[Congressional Record Volume 144, Number 97 (Monday, July 20, 1998)]
[Senate]
[Page S8548]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. THOMAS. Mr. President, I wanted to take the opportunity today as 
we gather, and before we begin debate on a specific bill, to talk a 
little bit about the Patients' Bill of Rights, the Republican bill that 
was introduced last week, a bill that I believe has a great deal of 
value for the American people. S. 2330, the Patients' Bill of Rights, 
will be the subject, I think, of our discussion this week and, indeed, 
should be.
  For some time now we have been hearing from the other side of the 
aisle with respect to a Patients' Bill of Rights, and they will have 
one. Hopefully what will happen, we will have an opportunity to 
consider both of these bills, have an up-or-down vote on each of them, 
and successfully pass one of these versions that will protect patients 
throughout the country.
  The Republican proposal is a carefully crafted plan intended to give 
patients and families more choices as we change the way health care is 
delivered in this country. And as we move toward more managed care, 
then there needs, I believe, to be some additional provisions put into 
law which will ensure that Americans and their families receive the 
kind of care we would like them to receive.
  There are differences between the two bills. Some of them, I believe, 
are significant--some of them are broad differences that are 
philosophical, I suppose. For example, the Republican bill deals with 
those health plans that are not regulated by the States.
  In Wyoming, my home State, things are quite different in terms of a 
health care delivery system compared to New York or California. We have 
a State of 100,000 square miles with 470,000 people, so you can 
imagine--we have small towns, and we have a different kind of system. 
Just this weekend I was in Casper, WY, celebrating the 15th anniversary 
of the Life Flight program in Wyoming. That is the helicopter, and a 
fixed wing as well, from the Central Wyoming Medical Center which 
serves the whole State.
  We have one Life Flight program for all of Wyoming. It serves the 
mountains in the north; it serves the towns in the south. It is quite 
different, for example, than you would have in New England. So I think 
it is important that we allow States to continue regulating those 
health plans that they have jurisdiction over so they may craft 
regulations tailored to their specific needs. The Republican Patients 
Bill of Rights, therefore, focuses solely on health plans outside State 
jurisdiction.
  Secondly, Republicans propose a different type of appeals process. 
The Democratic proposal says go to the courts; let's have more 
litigation; let's bring the lawyers in to decide health care issues. 
Republicans, on the other hand, say let's have a health care system 
where the appeals are decided more quickly, less expensively, and are 
made by doctors.
  I think those are very important differences. The main focus of this 
debate, then, will and should center around patients. That is really 
what health care is all about. And I think the Republican plan achieves 
the goal of dealing with the needs of patients.
  It includes at least six new consumer standards that I think are 
important for us to consider. One is access to emergency care. This is 
the kind of thing that I just spoke of in terms of Wyoming. As you can 
imagine, the Life Flight helicopter is an expensive project but very 
necessary. There is no other way to carry patients from a small town in 
the Big Horns to the medical center in Casper. This ensures that 
emergency care will be received.
  The prudent lay care standard is adopted where emergency health care 
screening is guaranteed. And this is not the case, of course, in all 
managed care plans. So it is very important.
  Point-of-service access, point-of-service coverage, this provides 
that if you choose to see a provider outside of the managed care 
network, the program should make arrangements for you to be able to do 
that. We think that is important. For continuity of care in case the 
physician leaves the health plan or the plan changes, patients must be 
notified of such changes. Patients also should have the opportunity to 
continue seeing that provider for at least 90 days while they make the 
transition to choose another provider in the health plan's preferred 
network. This transition period would apply to patients in their second 
trimester of pregnancy or for those who may be terminally ill. Again, 
also, that is an important issue. By the way, many of these issues are 
the same in both bills and that is good; there will be some 
agreement. There needs to be open discussion of all treatment options. 
Those of us who are in managed care need to know exactly what is 
coming. We need to know exactly what benefits will be covered. On the 
other hand, if you are going to have managed care and choose that as a 
less expensive option, then we can only expect to utilize the benefits 
that are covered. So there needs to be open discussion of all treatment 
options, as well as full disclosure of the health plan's terms and 
conditions.

  There are some key differences, and I have mentioned them, between 
the GOP and the Kennedy bills. Most of the areas considered are the 
same or are, indeed, similar, and I think that is as it should be. But 
I have already mentioned that there is a grievance process that 
replaces litigation. I happen to think that is a great idea.
  One of the real problems we have had in health care through the years 
is not only the cost of litigation itself, but also the types of 
duplicative services performed to prevent lawsuits, tests that are 
terribly expensive. Over the last several years, we have been able to 
reduce these costs. But now we find ourselves faced with similar 
circumstances than may raise the cost of health care again.
  Obviously, you have to have some form of appeals program. However, 
the key is to make sure it proceeds in a timely manner so you do not 
wait 2 or 3 years to get redress. You don't have the time to do that in 
health care. You need some decisions made very quickly. The other 
requirement is to make sure such decisions are made by doctors, not by 
lawyers. That is important. So I think there is a great deal of merit 
to our approach.
  So there are a number of reasons why I think the Republican approach 
is best. One is, it gives rights and remedies to 48 million Americans 
whose current coverages are unregulated. It also provides for some new 
provisions. It allows full deductibility for the purchase of health 
insurance by the self-employed, which has not been the case in the 
past. It outlaws gag rules placed on physicians. Most States have done 
that. It expands emergency room coverage. It makes it easier to get 
service outside of the HMO. It remove barriers to seeing obstetricians, 
gynecologists and pediatricians, which provides great peace of mind. It 
also requires the continuity of care and more information to consumers. 
Consumers are entitled to these standards. Standards which are designed 
to make managed care plans more accountable. So as we change health 
care in this delivery system, there needs to be some regulatory 
revisions, and that is what the Republican Patients Bill of Rights 
does.
  This bill is something we need to do. The purposes are good. The 
legislation is well-written. It provides quality care based on sound 
medical evidence, and that is something that we sorely need in this 
country. I urge Members of the Senate to support the Republican health 
care bill.
  I yield the floor.
  Mr. WELLSTONE. Mr. President, I say to my colleague from Wyoming, way 
over there, if he needs more time, we don't have many people on the 
floor. I don't want him to rush on my account. Does he need more time? 
If so, I am pleased to wait.
  Mr. THOMAS. I thank the Senator from Minnesota. I have finished what 
I have to say. I appreciate his patience.
  The PRESIDING OFFICER. The Senator from Minnesota is recognized.

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