[Congressional Record Volume 144, Number 98 (Tuesday, July 21, 1998)]
[House]
[Pages H5965-H5966]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




THE IMPORTANT DIFFERENCES BETWEEN THE DEMOCRATIC AND REPUBLICAN HEALTH 
                           CARE REFORM BILLS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 21, 1997, the gentleman from New Jersey (Mr. Pallone) is 
recognized during morning hour debates for 5 minutes.
  Mr. PALLONE. Mr. Speaker, for months now the movie ``As Good as It 
Gets'' has become symbolic here in Washington with the debate over 
managed care reform.
  Everyone knows by now that in the movie, actress Helen Hunt unleashes 
an epithet-laden attack on her HMO after her HMO gives her trouble when 
she is trying to get treatment for her asthmatic son.
  In an effort to stop getting beat over the head with this example and 
what it symbolizes, last Friday the Republican leadership unveiled the 
language of its long-awaited managed care reform bill. To state it 
simply, Mr. Speaker, this Republican bill is as bad as it gets.
  The Republican leadership has really outdone itself with this bill. 
It is easily one of the worst speaks pieces of legislation they have 
put forward since they took control of the House in 1994. It is an 
unabashed sell-out to the insurance industry. In fact, it looks as if 
it were written by the insurance industry itself.
  Although it is called the Patient Protection Act, in an attempt to 
confuse it with the Democrats' Patients' Bill of Rights, a more 
appropriate title for the

[[Page H5966]]

Republican bill would be the Profit Protection Act.
  The worst aspect of this bill is that it allows the insurance 
companies, and not doctors and patients, to make medical choices. 
Remarkably, the Republican bill actually reaffirms the status quo and 
allows insurance company bureaucrats to decide what is medically 
necessary, so under the Republican plan, HMOs can define ``medically 
necessary'' any way they wanted. If you get sick and your insurance 
company decides the treatment you need is not medically necessary, you 
are simply out of luck.
  This is, in my opinion, truly a sell-out of the highest proportions. 
It ignores the central catalyst of the whole managed care debate, the 
strongly held belief among Americans that medical decisions should be 
made by doctors and their patients.
  The Democrats' Patient Bill of Rights, by contrast, insures that 
medical decisions would be made by doctors and patients. The Democratic 
bill defines ``medically necessary care'' based on the generally 
accepted principles of professional medical practice. What that means 
is that under the Democratic plan, patients and doctors determine what 
is the best course of treatment, not HMOs and insurance company 
bureaucrats.
  The Republican bill also fails to ensure access to specialists. If 
your child gets an illness and you want to bring your son or child to a 
specialist, you cannot, under the Republican bill. You may not be able 
to go to that specialist, depending on what the insurance company 
decides. But the Patient Bill of Rights, the Democratic bill, 
guarantees patients access to specialists when such access is needed.
  Another thing, the Republican plan does not even guarantee you full 
access to the nearest emergency room if you need emergency care, which 
has been a big issue during the course of this debate. The Republican 
bill includes a reasonable person's standard for access to emergency 
care, but it does not list severe pain as a reason why a person might 
determine that he or she needs to go to the emergency room.
  I want to repeat that, because it is really kind of mind-boggling. 
Under the Republican plan, severe pain is not considered a symptom of a 
possible emergency. So that means if you are suffering from severe pain 
and you rush to the emergency room to receive treatment for a 
legitimate problem, your HMO can still refuse to pay for it.
  The Democrats' Patient Bill of Rights also guarantees patients 
coverage if they go to an emergency room because they are suffering 
from severe pain. So regardless of the reason you go to the emergency 
room that is closest, if you get the emergency room care, the HMO has 
to pay for it.
  The Republican bill is also a failure when it comes to gag clauses. 
This is particularly interesting, because we passed prohibitions on gag 
rules here in the House of Representatives. But under the Republican 
bill, it would still allow a health plan to restrict communications 
between doctors and patients.
  The Democrats, on the other hand, prohibit plans from gagging doctors 
to inform patients about treatment options that are not covered by 
their health plan, and protects providers from retribution by the HMO 
for telling their patients the truth.
  When it comes to accountability, the GOP plan also is riddled with 
loopholes and omissions. The bill includes an external appeals process, 
but limits access to that process to individuals in plans under ERISA; 
in other words, only if your employer is self-insured. If you are 
covered by ERISA, you get the external review. Otherwise, you are out 
of luck.
  Then finally, and I want to stress this, the GOP plan also denies 
patients the right to sue their HMOs if they are denied needed care. 
Again, the right to sue is an enforcement mechanism that is necessary 
if these patient protections really are going to be enforced.
  The Democratic bill enforces all of the patient protections it 
provides by giving the patients the right to sue their HMO, and holding 
the HMOs accountable for the decisions they make. Again, this is an 
extremely important difference between the Democratic and the 
Republican plans.

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