[Congressional Record Volume 144, Number 99 (Wednesday, July 22, 1998)]
[House]
[Pages H6173-H6178]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          MANAGED CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentleman from New Jersey (Mr. Pallone) is 
recognized for half the time until midnight as the designee of the 
minority leader.
  Mr. PALLONE. Mr. Speaker, I am pleased tonight to be joined by two of 
my colleagues to talk about managed care reform, the gentleman from 
Texas (Mr. Turner) and the gentleman from Pennsylvania (Mr. Klink).
  Before I yield to them, I wanted to talk briefly about the 
Republicans' managed care reform bill, which to be accurate I like to 
call the Insurance Industry Protection Act. The reason I bring this up 
is because it has been noticed to be debated and, theoretically, I 
suppose approved or disapproved on the floor this Friday.
  This Republican version of managed care reform is in my opinion 
easily one of the worst pieces of legislation the Republicans have put 
forward since they took control of Congress in 1994.
  For weeks prior to the introduction of the Republicans' Insurance 
Industry Protection Act, supporters of the Democrat's alternative, the 
Patients'

[[Page H6174]]

Bill of Rights, were speaking out about what we knew was coming.
  What we expected they would do is to introduce a bill that was 
greatly watered down as a sort of cosmetic fix with regard to managed 
care reform. We expected the Republican leadership, who really are not 
interested in passing a managed care reform bill, would come out with a 
bill that would purport to provide patient protections, but really 
would not.
  The managed care issue, Mr. Speaker, is too explosive for the 
Republicans to ignore, so they have to at least create the impression 
that they are trying to rectify the weaknesses in the current system 
that are leading to the abuses we hear about on a daily basis.
  Let me say, we are truly hearing about these abuses daily. One need 
only turn on the TV, as I did tonight on the 6 o'clock news or pick up 
the newspaper, and see what I am talking about. In any event, just as 
we expected, before Congress adjourned for the July 4th recess, the 
Republicans released a set of principles which they said would all be 
incorporated into their bill.
  Mr. Speaker, these principles confirmed what Democrats expected. The 
Republican bill was going to be written so as not to interrupt the flow 
of support streaming into the Republican Party from the insurance 
industry.
  Last Friday, we finally got to see the language, and I think the 
American people need to know that the Republican Party went far beyond 
a cosmetic fix. They have introduced a bill that is far, far worse in 
my opinion than the existing law. Finding themselves caught between the 
insurance industry and the American people, the Republicans chose the 
insurance industry.
  Now they are gearing up to stuff this bill down the throats of the 
American people without giving them a chance to look at it. The 
Republican bill is scheduled, as I said, to be on the floor on Friday.
  In order to ensure the American people know as little about it as 
possible before everyone in the House is asked to vote on it, the 
leadership has bypassed the committee process. Not one of the three 
committees that has jurisdiction over this bill has had or will have a 
hearing on the Republican bill. And I would stress again that the 
language was only available last Friday.
  Because the Republican leadership refused to have hearings on its own 
bill, this week the Democratic Health Care Task Force held two hearings 
on this legislation. That was yesterday and today. At these hearings we 
heard testimony from administration officials, including the Secretary 
of Health and Human Services, Donna Shalala, and patients who have been 
abused by HMOs, doctors, and others. These hearings generated some 
truly disturbing and chilling revelations, I think, about the 
Republican bill.
  Mr. Speaker, I am not going to go into all of those now, because I 
think we can bring them out this evening as I yield to my colleagues 
who are here to join me and talk about some of the protections that are 
missing from the Republican plan, but included in the Democrat's 
Patients' Bill of Rights.
  Also, at some point I would like to talk about the issue of 
enforcement and how effectively the Republican bill has no enforcement. 
But at this time, I yield to the gentleman from Texas (Mr. Turner).
  Mr. TURNER. Mr. Speaker, I thank the gentleman from New Jersey (Mr. 
Pallone) for yielding. It is an important evening, though it be a late 
hour here in this hall. We will be, by all reports, considering managed 
care legislation on Friday. A very important day for the House, a very 
important day for the American people. A very important day for the 
future of health care in the United States.
  This is an issue that all of us, I think, take very personally. I, 
just a few weeks ago, took my father to the hospital because he was 
having some symptoms of dizziness and the doctor suspected it might be 
an early sign of stroke. We went immediately out to our hospital and he 
was given a CAT scan and, fortunately, it was determined that his 
dizziness was not a result of signs of early stroke.
  But I cannot help but think about what it would have been like if my 
father had been enrolled in a managed care plan, rather than being 
covered under Medicare. When we found out that he perhaps had an early 
sign of stroke, we would have been faced with calling our doctor and 
our doctor then having to call the HMO supervisor or clerk and 
determining first whether or not that procedure would have been 
authorized.
  It is in those kinds of delays that have been caused so many times in 
recent reports by many patients who have had unfortunate dealing with 
their HMO, it is those kinds of delays that make the difference in life 
or death.
  Mr. Speaker, I am very pleased that we have a bill as Democrats 
authored by the gentleman from Michigan (Mr. Dingell), a man who has 
served many years in this Congress, serving as chairman of the 
Committee on Commerce, and now as ranking member of the Committee on 
Commerce, a man who has been a leader in this Congress in providing a 
responsible managed care legislation.
  I had the opportunity, when I was in the State Senate in Texas in 
1995, to pass one of the first managed care bills passed anywhere in 
these United States. Interestingly enough, when we passed it in Texas, 
it had bipartisan support. In fact, the bill passed both the House and 
the Senate with relatively little opposition. It was a good strong 
bill.
  In Texas today, we have protection in place and, interestingly 
enough, we have had no increase in health care premiums as a result of 
the patient protection legislation that we passed in 1997, which was 
the year after I initially passed the bill followed by a veto of our 
governor and then repassage of the bill in 1995.
  So we have a good law in Texas. Now, I was surprised to learn just a 
few years ago that the legislation that we were working on and passed 
in Texas in 1995, and finally passed in Texas in 1997, does not apply 
to about half of the people who are enrolled in managed care in the 
State of Texas. That is because the courts have ruled that the ERISA 
law, a Federal law, preempts the State legislation that was adopted 
overwhelmingly by our State legislature.
  The reason we are considering this legislation in Congress is because 
the ERISA law has been interpreted by the courts to exempt all those 
enrolled in self-insured health care plans that are covered by ERISA, 
to exempt them from all the patient protections that have been passed 
in most of our States across our country.
  So we here in Congress feel very strongly on the Democratic side that 
it is wrong to have two classes of patients out there in Texas and the 
many other States that have passed patient protections. One group of 
patients who have the protections that were provided by their State 
legislatures, and the other group of patients who do not have those 
protections because a Federal court has ruled that their self-insured 
plan covered by ERISA is not covered by the protections that their 
legislature has put into the law.
  That is why we are here. The Democrats have come up with a bill that 
provides an answer to that problem. Our bill makes it clear that not 
only do we provide a clear base of protection in the law for everyone 
enrolled in managed care, but we provide each State the right to 
control all of the legal liabilities that relate to providing health 
care under those managed care plans.
  Our bill is a plan that respects States' rights and it is a plan that 
protects patients uniformly, irrespective of what kind of health care 
plan that they are enrolled in.
  So I think that we have a good bill, one that will stand the test of 
time, and contrary to the Republican plan will leave two classes of 
patients out there in this country, one covered by one set of rules 
that the Republicans want to place on ERISA covered plans and the other 
patients covered by the variety of State laws that have been passed 
across this country, but we as Democrats have a bill that will provide 
every patient the same protection who are enrolled in managed care 
plans in this country.
  Mr. PALLONE. Well, I just wanted to say that my colleague from Texas 
has brought up a number of really important points here. Number one, 
the whole issue of costs, we have been criticized, Democrats have been 
criticized, for their patient protection bill

[[Page H6175]]

by the allegations by the insurance industry that it is going to cost a 
lot more money.
  The gentleman points out that in Texas, there has actually been no 
premium increase. We had a report from the Congressional Budget Office 
that just came out a couple of weeks ago on our Democrat bill that said 
that even if everything passed and our bill was law, at the most, 
individuals would pay only about two dollars more per month for the 
patient protections that are so important to the American people.
  The other thing the gentleman pointed out is that we have, in effect, 
now, these two regimes, if you will, for people who are in ERISA and 
they are working for an employer that has a self-insured plan, which 
now preempts, the Federal law preempts it, and those people are not 
coming under ERISA.
  One of the things that is important is some of the proposals put 
forward by the Republicans, particularly the Senate proposal, actually 
does not even provide the patient protections if you are not under 
ERISA. So for those people who live in States other than Texas, that do 
not have the patient protections, they are not even going to get the 
patient protections if they are not in an ERISA self-insured type 
program.
  The other thing I wanted to say that the gentleman really brought 
out, and I think it is very important, too, is this whole issue of 
enforcement. We have been criticized by some of the opponents of 
managed care reform and they have said, well, the only difference or 
the only thing the Democrats want to do is they want to eliminate the 
ERISA exemption on the ability to bring suit, because under ERISA you 
cannot sue effectively for damages or to really recover the damages or 
the fact that you were not able to work or that you basically had a 
number of losses, you cannot bring a suit if you are under an ERISA 
plan because of the exemption from liability.
  What I wanted to point out is that if we do not repeal that ERISA 
exemption on liability, there is not going to be any effective 
enforcement of these patient protections.
  One of the criticisms I have is that under the Republican proposal in 
the House, basically not only do they not permit you to sue, they do 
not repeal the ERISA exemption on the ability to sue, but they also say 
that for individuals who have to buy the insurance in the individual 
market and not through a group plan, that they do not even have access 
to an appeal procedure where if they have been denied proper care, they 
do not even have a way of taking the appeal of that decision under the 
Republican proposal.
  So the Republican proposal in the House, on the one hand, excludes a 
lot of people from any kind of appeal if they have been denied 
coverage. It does not allow a lot of people to bring suit, if they are 
covered under ERISA, and essentially there is no enforcement. So there 
are tremendous loopholes in this Republican plan that we need to 
address and it is one of the reasons why we have been so critical of 
it.
  At this point, I yield to the gentleman from Pennsylvania (Mr. 
Klink), who is on the Committee on Commerce and has been really 
outspoken in bringing his concerns about managed care home to his 
constituents. I know the gentleman has had a lot of forums and he has 
heard a lot of horror stories over the last 6 months.
  Mr. KLINK. The gentleman from New Jersey is right. I want to thank 
the gentleman from New Jersey for his leadership on this issue. He has 
been here relentlessly, tirelessly, night after night, day after day, 
as he has been in the Democratic hearings, as he has been in talking 
with Members on both sides of the aisle trying to educate Members on 
this issue, and I think you are to be lauded, regardless of what comes 
out of the effort by either party. The gentleman has worked very hard 
on this issue.

  Before I get to my comments, I think I want to get to what the 
gentleman from New Jersey and the gentleman from Texas (Mr. Turner) 
were talking about. We sometimes start talking in alphabet soup terms 
in Washington, D.C. We talk in acronyms because it is the way the 
bureaucracy operates. We do not have time to say these long names and 
so we shorten it to the acronym, and ERISA is a very confusing acronym 
because it is a very complex law.
  Anyone who knew this law inside and out would make hundreds upon 
hundreds of thousands, if not millions, of dollars each year consulting 
with companies. It is the Employee Retirement Income Security Act, and 
that is why we call it ERISA. It deals, as the gentleman from New 
Jersey and the gentleman from Texas have stated, with multistate 
employers, usually self-insured, companies like General Motors, Ford, 
Chrysler, IBM, Westinghouse Electric, Pennsylvania Plateglass. All of 
these large multistate employers, because they are located in more than 
one State, do not come under a State insurance commissioner. They come 
under the Federal Government.
  In coming under the Federal Government, the judges, as was stated by 
my two colleagues, have determined that because of the ERISA law, 
because of this long named law, you cannot sue those insurance 
companies when they make a medical decision. If they deny you access to 
a hospital and you drop over dead, you could only retrieve from them 
the cost of the time you would have been in the hospital, or if they 
discharge you from the hospital early and you die or you lose a limb, 
you cannot get the cost of the damages for the loss of life or for the 
limb that you have lost. You can only get the 2 days that they denied 
you to be in the hospital. How ridiculous that is.
  The Democratic plan says, that is ridiculous. If you are going to 
make medical decisions, then you should be liable when those decisions 
are wrong. You should not be the callous kind of person that says, you 
have no choice. We are making the decision. I am looking at a set of 
figures here. You do not go to the hospital, unless you are willing to 
pay the piper when that decision is wrong.
  The Republican plan does not fix that. It does not make people who 
are making medical decisions, even though they may not be medically 
trained, because they work for insurance companies, it does not make 
those insurance company personnel responsible. Then, what the 
Republican plan further does, which the gentleman from New Jersey, I 
thought, explained very well, it only relates to those employers who 
come under ERISA plans, those multistate employers.
  If you work for a small company, if you are self-employed, if your 
employer is within one State where you come under that State insurance 
commissioner in all 50 states, you get no protection from the GOP plan 
at all. This plan is left wanting on both ends, and that is the 
difficulty.
  My problem with this is that this whole managed care debate is life 
and death. It is a life and death decision.
  I can remember back in 1993 and 1994, my friend, the gentleman from 
New Jersey, was here with me and we were trying to work on tackling 
this issue. I was not a proponent at that time of the Clinton plan, 
although I thought we needed to do something. I was at that time for 
more of a, let us try this and then we will do this. I did not like the 
whole omnibus idea, but what happened is something that is happening 
now and we have to learn from history, and that is the insurance 
companies took to the airwaves of this nation, spending tens of 
millions of dollars, saying, you do not want the Federal Government to 
have control of your insurance and, lo and behold, the people of 
America listened to all of those Harry and Louise ads and we said, I 
guess we do not want the Federal Government.
  Why would we want the government involved in our health care, not 
stopping to think that Medicare, which seems to work pretty well, which 
is run by the government, is controlled by the same government.

                              {time}  2310

  But nobody put two and two together. Very few people did. And so the 
insurance companies won, the Clinton administration lost, and life went 
on, except life did not exactly go on. Because the insurance companies 
now have control over the health care delivery system of this Nation. 
It is not big government, it is big business. And decisions are being 
made not for health reasons but for reasons of increasing the profits 
of those people who invest in or who manage those insurance companies. 
That is how the decisions are being made today.

[[Page H6176]]

  I began early last year in a small town called Slickville, 
Pennsylvania. Because I could not talk my Republican colleagues into 
holding hearings on this matter, we went to the tiny town of Slickville 
after hearing horror stories from doctors who could not treat their 
patients anymore because they could not be included in the HMO, after 
hearing from patients who no longer could go to their doctors because 
their doctors were not in the HMO and they had no choice, by the way, 
because their employer took the HMO. It was not like they had a choice 
to go out because they could not afford to go outside the employer 
plan. But now they could not go to their own doctors and they could not 
go to the hospital of their choice and they could not go to the 
pharmacist of their choice, they could not get the drugs that their 
doctor was recommending for them. They had all kinds of problems. We 
began over 60 hours of hearings. We heard horror stories which told me 
one thing. The people of this country were aware of what happened since 
the failure of the Clinton plan until now, they knew there was a 
problem, but inside the Beltway, the people running the House of 
Representatives here did not understand it, and I think to this day as 
they try to ram a bill that is horrible, without hearings, down the 
throats of this Congress and the American people, they still do not 
understand. They still do not get it. I will tell you, people know they 
are getting a raw deal. They know what is happening when the insurance 
companies force them to go through a series of hoops with the hope that 
somewhere along the line they will just give up and not fight anymore 
for the treatment that they should get. They know they are getting a 
raw deal when they cannot even get good information about what it is 
their insurance covers in the first place. And when their doctor has 
only two minutes to see them because they have to see so many more 
patients under managed care. Or when they cannot go to see a specialist 
that they may have been going to for years without having to go across 
town or to a different town to get a referral from a primary care 
physician. And they know they are getting a raw deal when they get 
these ridiculous bills from their insurer because they fell down 
unconscious and they failed to call the HMO for authorization when the 
ambulance then picked them up and took them to the nearest emergency 
room. Or they know they are getting a raw deal when they get kicked out 
of a hospital the day after major surgery even though the doctor says 
you need to stay in this hospital. And they know they are getting a raw 
deal, they know that something really bad is happening because care was 
denied and they discovered the health insurers are about the only type 
of business in this country that cannot be sued for pain or suffering 
when they make a decision.
  The Democratic Patients' Bill of Rights has answers for all these 
problems, but regrettably the Gingrich plan does not. It is that 
simple. One of the women, and really this is a horror story that we 
had, Mrs. Bloise from New Castle, Pennsylvania, her daughter came to 
see us in New Castle. It turns out her mother was admitted to a great 
hospital, the Cleveland Clinic, on December 13 of last year for surgery 
on her esophagus. By all accounts the surgery was very successful. But 
it was major surgery and it required a degree of postoperative 
attention.
  What happened is really beyond my comprehension I would say, Mr. 
Speaker. Even though she wanted to stay in the hospital after the 
surgery, and her family wanted her to stay in the hospital, and her 
doctor wanted her to stay in the hospital, Mrs. Bloise was discharged 
two days after major surgery on her esophagus over the objection of her 
family, her doctor and told she would have to come back two days later. 
But she was too sick to travel hours away from the Cleveland Clinic to 
New Castle, Pennsylvania. She was in no condition to travel. A day and 
a half after traumatic surgery, she was discharged and told she would 
have no choice but to stay at a hotel room across the street from the 
Cleveland Clinic and wait for her appointment two days later. Well, 
they did not have to worry about paying any more of Mrs. Bloise's 
hospital bills because she died in that hotel across the street from 
the Cleveland Clinic.
  Now, our dear friends in the insurance companies, they hear these 
stories, they say, ``Well, this is just anecdotal.'' When you get this 
many anecdotal stories in 60 hours of hearing in my district alone, 
something is wrong in this country with our health care delivery system 
and people are dying. And we are not just saying this because it sounds 
good, we are saying it because it is true and they are our 
constituents, they are our family members. Not one person that any of 
us, Republican, Democrat, Independent, Communist, Socialist, Green 
Party, not one person that we know, not one person that we talk to does 
not know someone who has not had a raw deal from the insurance 
companies. They now control health care. The Democrats want to change 
that. The Republicans, now wedded to the insurance companies, want to 
keep it business as usual. That is what they are going to try to do 
this Friday and it is a shame.

  How in the world, and I am a pro-life Democrat, but I am going to 
tell you something, I do not know how my friends on the pro-life side 
on the Republicans can say they are pro-life when they want this kind 
of loss of life, this kind of pain and suffering to continue day in and 
day out and they do not want to stand up to the insurance companies and 
do something about it. You cannot be pro-life until the child is born 
and then from that point on through their life when they are fighting 
to see doctors, when they are fighting to get medical care to save that 
life you turn your back on them. That is exactly what is happening.
  Mr. PALLONE. I just want to thank the gentleman again for his 
contribution here tonight, because I know how strongly he feels about 
this. He has all these cases. He has really spent the time in his 
district giving forums and opportunities, if you will, for individuals 
to come forward and talk about these abuses. We know how many there 
are.
  I just wanted to say briefly and then I will yield to the gentlewoman 
from Michigan. One of the major problems with the Republican bill is 
that when I talk to constituents and when I get feedback from different 
individuals, what they really want, most importantly, is the return of 
medical decision-making to patients and health care professionals, 
doctors, and not have medical decisions made by the insurance 
companies. The worst part I think of the Republican bill, the House 
bill and the Senate bill, is that it allows the insurance company, the 
HMO, to define medical necessity, so that we as Democrats have said 
that what we want to do is switch this whole phenomena so that the 
decision about whether or not you are going to be able to stay in the 
hospital a few more days or whether you have a certain medical 
procedure is made by the patient and the doctor.
  Well, if you leave it as the Republican bill does, if you leave the 
definition of what is medically necessary to the HMO, you do not have 
any patient protections. This is what I have been trying to say the 
last few days when this Republican bill was finally revealed last 
Friday, that it actually does not move us forward at all in terms of 
patient protections. This is one of the major reasons, because the 
definition of what is medically necessary is still going to be left up 
to the HMO.
  I just wanted to mention a few things briefly, because I do not know 
that we have specifically talked about some of the differences in terms 
of the actual patient protections. One is what I have mentioned, the 
protection of the doctor-patient relationship. It is still denied 
essentially by the Republican plan. The other is access to specialists. 
The Democratic plan lets you go to a specialist outside the network if 
there is not one available within the HMO network. The Republican bill 
does not allow that. The Republican bill does not do anything in terms 
of coverage of mastectomies and requirement of coverage for 
reconstructive surgery. In other words, in our bill, we have a 
prohibition on the drive-through mastectomies and we require coverage 
for reconstructive surgery after a mastectomy. This is a very important 
provision that we have talked about for some time that is not in the 
Republican bill.
  Point of service. A big issue for a lot of Americans is the ability 
to go outside of the HMO network and see a doctor outside the network 
even if they

[[Page H6177]]

have to pay a little more if they want to do that. What the Democratic 
bill says is if your employer only offers you an HMO, a closed panel 
HMO, for only doctors or hospitals within the network, he also has to 
offer you initially the option of going outside the network if you are 
going to pay a little more. Well, in the Republican bill, they have so 
many loopholes in their point of service option that it might as well 
not exist. They say that there is an exemption for these new health 
insurance pools, there is an exemption if the employer does not want to 
contract with a plan to provide the point of service. They might as 
well not have anything.

                              {time}  2320

  I mean, they have so many loopholes it is incredible. So there is no 
point of service. There is no option, really, to go outside of the plan 
for a doctor or a hospital under the Republican plan.
  Under emergency care, we of course require that you would be able to 
go to any emergency room. You do not have to go 50 miles away. You do 
not need prior authorization because we have what we call a prudent 
layperson standard. If the average person thinks that this is an 
emergency, then they go to the local emergency room and they do not 
need prior authorization; otherwise, it is not an emergency.
  In the Republican plan, again, they have so many loopholes. They say 
that severe pain is not a standard that a reasonable person could apply 
and go into the emergency room. So if you think you are in severe pain, 
and that is the reason you go to the emergency room without prior 
authorization, it turns out you did not have a problem, then they are 
not going to pay for it, because your basis was going there with severe 
pain. I can go on, and I do not want to because I think we can bring 
some of these things out.
  Essentially, there is no progress on the issue at all with the 
Republican plan. It is not a meaningful way to move forward at all on 
the issue of managed care reform.
  Mr. Chairman, I yield to the gentlewoman from Michigan who, again, 
has been outstanding on this issue and has been getting a lot of input 
back from her constituents on the need for this Democratic proposal.
  Ms. STABENOW. Mr. Chairman, I thank my friend, the gentleman from New 
Jersey, and to echo what all of my colleagues have said for all of his 
hard work, he has been a wonderful leader and he has been here many, 
many late nights. We are all here late tonight, because we care very 
much about this issue, and he has been here many, many late nights.
  Today, we are here as Democrats from New Jersey to Pennsylvania to 
Texas to Michigan. I do want to start, though, by saying that, most 
importantly, we are here as Americans who want to allow every one of 
our families to be able to participate in what is the best health care 
system in the world.
  How ironic that we have the best health care, and, yet, people cannot 
receive the best health care because of the ways systems have been set 
up.
  We do not want to be here talking about Democrats versus Republicans. 
We want to ask them to join us. Unfortunately, it has become an issue 
separating us because of whose interests we are reaching out to 
protect, American people wanting health care or those who benefit, the 
insurance companies who are benefiting by the current status quo.
  I want to share with my colleagues this evening just one letter of 
many that I have received from families in Michigan. This speaks very 
much to the issue of emergency room care as well as a number of other 
issues that have been raised this evening. This is from a constituent 
of mine.
  ``My husband was working on a job when he had a chain saw kick back 
and cut into his lower left leg. He was rushed to the nearest hospital 
where he was immediately put into a trauma unit where the doctors began 
assessing the damage and preparing a medical plan of action. The chain 
saw stalled in his tibia bone after severing all the muscles, veins, 
and nerves in his lower leg.
  ``The hospital's plan was to take him to an operating room, with an 
orthopedic surgeon, vascular surgeon and a neurology surgeon. Per my 
health insurance card's instructions, the hospital personnel contacted 
my HMO who insisted that my husband be transferred to another hospital. 
The physician in charge did not agree, claiming the accident was too 
severe to move him. The HMO clerical claimed that, if treated, the HMO 
would not pay the bill.
  ``The ambulance drivers were instructed to leave my husband on a 
gurney by the door at the second hospital, where he remained for 9 
hours without any pain medication. He was not even given any ice to put 
on the wound. We finally saw the emergency room physician after 9 hours 
and after my husband tore a phone out of the wall and threw it on the 
floor'' due to his severe pain.
  ``Eventually, my husband was given nine loose stitches in his leg, 
put in a cast, and sent home after laying in his filthy, wood-chip 
covered clothing for 28 hours'' in the emergency room. ``He never 
received any surgery'', which was recommended, and ``is now in constant 
pain from permanent nerve and vascular damage, which were both 
medically repairable during the first 24 hours following the accident.
  ``We have found a physician who is willing to attempt some orthopedic 
repair. This has taken all of our savings because he is not in the 
`network' '' of the HMO.
  ``This corporation has been allowed to hold my family prisoner for 12 
months. The lack of medical care they have provided has cost my husband 
a normal life. We have since lost our business and are trying to 
sustain our family of four on one income.''
  This is a situation that should never happen in the United States of 
America. There is absolutely no reason why this gentleman was not 
treated immediately in the emergency room with the care that he needed 
which was recommended by the doctor in charge.
  Our bill, the Patients' Bill of Rights would reinstate that critical 
relationship between the physician and the patient. Instead, the 
Republican leadership bill would do little to protect the family that I 
just talked about.
  As my colleague, the gentleman from New Jersey, talked about earlier, 
the whole issue of referring to severe pain as well is excluded from 
their bill in terms of defining when you can receive care in an 
emergency room. In fact, what we are talking about is the medically 
sound advice of a doctor, such as the doctors in the emergency room 
that I just talked about, being able to treat someone without having to 
look to an HMO that is not in the best interest or used in the best 
interest of the patients involved.
  Let me just say, in conclusion tonight, that we are fighting for that 
woman, that family that was in that emergency room, and all of the 
other families across America that want very much, that expect in this 
country to have the quality health care that they need for themselves 
and their families.
  Ms. MILLENDER-McDONALD. Mr. Speaker, I would like to join my 
colleagues tonight in explaining to the American people what the 
Republican leadership is doing--as opposed to claiming to be doing--to 
address a disturbing trend in the nation's health care system.
  We have heard story after story of how doctors have recommended 
certain medical procedures and health insurance companies have claimed 
that it is not necessary and not covered. We have heard over and over 
again about women who have not been allowed to have their gynecologist 
serve as their primary doctor and instead, have been forced to waste 
time and money visiting their primary doctor each time they need to see 
their gynecologist. We know the same treatment occurs when patients 
seek specialists and are instead dragged through a painfully slow 
process of going to their primary care physician every time they need 
their specialist. This has resulted in delayed treatment and even in 
the loss of lives.
  One issue on which I have worked extensively is creating more 
opportunities for children and those in need to receive bone marrow 
transplants. Although most health insurance companies claim that they 
cover bone marrow transplants, in reality, few cover the complete cost 
involved in saving a child's life. Every year in this country, 30,000 
people are diagnosed with diseases such as Leukemia and Sickle Cell 
Anemia that can be successfully treated with a bone marrow transplant. 
The marrow transplant procedure is no longer considered an experimental 
procedure.
  It has been peer-reviewed in numerous professional medical journals, 
which is the basis for determining ``medically appropriate'' care that 
will be covered by insurance plans. Beyond meeting this standard, bone 
marrow

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transplant searches and procurement from donors must be covered as well 
in order to truly save lives.
  Bone marrow transplants are just one example of a clearly life-saving 
and medically appropriate and necessary procedure that needs to be 
covered by health insurance companies.
  The Republican bill leaves medical decisions in the hands of 
insurance company accountants and not in the hands of those who know 
best: the doctor and patient.
  The Republican bill does not ensure access to specialty care; does 
not prohibit HMOs from offering bonuses to doctors for denying 
necessary care; does not prohibit drive-through mastectomies; and 
perhaps, worst of all, the Republican bill does not hold the health 
insurance plans accountable when abusive practices kill or severely 
injure patients.
  Despite what those who would rather squander extra dollars for the 
health industry say, these protections would not result in a 
significant increase in costs. A recent congressional study concluded 
that the right to sue, which is in the Democratic Patients' Bill of 
Rights bill, would result in only an extra $2 a month per employee.
  These are just some of the 16 protections that are missing from this 
Republican fig leaf of a bill that are included in the Democratic 
Patients' Bill of Rights bill. The Republican bill flies in the face of 
those lives who have been lost or severely impaired by an incomplete, 
unfair and sometimes ruthless HMO system. This legislation is seriously 
flawed not only because it is extremely partisan and has completely 
circumvented the legislative process, but also because it does little 
to resolve some of the most daunting problems facing Americans today.

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