[Congressional Record Volume 144, Number 98 (Tuesday, July 21, 1998)]
[House]
[Page H5962]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[[Page H5962]]
                      THE PATIENTS' PROTECTION ACT

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 21, 1997, the gentleman from West Virginia (Mr. Wise) is 
recognized during morning hour debates for 4 minutes.
  Mr. WISE. Mr. Speaker, I say to my friend, the gentleman from 
Illinois, perhaps the ultimate test of the marriage tax is that it 
truly shows that couples love each other if they are still willing to 
get married, knowing they are going to pay more for the privilege.
  Mr. Speaker, I want to talk about the Patients' Protection Act. It is 
essential that it be debated on this floor, and I mean a full Patient 
Protection Act that protects patients who are in managed care plans. 
That is why I was number 29 out of 159 that have so far signed the 
discharge petition, an extraordinary remedy, to bring this bill to the 
floor, to force it to the floor so this entire House can vote on it, 
because it is very likely that the House will not get to vote on this 
bill unless we get this discharge petition signed by 218 Members. One 
hundred fifty-nine of us signed it yesterday. I was pleased to be the 
29th in line to sign it.
  We support a bipartisan Patients' Protection Act, a Patients' 
Protection Act that works and protects people in managed care plans. 
Managed care plans can be health maintenance organizations, HMOs. They 
can be PPOs, preferred provider options. They can be other plans in 
which you pay less, but you also give up some of your choice in terms 
of choosing providers and where you go to get your care.
  The Patients' Protection Act that I support, and that so far we have 
159 Members who have signed the discharge petition on, would say, for 
instance, that a person going to the emergency room cannot be denied 
reimbursement for that if they use a prudent layperson's standard, if 
they had reasonable grounds to go to that emergency room. No insurance 
company can come behind them and say, no, those pains really were not 
justified. You do not get paid.
  This would also grant a patient a fast appeal, so if an insurance 
company turns down the doctor and said, no, you cannot give that test, 
or you cannot perform that procedure, that patient has a right to a 
fast appeal on that.
  It eliminates gag rules. In other words, physicians cannot be told by 
insurance companies and managed care plans that they cannot tell 
patients about certain procedures that might assist them, even though 
those procedures are not covered by the plan. It also guarantees access 
to specialists. If you do not like the specialist they send you to, it 
provides you access to other specialists. That is not the case in all 
managed care plans.
  It has prohibitions on financial incentives given to physicians not 
to provide care. The physician should not be rated on the basis of 
whether or not they were able to divert people from the care they need. 
They should be paid on the basis of the excellent care they are capable 
of giving.
  The Patients' Protection Act also has accountability. It has 
enforceability, for the patient to enforce the provisions on insurance 
plans. It is not fair that that a physician, in the best exercise of 
his or her judgment, would try to prescribe a treatment, say a CAT 
scan, and the insurance company refuses to pay for it, therefore making 
it not available to that physician to prescribe and to that patient.
  Should something happen, who is it that gets sued? The physician gets 
sued, but the people who actually put it into motion do not. What this 
would say is that everybody is going to be held accountable in the same 
way.
  The Congressional Budget Office, no friend of the Democratic Party 
but run by the Republican Party, has estimated the increased cost would 
be, at the most, about $2 per month to consumers, $4 per month overall. 
That is not very much to pay for an adequate Bill of Rights.
  The plan that we support would apply to 161 million Americans. 
Regrettably, the one the Republican leadership wants to put forward 
would apply to only 48 million Americans. In West Virginia, this is a 
fast-growing area of concern. We have seven HMOs alone that now take up 
about 11 percent of all patients covered by insurance, around 202,000 
people. Those are just the HMO. They do not deal with the other managed 
care plans.
  While 73 percent of Americans are now covered by some kind of managed 
care plan, we have not seen that kind of deep penetration yet in our 
State, but we will, so I want to head problems off in managed care 
plans before they get to the mountain State. That is why I support a 
Patients' Protection Act, and why I think it is essential that this 
Congress vote on it this week.
  Mr. Speaker, we urge all Americans to rally around a Patients' 
Protection Act. It is vitally important that we get a Patients' 
Protection Act that has true accountability in it, that makes insurance 
companies responsible, the same way our doctors and providers and 
nurses and hospitals are responsible.
  We want to make sure that we have access to specialists under these 
insurance plans, these managed care plans. We want to make sure that 
there are no gag rules. We want to make sure that doctors are not 
discouraged from providing the treatment that they know they want to be 
providing.
  That is why it is important that this Congress vote, Mr. Speaker, on 
a Patients' Protection Act that really does something for America.

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