[Congressional Record Volume 144, Number 96 (Friday, July 17, 1998)]
[Senate]
[Pages S8540-S8542]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      REPUBLICAN HEALTH CARE BILL

  Mr. JEFFORDS. This has been, to me, one of the more important days of 
this session. I believe that is true because of the introduction 
earlier by Senator Lott of the Republican health care bill.
  First, I commend the majority leader for the dexterous way in which 
he handled both allowing the members of a committee, a standing 
committee, to work, and then to join them with a leadership task force, 
formed by the majority leader, to put together a bill which could be 
backed by all Members of the Republican side.
  That was no easy task, but I am happy to say that by working together 
I think we have provided, for the Senate's review, an outstanding piece 
of legislation. I also want to begin by commending Senator Nickles and 
all the Members who participated in putting this legislation together 
on the task force, and in my committee. I think it is solid legislation 
that will result in a greatly improved health care system for 
Americans. I am proud to be a cosponsor of the Patients' Bill of 
Rights.
  As always, there has been a flurry of work over the past few weeks as 
we have put this legislation together. But this last-minute work is 
only possible because we laid a sound foundation throughout the entire 
105th Congress through many hearings.
  In particular, there are members on my committee, who also served on 
the task force, who I think were key in bringing about a consensus.
  First, Senator Frist, who, obviously, from his valuable expertise as 
a physician, as well as a masterful legislator, has assisted in helping 
us provide a bill which we can be proud of and which we can be assured 
will be in the best interest of all patients as well as the health care 
system.
  Senator Collins, who came here after being a State regulator in the 
health care area, provided tremendous knowledge and insight into how we 
could weave in and out the very complicated aspects of what should the 
Federal Government do and what should the States do, with leaving an 
emphasis primarily on allowing the States--which I will talk about 
later.
  Over the past 14 months, the Labor and Human Resources Committee has 
held 11 hearings related to issues of health care quality, 
confidentiality, genetic discrimination, privacy, and HCFA's 
implementation of its new health insurance responsibilities.
  Senator Bill Frist's Public Health and Safety Subcommittee has also 
held three hearings on the work of AHCPR. That has to do with trying to 
ensure that we have adequate information about outcomes and to try to 
utilize that information to better equip our professional people to be 
the best in the world in health care. Each of these hearings helped us 
in developing the separate pieces of legislation that are reflected in 
the Patients' Bill of Rights.
  Other colleagues here and on the House side have worked on this 
subject for an extended period of time, as well. Many of the 
protections that are included in the Patients' Bill of Rights are 
similar to those fashioned by Senator Roth in the Finance Committee 
last year when we provided many of these same protections to plans that 
serve Medicare patients.
  As we prepared this legislation, we had three goals in mind: first, 
give families the protections they want and need; second, ensure that 
medical decisions are made by physicians in consultation with their 
patients; and, finally, keep the cost of this legislation low so it 
does not displace anyone from being able to get health care coverage.
  As we all know, the number of people who participate is extremely 
sensitive

[[Page S8541]]

to the cost of health care. Information about products or services is 
the keystone to any well-functioning market. The bill requires full 
information disclosure by an employer about the health plans that he or 
she offers employees. People need to know what the plan will cover and 
what their out-of-pocket expenses will be. And this should be in clear 
and obvious language which is readily available for the patient or the 
prospective purchaser of the insurance to review so they do not 
suddenly realize they have run out of money as far as the plan is 
concerned or they find that many aspects are not covered.
  They need to know where and how they will get their health care, and 
who will be providing these services. They also need to know how 
adverse decisions by the plan can be appealed, both internally and 
externally, to an independent reviewer. This is an extremely important 
part of this bill. This aspect of the bill which gives employees a 
brand new ERISA remedy of an external grievance and appeals process is 
one of which I am particularly proud since it is the cornerstone of S. 
1712, my Health Care QUEST Act, which, incidentally, was a bipartisan 
bill.
  Under our bill, patients will get timely decisions about what will be 
covered. Further, if an individual disagrees with the plan's decision 
about coverage, that individual may ultimately appeal the decision to 
an independent, external reviewer after an internal review decision. 
And this can be done in an expedited situation, if it is necessary.
  The reviewer's decision will be binding on the part of the health 
plan, and the patients maintain their rights under ERISA to go to 
court. This is extremely important. This will be binding on the plan. 
So there will be no appeal by the plan through the courts or elsewhere 
from the decision by the reviewer.
  It is infinitely better to be able to get the care needed than to sue 
to recover damages because he or she could not get the care they 
needed, and the fact that that care was not being granted resulted in 
grievous situations for them.
  The medical records provision, which my committee also worked on for 
the past year, will give people the right to inspect and copy their 
personal medical information, and it will also allow them to append the 
record if there is inaccurate information. The bill will ensure that 
the holders of the information safeguard the medical records and 
requires them to share, in writing, their confidentiality policies and 
procedures with individuals. This is part of what was called the PIN 
Act, the Privacy Act, which also was a bipartisan bill.
  I want to again mention the task force. Senator Nickles started out 
some months ago desiring to provide the Republicans with a bill with 
which they could be pleased. A lot of work went into that. Many, many 
meetings were held. Many hours were spent trying to decide and make 
final decisions. I was a member of that task force, as was Senator 
Frist and Senator Collins from our committee.
  We had the ability to be able to utilize the expertise of the 
committee and the professional staff involved with them. I would like 
to mention Paul Harrington, in particular, and Karen Guice, of my 
staff, who is also a pediatrician and a fellow, for their incredibly 
good determinations on what the bill should have and their assistance 
in putting it together.
  I praise Senators Snowe and Domenici, who worked together to give us 
a portion of the bill which has to do with genetics and the protections 
that a patient should have, or an enrollee in a plan should have, to 
ensure that the genetic information--that genetic information--is not 
used against them to screen them.

  What I want to get to now, and I know there will be a lot more 
discussion next week, is the question of whether or not it is better to 
hand over much of the regulation to the Federal Government or whether 
it is better to leave it with the States.
  The 104th Congress enacted the Kassebaum-Kennedy legislation known as 
the Health Insurance Portability and Accountability Act in 1996, fondly 
referred to as HIPAA. Many consider this legislation to be the most 
significant Federal health insurance reform of the past decade. During 
this Congress, I have tried to closely monitor the impact of HIPAA over 
the past year to ensure its successful implementation consistent with 
legislative intent.
  The Federal regulators at HCFA have faced an overwhelming new set of 
health insurance duties under HCFA. What we said was that if the States 
wanted to--and almost all of them did--they could take control and 
implement the provisions of HIPAA. But five decided not to--California, 
Massachusetts, Michigan, Rhode Island, and Missouri.
  So what happened is that enforcement was handed over to the Federal 
Government. That is the point I want to make as to what has happened 
because of that. The Department of Health and Human Resources is now 
required to act as the insurance regulator for the State HIPAA 
provisions.
  Based on the findings of the GAO report that will be released next 
week, HCFA is ill equipped to carry out the role of insurance 
regulator. Building a dual system of overlapping State and Federal 
health insurance regulation is in no one's best interest, and the 
principle that States should regulate private health insurance guided 
the design of our legislation to get out of the problems created by 
HIPAA.
  Our legislation creates new Federal managed care standards to cover 
those 48 million Americans covered by ERISA plans that the States 
cannot protect. That is the second point. There are areas that the 
State is preempted from by ERISA which was passed in 1976. Under ERISA, 
it stated that those plans for self-insured or those that are 
multistate situations are under Federal order to provide uniformity in 
the regulation. We feel it would be irresponsible to set health 
insurance standards that duplicate their responsibility to the 50 State 
insurance departments and have HCFA enforce them.
  In a July 16 House Ways and Means committee hearing, HCFA's 
administrator stated she intended to postpone, among other things, 
prospective payment systems for home health services. To Members who 
will note this, this is a real blow to many States, Vermont in 
particular, who are being damaged severely by the present situation 
with respect to the home health care services and payments.
  The balanced budget amendment of 1997 establishes a prospective 
payment system, or PPS, for home health care in fiscal year 2000. The 
payment system designed for the interim period is proving to be an 
intolerable burden for the home health agencies that service Vermont's 
Medicare beneficiaries. They have already written to urge HCFA to urge 
a PPS by the October 1999 deadline set by Congress, thus minimizing the 
time an interim payment system will be in place. Her statement that she 
has delayed will result in many home health providers not receiving the 
reimbursement that they deserve. Given HCFA's inability to carry out 
its current responsibilities, I believe it would be irresponsible to 
promise the American people that it will be able to guarantee other 
rights by regulating the private health insurance industry.
  I will not offer Americans a promise that experience tells us will be 
broken, a hope that I believe won't be met. Our proposal, by keeping 
the regulation of health insurance where it belongs--at the State 
level--provides the American people with a real Patients' Bill of 
Rights that they can have the confidence in knowing that they will be 
there when they need it.
  I am afraid that the political battle over this legislation will be 
the subject that dominates the headlines. But the real issue here is to 
give Americans the protections they want and need in the package that 
they can afford and that we can enact, and also that they will have a 
remedy which will allow them to expeditiously get the care they need by 
having outside professionals give them that opportunity. That is why I 
and others have been working on this legislation since the beginning of 
Congress and why I hope it will be adopted before the end of Congress 
and signed into law by the President.
  This is too important of an issue for us to get bogged down in 
partisanship. I know the Democrats, and many of them on my committee, 
too, have worked very hard on their own bills.

[[Page S8542]]

 But let us not try to find out whose bill is better. Let us join 
together and make sure we can put together in the final analysis, 
through the legislative process, a bill which we all can be proud of 
and which the American people will be pleased with.

                          ____________________