortunately, in the parts that we have seen of the 
Republican proposal, only some specialists are covered, not all of 
them.
  We lift the gag rule. A doctor can say, well, you may need this CAT 
scan, and even though your plan does not pay for it, I can refer you 
outside your plan for this specialty. Right now, many doctors are 
forbidden, underneath the contract they have signed with the managed 
care plan, not to even make referrals outside the plan that would cost 
the plan more money. Therefore, there is what has always been called a 
gag rule on the physicians. That would be lifted.
  So you can see, the Democratic plan, in fact, I am looking at the 
National Journal of Congress Daily of June 25, just before we broke, 
and the proposal was floated, GOP plan draws diverse criticism. Even 
those that are supporting the plan were criticizing the Republican 
proposal because it provides controversial proposals that would make it 
easier for small businesses to band together and would escape State 
benefit mandates, cap damages awards.
  While you are trying to give the consumer more power, the Republican 
plan actually took the power away from the consumer, away from the 
medical profession.
  So the Democrats, the insurers, the consumer groups and even the 
American Medical Association all happen to like H.R. 3605, which is the 
Patient's Bill of Rights put forth by the gentleman from Michigan (Mr. 
Dingell). I would hope each and every Member would take a chance, take 
a look at this bill and support us with this legislation.

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