[Congressional Record Volume 144, Number 101 (Friday, July 24, 1998)]
[House]
[Pages H6395-H6417]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1215
                     PATIENT PROTECTION ACT OF 1998

  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentleman from 
Ohio (Mr. LaTourette).
  (Mr. LaTOURETTE asked and was given permission to revise and extend 
his remarks.)
  Mr. LaTOURETTE. Mr. Speaker, I want to thank the dean of the House 
the gentleman from Michigan (Mr. Dingell) and my classmate the 
gentleman from Iowa (Mr. Ganske) for the opportunity to address my 
support for the Patient Bill of Rights. I also want to thank the 
gentleman from Illinois (Mr. Hastert) for doing what he thinks is the 
right thing.
  Obviously there is a slight concern when you endorse a proposal that 
is labeled the Democratic bill when you are a Republican and vice 
versa. While I am saddened that this issue has a partisan spin to it, 
today I am driven to support the initiative that I believe gives the 
greatest protection and possibility of care for the people that I 
represent. That bill is Ganske-Dingell.
  I want to direct my remarks to the liability provisions, however, 
relating to employer-provided health care plans. Being a lawyer, I like 
that profession as well as any other, but I am sensitive to the 
concerns of small business owners, many of whom administer their own 
plans, about the liability problem. Some of the calls our office has 
received have been driven from K Street, but many others have come from 
business owners who are operating on small margins and who want to do 
the right thing by their employees.
  Last night, therefore, I read and I reread page 66 of the Ganske bill 
concerning liability, and it only reinforced my belief that employers 
have been needlessly frightened, similar, I am sad to say, to the 
shameful way seniors were frightened during the Medicare debates.
  The only time that an employer is exposed to liability is when the 
employer makes discretionary medical decisions. Not a doctor, not a 
hospital, not a nurse, not an HMO. I cannot even think of one situation 
where an employer would want to make a medical decision, good, bad or 
otherwise.
  Nevertheless, I would ask the sponsors of the bill to tighten the 
language of the employers' exception in conference. The one thing that 
I do know about my profession is that they have a unique ability to 
take words that seem to say one thing and then get a judge somewhere, 
usually an appointed one, to interpret them in another.
  I urge passage of the substitute and would ask both parties to work 
diligently in conference to create a product that represents the best 
of both bills. I would ask that we not be about the business of 
creating campaign commercials here on the floor today but we be about 
the business of helping Americans of all ages receive the care that 
they need.
  Mr. HASTERT. Mr. Speaker, I yield 1 minute to the gentleman from 
Arkansas (Mr. Dickey).
  Mr. DICKEY. Mr. Speaker, I come here as a former small business owner 
and as a lawyer. When I first looked at this situation, I looked at it 
from the doctor's standpoint and I saw a tremendous need, dire 
circumstances that doctors are facing, even to the extent that we were 
going to lose doctors presently existing and applicants were not going 
to apply. And I rushed in with my philosophical approach to this and 
said, ``We've got to help the doctors at all costs.'' What I found out 
was that ``at all costs'' meant the cure was going to be worse than the 
disease, that the small business owners were going to be killed by 
being put into courtrooms without any type of protection and in greater 
numbers.
  So what I wanted to do was to try to look at the patients and say we 
need to

[[Page H6396]]

get them in the treatment room and not in the courtroom. I have looked 
carefully at this and I can see that the Hastert bill is a perfect 
solution for this, or maybe not perfect but it is a perfect start. It 
is something we need to look at. If we do not do this, we are going to 
have patients who will not have choices because they won't have 
doctors, and that is serious.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Mrs. Capps).
  (Mrs. Capps asked and was given permission to revise and extend her 
remarks.)
  Mrs. CAPPS. Mr. Speaker, on behalf of the patients of the central 
coast of California and all across America, I rise to say that enough 
is enough. I have been an elected official for only four months but I 
have been a nurse for over 30 years. As a nurse I know firsthand the 
importance of accessible, quality, patient-centered care.
  We must pass a bill which is more than a band-aid, which will ensure 
patients' rights and consumer protection against the abuses of HMOs. 
For common sense, comprehensive managed care reform, we must guarantee 
that critical decisions will remain in the hands of doctors and nurses, 
not insurance companies. We must guarantee access to specialists, so 
that people can really choose their own doctors. We must guarantee an 
end to financial incentives to limit medical care. We must guarantee 
emergency room care so people are not turned away from the hospital 
door. We must guarantee tough enforcement to hold insurance company 
bureaucrats responsible for their cost-cutting actions.
  The American people deserve a bill with these guarantees, not a 
Republican bill, not a Democrat bill but a people's bill. The Ganske-
Dingell proposal protects patients with the force of law. This 
bipartisan bill will allow people to choose their own doctor, end 
oppressive gag rules so patients can have access to all critical 
treatment options, and perhaps most importantly give patients legal 
recourse when insurance companies deny important medical coverage.
  Basic patients' rights can mean the difference between life and 
death. If patients can sue their doctors for poor care, they should be 
able to sue the insurance bureaucrats who pull the strings and are 
behind these cost-cutting decisions.
  As one of three nurses in Congress, it is my duty to speak out. The 
leadership bill has huge loopholes which do nothing to prohibit HMOs 
from denying care. Our health care system needs serious medicine, not a 
political placebo.
  Mr. Speaker, we still have time to act. With 32 days left in 
Congress, if we do nothing else, we must guarantee real patients' 
rights for the American people. Let us pass comprehensive, bipartisan 
managed care reform today.
  Mr. HASTERT. Mr. Speaker, I yield 3 minutes to the gentleman from 
Georgia (Mr. Norwood) who worked on the task force and certainly was 
the creator of a lot of the thoughtful positions that are included in 
our plan.
  Mr. NORWOOD. Mr. Speaker, it seems to me that it has been years in my 
life till we get to this day. I have wanted this to happen a long time. 
I am saddened deeply by what I hear and see happening in this room 
today. I had hoped that all of us would recognize the importance of 
protecting human beings' lives, the importance of correcting the 
malfunctioned ERISA laws of 1974 and could come together and actually 
offer good patient protections that the people of this country so 
deserve. But I hear over and over again demagoguery, politicization, 
misrepresentation, total untruths, just simply getting it wrong and not 
telling it right, and I am saddened by that.
  The Dingell-Ganske bill has good patient protections in it. I do not 
question that. I know that it does. It is imperfect, however. The 
Republican bill has excellent patient protections in it, though it, 
too, is also imperfect.
  I want to speak to my friend from Texas who says, oh, all of a sudden 
the Democrats have realized we need to protect patients. We bring this 
up today because we are Democrats.
  I would remind my friend from Texas that you are the same group that 
tried to put everybody in the country in managed care 4 years ago, with 
no thought to any particular patient protections. I have for at least 
two terms of Congress as a Republican tried to protect patients, and I 
am delighted that you have joined with us at this late date.
  Mr. Speaker, I have spent the last year and a half calling for 
support to end the ERISA preemption of State medical malpractice law. I 
pled with the President to add ERISA liability to his advisory 
committee report in November 1997. He did not. I requested that the 
President call for ERISA liability reform in his State of the Union 
address in January of 1998. He did not. I argued day after day with the 
Republican Working Group to add ERISA liability reform to this bill. 
They would not. There is a reason for that. It is a big enough reason 
that we can end up this year with no law, no patient protections over 
this subject. As much as I am for it, I am for a law this year that 
will get as many patient protections as we possibly can meet. The task 
force met me more than halfway with a new proposal that I frankly like 
very much. It is about liability and it is about suing an HMO. If I 
could only have one of the two liability provisions, I believe today 
that I would take our own. I ask you to stop this politicization of 
this bill and let us work together and pass patient protections.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentlewoman from Colorado (Ms. DeGette).
  Ms. DeGETTE. Mr. Speaker, I rise today in strong support of the 
Ganske-Dingell Patients' Bill of Rights, and in equally strong 
opposition to the Hastert bill. Nothing in the Republican bill would 
have protected the rights of young Brice Randa from Colorado. Here is a 
picture of the Randa family, Allen and Jodi with their children Taylor 
on the left and Brice on the right. Brice died just two months after 
this picture was taken.
  Brice was diagnosed with Lissencephaly, a terrible disease that made 
Brice's short life limited to breathing tubes, stomach wraps and motor 
seizures, a disease which eventually killed him. Although it was 
inevitable, Brice's death is heartbreaking for more than one reason. 
The tragedy lies in the fact that this family spent the few precious 
months they had with their son negotiating with the HMOs instead of 
taking care of their precious little boy. The 16 months the Randas had 
with Brice were consumed with lawyers filing paperwork and appealing 
decisions made by their HMO.
  The Randas' doctor wrote the HMO begging, ``The family is 
overwhelmed. We petition for 4 hours per day extra assistance,'' and 
the HMO denied this.
  Under the Republican bill, a health plan can define medical necessity 
any way it wants, giving families like the Randas no protection from 
insurance company bureaucrats deciding what medical care is 
appropriate. Moreover, under the GOP's rules, if the Randas did want an 
external review of the decision denying the 4 hours a day of care for 
Brice, they would have to pony up $100 from their pocket just to have 
the case heard by somebody who would have to follow guidelines set by 
the very HMO that denied the care in the first place. And if Brice had 
needed emergency care, the HMO would have had 72 hours to consider an 
appeal of an emergency care decision. Frankly, this GOP scheme is worse 
than the status quo. It stabs at the heart of what the debate over HMO 
reform is really about. On the other hand, the Ganske-Dingell bill 
ensures that the medical profession will define medically necessary 
care.
  Vote for our alternative. Vote ``no'' on the Hastert bill.
  Mr. HASTERT. Mr. Speaker, I yield myself 10 seconds. I just want to 
remind the gentlewoman from Colorado that if it is emergency care, our 
patients are in the emergency room immediately, not 72 hours. She is 
wrong and she misrepresented the facts.
  Mr. Speaker, I yield 1 minute to the gentleman from Arizona (Mr. 
Hayworth).
  Mr. HAYWORTH. I thank my colleague from Illinois and I thank the 
gentlewoman from Colorado, because she unintentionally demonstrates why 
we should oppose the Dingell bill and support the reasonable, rational, 
compassionate Patient Protection Act.
  You see, Mr. Speaker, we are faced with a choice today. Do we support 
a true patient bill of rights, or do we support a lawyer's right to 
bill? I rise with

[[Page H6397]]

colleagues from both sides of the aisle who say they do not want 
decisions made by bureaucrats, whether they are Washington bureaucrats 
or insurance company bureaucrats. Health care decisions should be made 
by physicians and health care professionals consulting with their 
patients. That is the element that we preserve, uphold and amplify in 
the Patient Protection Act. Sadly, endless litigation and lawsuit after 
lawsuit is provided for in the Dingell substitute. That is what we have 
to remember; true compassion, not courtroom drama.

                              {time}  1230

  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Wisconsin (Mr. Kleczka).
  Mr. KLECZKA. Mr. Speaker, I rise today in opposition to H.R. 2450, 
what the Republicans have called the Patient Protection Act, but is 
better termed the Republican Patient Election Year Posturing Act.
  H.R. 4250 is full of hollow promises and empty protections. 
Republicans call this a managed care reform bill, but in reality it is 
far from it.
  For starters, the Election Year Posturing Act does little to address 
the serious problems of our current health delivery system and does a 
lot to maintain the status quo.
  Let me detail what the Republican bill does not provide. It does not 
put medical decisions back in the hands of doctors and, instead, keeps 
it in the hands of insurance company accountants and their executives, 
people who we call the bean counters.
  It does not give patients access to specialty care where they need 
it. We heard from our Republican colleague the gentleman from Florida 
(Mr. Weldon), a doctor, previously indicating he was on a talk show, 
and a woman indicated she was in the same Federal health plan as all of 
us. He asked, ``why did you not choose a different one to get the 
doctor of your choice?'' She said to him, and hopefully I am quoting 
this right, she could not afford it.
  So the bottom line is we cannot afford it. We get substandard care. I 
think that is wrong on the part of the Republicans. It does not give 
patients access to specialty care. It does not provide women undergoing 
a mastectomy from being pushed out of the hospitals just hours after 
surgery and does not require insurers to cover reconstruction surgery 
after mastectomy. It does not allow a woman to choose a gynecologist or 
other specialist as a primary care doctor.
  Let me also indicate that we heard from a trial attorney Republican 
supporting the Republican bill. He indicated that if one is 
misdiagnosed and does not get subsequent needed treatment, we are going 
to give them $500 a day. Oh, well, we will give you $1,000 a day.
  But if that is one's mother, and that misdiagnosis or lack of 
coverage and treatment, like a bone marrow transplant, or needed 
chemotherapy, is denied, it might be to the insurance company's 
advantage to give them the $1,000 a day versus having the right to sue 
the provider and the health care bean counter.
  Mr. Speaker, I ask the Members to support the Dingell-Ganske bill.
  Mr. HASTERT. Mr. Speaker, I yield 2 minutes to the gentleman from 
South Carolina (Mr. Graham).
  Mr. GRAHAM. Mr. Speaker, I thank the gentleman for yielding to me.
  For any lawyer out there, listen up close. The $500 a day is to 
ensure prompt payment. The bill ensures treatment. That is the whole 
point of this bill. If one has a medically urgent situation, one can go 
to court within minutes of being said no to and get a temporary 
restraining order ordering the treatment to be given.
  Also, the physician and hospital can provide one the treatment and 
subrogate to one's interest and have an external review of the HMO 
decision within 6 days. That is when the $500 per day kicks in, to get 
them to pay.
  During the initial waiting period, one is getting the treatment. That 
is the point. The $500 a day is to ensure payment. Under our bill, one 
gets treatment from day one, from minute one, because one has avenues 
to compel them to treat them.
  But what about the $500 claim? As a lawyer, one comes in to my office 
with a $500 claim, no matter how meritorious it is, I am going to say 
that is very nice, but I have got to make a living and feed my family. 
I cannot chase $500.
  Under the Democratic bill, if we have a small claim, we are not 
entitled to external review until the significant threshold is passed. 
Under the Republican bill, if they nickel and dime us for $100, $200, 
$500, and that is what happens every day. They nickel and dime us out 
there. We allow people to go to external appeal no matter how small the 
claim is if they put up from $25 to $100. The filing fee in South 
Carolina for tort actions is $35.
  So they get an external appeals process and a small claim, then the 
$500 a day kicks in plus attorneys' fees, plus the benefit. I will take 
the case then, because I can get paid, and there is a $500 clock 
running for the small claims.
  So HMOs will not nickel and dime people. That is where the abuse is 
at. And my colleagues do nothing about that. This really makes them 
honest. We get the treatment up front. The penalties are significant. 
We get people what they need, which is health care, not a jury award 4 
years later when they are dead.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentlewoman from Connecticut (Ms. DeLauro).
  Ms. DeLAURO. Mr. Speaker, I rise in support of the Ganske-Dingell 
bill and in opposition of the Republican bill.
  For the last 2 years, I have been working on legislation to end the 
practice of drive-through mastectomies. The bill simply ensures that 
breast cancer patients are allowed 48 hours in the hospital to recover 
from this physically and emotionally devastating surgery. It does not 
seem like much to ask, and yet the Republican leadership has refused to 
schedule hearings on this important legislation.
  The Democratic Patients' Bill of Rights ends the practice of drive-
through mastectomies. The House Republican leadership bill ignores this 
problem. What is worse, their legislation will actually strip away 
existing State protections.
  My State of Connecticut has led the fight to end outpatient 
mastectomies. The Connecticut legislature has already acted to outlaw 
this outrageous practice. But the Republican bill would repeal those 
hard-fought patient protections.
  The Republican bill will not put medical decisions back in the hands 
of doctors and patients. It makes current problems worse. It eliminates 
consumer safeguards. In the case of breast cancer patients, this bill 
is a slap in the face.
  Mr. HASTERT. Mr. Speaker, I yield 1 minute to the gentleman from 
Nevada (Mr. Ensign).
  (Mr. ENSIGN asked and was given permission to revise and extend his 
remarks.)
  Mr. ENSIGN. Mr. Speaker, I rise in support of the Republican bill 
today for several reasons. First of all, we have to listen to the other 
side. These are the people who are now saying that they want the 
doctors to choose their health care and the type of choices in those 
health care plans. But these are the same people who 4 years ago or 5 
years ago were saying, ``Do you know what? We want everybody to be in 
nationalized health care, and we want bureaucrats to make those 
decisions.'' Look beneath the surface.
  The Republican plan contains medical malpractice and medical savings 
accounts, two things that I strongly support. In the final bill, they 
probably will not be able to be included because the President has said 
he would veto the bill over those two provisions, unfortunately, 
because they would help bring costs down. But we could still have good 
patient protections in this bill if it is enacted even if we have to 
drop those provisions.
  In the State of Nevada, we got together, Republicans and Democrats 
alike, and enacted patient protections similar to what are in the 
Patients' Bill of Rights that we have on the floor today. This was 
authored, by the way, by a Nevada Democrat State legislator. We ought 
to do the same thing here. Put common sense together; put party 
politics aside.
  Mr. DINGELL. Mr. Chairman, I yield 2 minutes to the distinguished 
gentlewoman from Connecticut (Mrs. Kennelly).
  Mrs. KENNELLY of Connecticut. Mr. Speaker, the 161 million Americans 
in

[[Page H6398]]

managed care today deserve to know that their health care comes first.
  For 18 years, I have represented Hartford, Connecticut, the insurance 
capital of the world. So I know how managed care came into being. 
Health insurance premiums were rising at double-digit rates, 17 percent 
in 1988, 21 percent the following year, 17 percent again in 1990.
  The industry responded to rein in the costs, and it worked. But it so 
often happens in reform, once a balance is reached, some people do not 
know when to stop. So now profits became the prize.
  Yes, we have stable prices, but they have come at a terrible cost. 
That is what we are addressing today, the cost of our confidence that 
we will get the health care that we need, that we deserve, and that we 
pay for.
  Specialist treatment, continuity of care, emergency room treatments 
are not options. They are not frills, as some managed care companies 
seem to believe. When patients are denied adequate care by arbitrary 
decision-makers, they must have recourse.
  Mr. Speaker, we must put patients first again in this bill. H.R. 3605 
offers real relief at modest cost, and I urge my colleagues to do this 
today.
  Mr. HASTERT. Mr. Speaker, I yield 1 minute to the gentlewoman from 
Kentucky (Mrs. Northup).
  Mrs. NORTHUP. Mr. Speaker, we all know that, in this fast-emerging 
change in health care that there have been abuses by HMOs, and we are 
proud to be here today to deal with those and to address those and make 
sure that there is the important level of care that every American 
deserves. We are going to deal with that today.
  But we should not let this be an excuse for huge new Federal controls 
of the delivery of health care. That is what people that believe in a 
big bureaucracy dealing with health care support. We should not also 
make this an excuse to give the trial attorneys a huge new cut of our 
medical premiums. Medical money needs to go to medical care and not to 
trial attorneys.
  I am proud that I am not on the trial attorneys' side and not on 
their team. It is no wonder that the team that is on their side is 
supporting this substitute here today.
  The SPEAKER pro tempore (Mr. Foley). The gentleman from Michigan (Mr. 
Dingell) has 16\1/2\ minutes remaining. The gentleman from Illinois 
(Mr. Hastert) has 17\3/4\ minutes remaining.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Rhode Island (Mr. Kennedy).
  Mr. KENNEDY of Rhode Island. Mr. Speaker, today I stand on behalf of 
Kathryn Carberry in my State of Rhode Island. She was released too 
quickly from the hospital because her insurance company denied her 
treatment for a breast operation that she had and continued treatment 
for that.
  I also stand on behalf of Deborah Kushner's little boy who was nearly 
killed because her HMO denied treatment in an emergency room.
  The Republican leadership have refused any committee debate with full 
and free testimony because they are afraid of these stories. Now they 
come up with a bill that is a product of the HMO industry itself.
  We have waited for managed care reform, so why should we settle for 
the HMO's own plan. This bill leaves out so many crucial provisions, it 
is almost laughable. Where is the provision against drive-through 
mastectomies that could have saved Ms. Carberry's life. It is not in 
there. Where is the prudent layperson for Mrs. Kushner's son? It is not 
in there. Where is the provision to hold accountable these HMOs? It is 
not in there.
  Every other product in this country can be held liable but managed 
care organizations. It is time we put a stop to managed care 
organizations who are practicing medicine without a medical license.
  Mr. HASTERT. Mr. Speaker, I yield myself 5 seconds. I would just like 
to recommend to the gentleman from Rhode Island that he read the right 
bill.
  Mr. Speaker, I yield 1 minute to the gentleman from North Carolina 
(Mr. Ballenger).
  Mr. BALLENGER. Mr. Speaker, I support the Patient Protection Act. 
While the bill is not perfect, it is an important step in ensuring 
access to health care insurance for many people who are currently 
without it.
  As a small business officer of a company which self-insures its 200 
employees, the unlimited liability of the Dingell bill is frightening. 
We insure all of our employees currently, but if big government Dingell 
bill were to become law, we would be forced to give our employees the 
money and let them buy their own insurance at, obviously, a higher 
cost. Many businesses would have to do the same.
  The Dingell bill encourages patients to sue after a denial of 
coverage occurs rather than bringing a quick appeals process that would 
help the patient get coverage for care in a timely fashion.
  Also, the Congressional Budget Office has estimated that the Dingell 
bill will increase the cost of health care and not make it more 
affordable. On behalf of the American people who need affordable care, 
oppose this substitute.
  In the United States today, there are more than 42 million Americans 
without health insurance--many of whom are employed, or have a family 
member employed, by a small business that cannot afford to offer health 
care coverage for its employees.
  The Patient Protection Act addresses the lack of coverage of these 
individuals in several ways, including the creation of association 
health plans which will be governed by uniform standards. These plans 
would allow small businesses, trade associations, labor unions and 
professional associations to pool together to obtain the same economies 
of scale, purchasing clout and administrative efficiencies, that 
employees of large employers benefit from. Association health plans 
will have the freedom and flexibility to design more affordable benefit 
options. This will allow small businesses to offer their workers access 
to the same benefit choices regardless of where they live. At the same 
time, these plans must meet strict new solvency standards to protect 
patients' interests and ensure that their benefits are paid.
  I want to mention just very briefly that I appreciate that authors of 
this bill attempt to deal with the issue of confidentiality of medical 
information. It's a complicated issue, and one that has to be dealt 
with carefully. I do have some concerns with what is in the bill, in 
terms of its potential risk to employers and the lack of clarity, 
particularly with regard to two areas in my committee's jurisdiction, 
workers compensation and occupational safety and health. I hope that 
these are issues that we can address during the conference to ensure 
that the medical confidentiality provisions work well, and do not 
inadvertently create problems in these areas.
  Accessible, affordable, quality health care is very important to all 
Americans. I have been contacted by many constituents who are demanding 
that we act in their interest. So, with their letters and concerns in 
mind, I support this important piece of legislation and urge my 
colleagues to do the same.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Texas (Mr. Green).
  (Mr. GREEN asked and was given permission to revise and extend his 
remarks.)
  Mr. GREEN. Mr. Speaker, for many months, a lot of Members have been 
working for this debate today. What is frustrating is the debate we 
have now.
  I rise in support of the Dingell-Ganske amendment. But instead of a 
real debate and a committee process we have, the Republican leadership 
is forcing this weak fig leaf bill through which will do little to give 
the American people what they really need for their health insurance.
  In fact, it will hurt State laws now in effect. In my home State of 
Texas, this Republican bill would override State law on mammogram 
screening, Alzheimer's treatment, and prostate cancer screening, and 
many more.
  On page 187 of their bill, because some of us had a chance to skim 
their bill that was released last night, line 19 exempts these State 
protections. So maybe they ought to read their bill before they defend 
it.
  I think it is ironic they talk about this being a trial lawyer bill, 
Mr. Speaker, and I ask unanimous consent to place in the Record a 
letter from the American Medical Association, who typically does not 
support the trial lawyers. It was sent to me yesterday, talking about 
the reasons that the Republican bill is so bad and the Dingell-Ganske 
amendment is so good.
  The letter referred to is as follows:

                                 American Medical Association,

                                       Chicago, IL, July 23, 1998.
     Hon. Gene Green,
     House of Representatives, Rayburn House Office Building, 
         Washington, DC.
       Dear Congressman Green: The American Medical Association 
     (AMA) recognizes that

[[Page H6399]]

     changes may be offered to H.R. 4250, the House Republican 
     ``Patient Protection Act of 1998,'' when it is brought to the 
     House floor, to begin to address some of the serious concerns 
     with the legislation as introduced. We urge Members of 
     Congress to take the time to fully explore whether any such 
     amendments correct the problems outlined below. As you may 
     know the AMA has carefully reviewed and lent its full support 
     to H.R. 3605, the ``Patients' Bill of Rights Act of 1998.'' 
     We believe that H.R. 3605 provides comprehensive and 
     meaningful patient protections that should be enacted before 
     Congress adjourns this fall.
       On behalf of the 300,000 physician members of the AMA and 
     the millions of patients we serve, we strongly urge you to 
     oppose H.R. 4250, as introduced, and to vote in favor of the 
     Ganske-Dingell substitute (text of H.R. 3605). In our view, 
     only H.R. 3605 would provide meaningful patient protections 
     to address existing abuses in managed health care.
       There are ten reasons to vote against H.R. 4250 and to vote 
     for H.R. 3605.
       Reason #10: ``The Devil is in the Details''--Here are the 
     facts.
       H.R. 4250 claims to offer ``similar'' protections to those 
     extended in H.R. 3605, but the legislative language of H.R. 
     4250, at nearly every turn, clearly favors health plans and 
     insurance companies at the expense of patients. These 
     problems are much more than just ``technical drafting 
     matters.'' In fact, Members of Congress have not had time to 
     fully understand critical differences in the two bills since 
     last Friday's introduction of the House Republican bill. By 
     contrast, H.R. 3605 was drafted and introduced earlier this 
     year, with ample time for public examination; its provisions 
     ensure that patients would receive medically necessary 
     covered services. H.R. 4250 would continue to allow insurance 
     companies and health plans to put their financial bottom-line 
     ahead of patient care.
       Reason #9: H.R. 4250 would allow health insurance companies 
     to decide what is medically necessary; H.R. 3605 would 
     restore physician medical decision-making.
       By retaining the power to define what is and what is not 
     medically necessary, under H.R. 4250, health plans--not 
     physicians--would continue to decide all patient health care 
     decisions, Linda Peeno, MD, a former HMO medical director, 
     described this retained control ``as a health plan's smart 
     bomb capability'' in testimony before the House Commerce 
     Committee. Consequently, the external appeals process 
     proposed by H.R. 4250 would be of little or no value if the 
     health plan were always allowed to define what is medically 
     necessary or appropriate. By contrast, H.R. 3605, promotes 
     good medical practice by specifically prohibiting health 
     plans from practicing medicine by substituting their 
     decisions for the patient-specific medical judgments of the 
     treating physician.
       Reason #8: The internal and external review process in H.R. 
     4250 does not require health plans to use physicians with the 
     appropriate medical specialty training to review treatment 
     denials. H.R. 3605 is clear that only ``clinical peers''--
     physicians with similar specialty training will review other 
     physicians' medical decisions.
       As an example, only cancer specialists should review cancer 
     treatment. Reviewers must have the right specialty training 
     to decide life and death issues. Only H.R. 3605 would provide 
     this critical patient protection.
       Reason #7: H.R. 4250 would require patients to pay for the 
     privilege of an external review of treatment denial; H.R. 
     3605 imposes no such fees on patients seeking to exercise 
     their rights.
       Patients should not have to pay to have a treatment denial 
     reviewed.
       Reason #6: H.R. 4250 does not contain several key physician 
     choice provisions that are included in H.R. 3605.
       H.R. 4250 does not include a provision found in H.R. 3605 
     that would allow a patient in the midst of serious illness or 
     pregnancy to continue a relationship with a physician who 
     leaves or is forced to leave a health plan network. The House 
     Republican bill also does not provide patients with critical 
     ongoing access to specialists for chronic conditions (such as 
     asthma, diabetes, etc). H.R. 4250 also does not require plans 
     to disclose to prospective enrollees the adequacy of the 
     physician network to serve a given patient population. H.R. 
     2605 provides both access to necessary specialty care and 
     disclosure of the plan's physician mix to patients.
       Reason #5: H. R. 4250 would provide a huge loophole for 
     plans to circumvent the point of service provisions.
       Under the terms of H.R. 4250, employers would not have to 
     offer employees point of service coverage if they could prove 
     that the plan's premiums would increase by 1%. The AMA has 
     always said that patients may choose to bear reasonable 
     additional costs to obtain a point of service option that 
     would ensure greater choice of physicians. This opt-out 
     provision of H.R. 4250 could effectively ``gut'' the concept 
     of a point of service option for many plan participants.
       Reason #4: H.R. 4250 would delay the effective date of 
     patient protections for up to two years after the date of 
     enactment. H.R. 3605 would provide for nearly immediate 
     implementation of most patient protections.
       The evidence is overwhelming that patients need and are 
     demanding protections now. The delayed effective date in H.R. 
     4250 is an opportunity for more legislative mischief by 
     health plans seeking passage of ``gutting'' amendments before 
     patient protections are actually offered to patients. H.R. 
     3605 would generally extend all patient protections soon 
     after enactment.
       Reason #3: H.R. 4250 does not adequately protect the 
     broadest possible range of ``medical communications,'' nor 
     would it ensure all necessary emergency care. It even cuts 
     back on the Balanced Budget Act's antigag clause/practices 
     and prudent layperson provisions that cover Medicare 
     patients.
       On anti-gag practices, H.R. 4250 does not include the words 
     ``otherwise restrict'' medical communications. The omission 
     of these key words would allow health plans to continue to 
     gag physicians. The ``prudent layperson'' provision for 
     emergency services in H.R. 4250 does not include ``severe 
     pain'' in the definition of what a reasonable person would 
     think requires immediate treatment.
       Reason #2: H.R. 4250 creates a new federal preemption of 
     state patient protections laws for association health plans 
     and would override many of the patient protections laws 
     already enacted by some 43 states.
       Association health plans would be exempt from state patient 
     protection requirements. H.R. 4250 also lacks express 
     language recognizing the authority of state legislators to 
     regulate the health care delivery practices of such entities 
     for state residents.
       Reason #1: H.R. 4250 does not hold health plans properly 
     accountable for making medical treatment decisions that 
     result in patient injury or death.
       The managed care liability issue is about basic fairness 
     and holding health plans accountable for their conduct. No 
     other industry in America enjoys the special legal 
     protections currently extended to health plans. Members of 
     Congress have spoken out against special legal protections 
     for tobacco companies. Why should health plans continue to be 
     given special liability protections? The AMA continues to 
     lobby for tort reforms, but we have never advocated that 
     patients should be denied adequate compensation for true 
     medical negligence. The damages and penalties in H.R. 4250 
     fall far short of providing patients with proper compensation 
     for preventable injuries and death.
       Again, we urge you to vote for a House floor procedure rule 
     that will allow a vote on H.R. 3605, and to vote for passage 
     of H.R. 3605.
           Respectfully,
                                   E. Ratcliffe Anderson, Jr., MD.

                              {time}  1245


                         Parliamentary Inquiry

  Mr. DINGELL. Mr. Speaker, I have a parliamentary inquiry.
  The SPEAKER pro tempore (Mr. Foley). The gentleman will state it.
  Mr. DINGELL. Mr. Speaker, who has the right to close debate on this 
bill?
  The SPEAKER. As stated on page 567 of the House Rules and Manual, the 
Chair will assume that the manager of a measure is representing the 
committee of jurisdiction, even where the measure called up is 
unreported.
  House Resolution 509 specifically named Mr. Hastert as the manager of 
this bill; Mr. Hastert called up the measure; and Mr. Hastert is a 
member of the committee having primary jurisdiction over the bill. As 
such, the gentleman from Illinois has the right to close.
  Mr. HASTERT. Mr. Speaker, I yield three minutes to the gentleman from 
California (Mr. Thomas), Chairman of the Subcommittee on Health Care of 
the Committee on Ways and Means.
  (Mr. THOMAS asked and was given permission to revise and extend his 
remarks.)
  Mr. THOMAS. Mr. Speaker, I thank the gentleman for yielding me time.
  Mr. Speaker, one of the things we have to make sure we do not do is 
revise history. I think it might be useful just to remember where the 
prudent layperson language in the Republican provision and in the 
Democrat provision came from. It came from the changes that were made 
in the Medicare program.
  I think when you examine the gag rule provision, it is in the 
Democratic bill, it is in the Republican bill, it came from the 
Medicare revisions. If you recall, I said, prior to the election, the 
Democrats were accusing the Republicans of trying to destroy Medicare. 
After the election we sat down and put together a prudent package to 
preserve and protect Medicare. We included a number of provisions that 
were applicable only to Medicare because it was a bill dealing with 
Medicare. That was in 1997.
  We then began in the Subcommittee on Health a series of hearings 
about the problems that were out in the current marketplace because of 
the distortion of the rapid movement to managed care. We began 
examining the Medicare changes to find what we could include in the 
package.
  You have heard repeatedly that somehow the Republican plan was

[[Page H6400]]

thrown together in a couple of days. That is pre-election rhetoric. It 
simply is not the truth.
  We include significant patient protections; they include some patient 
protections.
  We include the opportunity to get health care, make it more 
affordable, make it more accessible. Do not believe me, believe the 
Congressional Budget Office. They looked at their bill. They evaluated 
it. They priced it out. They said if the Democrat's bill were law, 
premiums would cost more. Health care costs would go up.
  The Congressional Budget Office looked at our bill, they examined it, 
they priced it. The nonpartisan fiscal analyst said if the Republican 
bill became law, health care costs, premiums, would go down.
  In addition to that, a provision that they had said is a poison pill, 
it would kill the bill, the medical malpractice provision that is in 
the Republican bill, it is not in the Democratic bill, that that 
measure alone, reforming medical malpractice, would save, directly save 
the Federal Government and the Medicare and Medicaid program, $1.5 
billion a year over a 10 year period; $1.5 billion.
  Where is that money going to come from? It is going to come from 
money that does not go to trial lawyers. Why do they call it a poison 
pill? Frankly, given the way their bill is structured, it is the trial 
lawyers who are going to be the main beneficiaries of those premiums 
going up. CBO says their plan increases premiums. CBO says our plan 
reduces premiums.
  Yes, it is important to address the changes in the health care market 
today about patient protections. It is also important to make sure that 
health care is affordable for more Americans. Our plan does it; their's 
does not.
  Mr. DINGELL. Mr. Speaker, I yield one minute to the distinguished 
gentleman from Michigan (Mr. Levin).
  (Mr. LEVIN asked and was given permission to revise and extend his 
remarks.)
  Mr. LEVIN. Mr. Chairman, let me give you a real live example of the 
major differences between these two bills. Twenty-five years ago one of 
my constituents was diagnosed with multiple sclerosis. A battery of 
medications have been developed in recent years that can often slow the 
course this disease, but it is expensive. His doctor prescribed the 
medication, but then the HMO said, ``You need another opinion.''
  The day after he went to that second doctor, he received a letter 
from the HMO stating no way would they pay for the drug. So my 
constituent called that second neurologist and he said he had not even 
spoken to the HMO.
  Then the HMO said the reason my constituent was denied access to the 
drug was that he was at stage seven of MS, and there was no published 
research about the use of this drug on stage seven MS. So even though 
two doctors believed that he would benefit from the medication, they 
were overruled by the HMO.
  Ganske-Dingell, the Patients' Bill of Rights Act, would help avoid 
situations like this. Vote for Ganske-Dingell.
  Mr. HASTERT. Mr. Speaker, I yield three minutes to the gentlewoman 
from Connecticut (Mrs. Johnson) a member of the Subcommittee on Health 
of the Committee on Ways and Means, and distinguished for her work on 
health care for many, many years.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank the gentleman from 
Illinois for yielding me time, who has done such an outstanding job in 
leading this task force and developing this bill.
  This is indeed an historic day for the U.S. House of Representatives. 
We are going to pass legislation that forcefully protects patients' 
needs, puts physicians back in charge of medical decisions, holds 
insurance companies accountable for quality care and gives millions of 
uninsured Americans access to affordable health coverage. We have heard 
the many concerns of the American people and are acting to address them 
directly and realistically.
  Key to the reforms in this bill is the strong internal and external 
appeals mechanism that guarantees physicians will control medical 
decisions. Both the internal and external appeals process, in both of 
those processes, the physician must review the decision. It is 
physician-controlled and physician-directed, both within the plan and 
in the independent external review process. This guarantees that 
physicians, not HMO bureaucrats, will control medical decisions.
  Both the internal and external appeal decisions are governed by 
strict time frames within which decisions must be made. Patients will 
no longer be kept in limbo while bureaucrats delay. Rather, physicians 
will make timely decisions about lifesaving medical treatments. This 
will inject fairness and objectivity into our medical system.
  Accountability is key to this legislation. I have worked with the 
bill's sponsors to insert an important provision that will force public 
accountability of the insurance companies on this very issue, because 
we will now report publicly the results of these appeals processes. In 
other words, if the plan denies a patient care and that decision is 
overturned on external appeal, people will know it. They can change 
plans. They will not buy that plan. The market will deliver a far more 
devastating verdict to that plan than the courts could over many years.
  The external and internal appeals, because they are physician-
controlled, they are patient-oriented, will bring timely decisions and 
access to specialty care, in the right way, to the people without 
raising costs, but improving quality of care.
  Coupled together, the provisions in this bill are what we need to 
restore fairness and quality to our health care system. This is a good 
bill that not only provides the consumer protections the American 
people have been looking for, but it expands access to all those that 
are too often ignored, the uninsured in America, and prevents an 
increase in costs that would merely drive people out of the system.
  I urge support of this legislation.
  Mr. DINGELL. Mr. Speaker, I yield one minute to the distinguished 
gentleman from Maryland (Mr. Cardin).
  Mr. CARDIN. Mr. Speaker, let me thank my friend from Michigan for 
yielding me this time and congratulate him on his leadership.
  Mr. Speaker, we have a clear choice. If you want to provide 
protection for your constituents for full access to emergency care with 
symptoms with severe pain; if you want to provide your constituents 
with a choice of doctors within their HMOs, access to specialists like 
cancer specialists, women adequate care for mastectomies and the right 
for reconstructive surgery, that will provide continuing care if the 
HMO drops a doctor so you can continue to see that doctor until you get 
to a new doctor; if you want to provide your constituents with clinical 
trials and experimental treatment which may be the only way to save 
their life; if you want them to have the latest drugs that your doctor 
thinks are needed; if you want to make sure that an HMO has enough 
doctors and locations so your constituents can get to see the doctor; 
if you want to provide all these protections to your constituents, then 
you must vote for the Ganske-Dingell substitute, because the Republican 
bill does not provide those protections to your constituents and does 
not provide for adequate enforcement.
  The choice is clear. I urge my colleagues to support the amendment.
  Mr. HASTERT. Mr. Speaker, I would inquire as to the remaining time.
  The SPEAKER pro tempore (Mr. Foley). The gentleman from Illinois (Mr. 
Hastert) has 10\3/4\ minutes remaining and the gentleman from Michigan 
(Mr. Dingell) has 12\1/2\ minutes remaining.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from California (Mr. Waxman).
  Mr. WAXMAN. Mr. Speaker, today this House has a very basic decision 
to make: Are we going to pass effective and enforceable legislation to 
ensure a patient bill of rights for people in this country? Are we 
going to agree to the Ganske-Dingell proposal which is going to give 
people the rights they need to deal with arbitrary and unfair treatment 
by big insurance companies and HMOs? Or are we going to rush through a 
Republican leadership bill that is designed to do just one thing, fool 
people into thinking that something is being done to help them just 
long enough to get through the next election? Because that is exactly 
the issue before us.
  Are we going to pass legislation that requires HMOs to have an 
adequate

[[Page H6401]]

number and variety of health care providers so that people can get the 
services they need and are paying for? The Ganske-Dingell bill does 
that. The Republican leadership bill does not.
  Are we going to be sure that people can get to a specialist if they 
need one? Ganske-Dingell says yes. The Republican bill does not.
  Are we going to let insurance companies make the decisions about what 
medical patients need? Ganske-Dingell says decisions belong to the 
patients and their doctors. The Republican bill does not. That is why 
the doctors support the Ganske-Dingell legislation.
  Today this House has a very basic decision to make: are we going to 
pass effective and enforceable legislation to ensure a patient bill of 
rights for people in this country?
  Are we going to agree to the Ganske-Dingell proposal which is going 
to give people the rights they need to deal with arbitrary and unfair 
treatment by big insurance companies and HMO's?
  Or are we going to rush through a Republican leadership bill that is 
designed to do just one thing: fool people into thinking that something 
is being done to help them just long enough to get through the next 
election.
  Because that is exactly the issue before us.
  Are we going to pass legislation that requires HMO's to have an 
adequate number and variety of health care providers so that people can 
get the services they need--and are paying for? The Ganske-Dingell bill 
does that. The Republican leadership bill does not.
  Are we going to be sure that people can get to a specialist if they 
need one? Ganske-Dingell says yes. The Republican bill does not.
  Are we going to let insurance companies make the decisions about what 
medical care patients need? Ganske-Dingell says that decision belongs 
to the doctor and the patient. The Republican bill does not. It 
actually increases the power of insurance companies to decide what is 
medically necessary. Since when did insurance bureaucrats become 
qualified to be doctors?
  Are we going to override the protections the States have enacted to 
assure people health benefits and give them some consumer protections? 
Ganske-Dingell builds on and strengthens them. The Republican 
leadership bill actually takes away the protections that are there.
  And are we going to make sure that people have an effective way to 
enforce the rights we are giving them, or not? Ganske-Dingell says if 
you can't enforce it, you don't have it. The Republican leadership bill 
sneaks in language that makes sure the insurance companies decision 
about what is medically necessary is not going to be challenged.
  We owe the American people legislation that works to protect their 
rights. We need to level the field between big insurance and their 
desire to profits, and patients who depend on their insurance and HMOs 
for their health care. We owe people a way to make sure they get the 
medical services they need from their HMO or any other health plan.
  This debate should be about patients, not profits.
  The Republican leadership bill is on this floor today only for one 
reason: after months of opposition and working hand in hand with big 
insurance to kill any patient bill of rights, they noticed the polls 
told them the American people were demanding action.
  So Mr. Gingrich and his allies have responded with a cynical bill 
that is designed to look like it's doing something when it is not.
  They've made sure that this bill didn't get looked at by the 
Committees or the public. They've made sure that we vote on this before 
anyone has a chance to know what it really does.
  They claimed to have privacy protections--but actually they made it 
OK to sell medical records. When they were caught, they changed it.
  They claimed to make sure emergency care would be covered if a 
prudent person would think it was necessary. But they actually weakened 
the protections we already have in law for Medicare beneficiaries. They 
said severe pain wouldn't be a reason to go. They said the HMO could 
make you foot most of the bill if you didn't go to their facility. In 
other words, they gutted the protections.
  Well they got caught again, so they changed it.
  How many things are in this bill that haven't been found yet? It's a 
cynical way to deal with people's lives and health care.
  Does anyone believe that a Republican leadership that has urged 
insurance companies to spend money to defeat these bills is actually 
going to write a good one? Does anyone believe that after they've 
fought it every step of the way, they've suddenly seen the light?
  Let's adopt the bill that works. Let's adopt the bill that has been 
endorsed by the doctors and the nurses and the patients. Let's adopt 
the Ganske-Dingell bill.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from New Jersey (Mr. Pascrell).
  (Mr. PASCRELL asked and was given permission to revise and extend his 
remarks.)
  Mr. PASCRELL. Mr. Speaker, a question was asked a few seconds about 
whose side are we on.
  The average CEO from an HMO makes $6 million a year. It goes up to 
$20 million a year. You are asking us whose side we are on?
  A woman in my district recently summed up the problems with our 
current managed care system in a conversation with me. She asked if 
there was a way she could get into Medicare early because she thought 
she could receive better care under her Medicare than under her current 
health insurance program.
  All across my State of New Jersey, patients are being denied their 
basic rights, and I think that is what this argument and debate is all 
about. New Jerseyans who benefit from some of the strongest patient 
protections in the country would lose under the original bill.
  Benefits and services such as bone marrow transplants, diabetic 
supplies, mammogram and prostrate screenings and minimum maternity 
stays would all be in jeopardy for thousands of patients in our State. 
Let us do the right thing today.
  Mr. HASTERT. Mr. Speaker, I yield 4\1/2\ minutes to the gentleman 
from Georgia (Mr. Norwood).
  Mr. NORWOOD. Mr. Speaker, as we close down this debate and come 
toward the end of what, for me, has been a long time coming, I want you 
to know I am not only saddened by the debate but I am exhilarated by 
this debate also because it is with great pleasure I see each side of 
the aisle trying to outdo the other on patient protections, and Lord 
knows that has been a long time coming.
  It is often asked of me why would a conservative Republican like 
myself, why would you be involved in something like this? Why would you 
want to deal with national standards? I think that is a reasonable 
question, and I think it is a fair question.
  The answer is pretty clear. What I want to do is take health care out 
of the ERISA laws that should never have been put in the ERISA laws, 
that never was about health care but always about your pension plans, 
but we cannot do that.

                              {time}  1300

  But we cannot do that. The other option is to do nothing, and we all 
know that is wrong, and the other option then is to set some national 
standards, and that is where I am, and that is where we are in this 
debate today.
  We have today one of the reasons I might mention that I am involved 
in this is that we have today the best medical care, best trained 
physicians, best technology in the world, but it does no good to have 
any of that if we are denied our care. We all can agree, I believe, on 
that.
  I have been in Congress 3\1/2\ years. There is a lot I do not know, 
but I will tell my colleagues one thing I do know something about. I 
know something about treating patients. I have been doing that all of 
my adult life. In fact, I have been doing that longer than any of my 
colleagues have been in Congress, except maybe the gentleman from 
Michigan (Mr. Dingell). Generally speaking, that is all I know, And I 
have in every sense since I have come to this town tried to say that 
there are serious problems out there that are occurring that we must 
address. Thank God we are. It is a contest of who is addressing them 
best, perhaps.
  Mr. Speaker, I remember seeing patients back when there really was a 
doctor-patient relationship, back when there was a free market, before 
the 1973 HMO Act, before the 1974 ERISA Act. Things are not better 
today for patients. Maybe our skills are better, maybe our technology 
is better, but people have been denied the benefits that are in their 
plan. I thank my colleagues for joining with us, I thank them for 
joining with us to try to address that, and we are going in the end to 
address that, I believe, in a very correct manner.
  One of the other reasons I have been so interested in this is that in 
1994 I did not like Clinton care. Do my colleagues want to know why? 
Clinton care was a program to deny patients' choice of

[[Page H6402]]

doctor and of hospital. It was a program that would deny them care and 
rationed care, and it was a program designed to use untrained and less 
trained people to take care of patients. Guess what? They won. That is 
exactly what we have today. The big difference is Mr. Clinton would 
have used Federal bureaucrats; today we use corporate bureaucrats. I 
promise my colleagues, a patient that has been denied care and their 
child has died does not care whether it was a corporate bureaucrat or 
whether it was a Federal bureaucrat.
  Mr. Speaker, we have before us today, I say to my colleagues, two 
bills, and we are debating actively on who has done the best job. These 
bills are fighting to see who can protect patients most. I think that 
is wonderful.
  Let me just simply close by saying that there are many things that 
are similar. There are many very good protections in the Republican 
bill, and I certainly do not oppose the liability part, except I am 
scared that it will kill the bill for this Congress and we will have no 
protections.
  Vote against the motion to recommit, vote for this bill, and work 
with us to make it all better.
  Mr. DINGELL. Mr. Speaker, I yield 30 seconds to the distinguished 
gentleman from New York (Mr. Schumer).
  (Mr. SCHUMER asked and was given permission to revise and extend his 
remarks.)
  Mr. SCHUMER. Mr. Speaker, I want to thank the gentleman for yielding 
me this time. I want to say that the American people are clamoring for 
real reform of HMOs. If we pretend to give them reform, if we offer a 
phoney solution, they will not be fooled. The Dingell-Ganske substitute 
will make a true difference to millions of families. Let us go the real 
way. Let us really help people and not just make it appear we are.
  Let us support Dingell-Ganske and make a difference for the millions 
who are suffering under the yoke of unfair HMOs.
  Mr. HASTERT. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Washington (Ms. Dunn), a member of our leadership.
  Ms. DUNN. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  I rise today to say to American families who are worried about their 
health care coverage, we understand your fears and your anxieties, and 
help is on the way.
  H.R. 4250, the Republican plan to make health care more accessible 
and strengthen patient protection, is a sensible approach to the 
problems facing Americans, especially working women.
  Mr. Speaker, 80 percent of all the health care decisions in this 
country today are made by women. As a result, women view health care as 
a consumer issue, not a political issue. That is why the Republican 
plan addresses the need to expand access to health care for those who 
cannot afford it, or are uninsured by their employers. H.R. 4250 makes 
some important reforms that will allow small businesses, an area of our 
economy increasingly dominated by women, to ban together to purchase 
health care coverage.
  One of the biggest obstacles to health coverage for small business 
women and their employees is cost. By allowing these small businesses 
to join together and pool their resources, they will be able to 
purchase health care at the same discounted rates enjoyed now by big 
business.
  In addition, our Patient Protection Act will give our Nation's women 
direct access to their OB-GYN. These physicians are extremely important 
to the lives of every woman and they should not be considered 
specialists. We should demand that the essential care that they give be 
accessible without having to jump through bureaucratic hoops.
  The Republican plan will also help our Nation's mothers get easier 
access to pediatricians for the care of their children. Once again, the 
care given to our Nation's youth is critical to fostering a healthy 
childhood and it must be available without delay.
  Whether it be expanding access to health care for America's small 
business women or ensuring that mothers and children have the care that 
they deserve when they need it, the Republican health care plan is 
right for our Nation's families.
  Mr. Speaker, I urge my colleagues to support H.R. 4250 and help give 
families the peace of mind they so richly deserve.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentlewoman from Oregon (Ms. Hooley).
  Ms. HOOLEY of Oregon. Mr. Speaker, I thank the gentleman for the 
leadership he has shown on this issue.
  Let me tell my colleagues a little bit about this issue. I look at 
these two bills and I see mirror images. The Hastert bill takes us a 
step backwards, at least in Oregon, in protecting patients, and the 
Ganske-Dingell bill moves that agenda forward.
  I want to tell my colleagues how backwards this takes us. In Oregon, 
our State has already adopted model patient protections. Make no 
mistake: I would like to see us move forward on patient protection. 
This, in fact, moves Oregonians backwards. It repeals protections 
Oregonians already have been guaranteed by the State. Cervical cancer, 
mammogram screenings, minimum maternity care, mastectomy stays, breast 
reconstruction, alcoholism and drug abuse treatment, well child care.
  In the last session of the Oregon legislature they worked in a 
bipartisan fashion, held extensive hearings, took the data and opinions 
of everyone concerned, and what they got was a model piece of 
legislation. They had hearings on it. What a contrast to this.
  Please support the Ganske-Dingell bill.
  The SPEAKER pro tempore (Mr. Foley). The gentleman from Illinois (Mr. 
Hastert) has 9 minutes remaining; the gentleman from Michigan (Mr. 
Dingell) has 4 and a quarter minutes remaining.
  Mr. HASTERT. Mr. Speaker, I yield 15 seconds to the gentleman from 
Georgia (Mr. Norwood).
  Mr. NORWOOD. Mr. Speaker, let us try to get this straight. The 
Federal law known as ERISA is what preempts State laws. It is not this 
bill; it is the ERISA law that preempts State laws.
  Mr. DINGELL. Mr. Speaker, I yield such time as she may consume to the 
gentlewoman from California (Ms. Pelosi).
  (Ms. PELOSI asked and was given permission to revise and extend her 
remarks.)
  Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding and for 
his tremendous leadership in providing access to quality health care 
for all Americans.
  I rise in strong opposition to the Republican bill and in strong 
support of the Ganske-Dingell bill.
  Mr. Speaker, I rise in strong support of the Patients' Bill of 
Rights, the substitute to the fatally flawed Republican HMO protection 
bill. The manner in which this legislation is being rushed through by 
the leadership should tell us clearly that they want to avoid real 
scrutiny, and given their bill, that is understandable.
  With the health care system transforming around us, the most 
important decision we have to make in writing health care reform 
legislation is: What interests are we going to protect? Do we stand 
with patients trying to access quality care and needed specialty 
services? Or do we craft legislation which gives cover to the industry 
and considers patients second?
  The Democratic Patients' Bill of Rights is true patient protection 
that will make a difference in the lives of every American.
  The contrasts between the Republican and Democratic plan are many and 
stark. I want to focus on three issues which are very important to 
constituents in my district.
  First, OB/GYN services are among the most personal, and important, 
health care services. This area of health care goes to the heart of the 
treasured doctor-patient relationship. When that relationship is full 
of trust and honesty, it can lead to better diagnosis, treatment, and 
comfort in the medical care setting.
  The Democratic plan gives women direct access to OB/GYN services, 
without limitations that can stand in the way of receiving services, 
such as limits on the number of visits to the doctor. The Republican 
plan does not guarantee this coverage for all health insurance 
consumers.
  Second, I am often approached by people in my district who depend on 
access to clinical trials. People with AIDS, breast cancer, and other 
health problems know that the cure for their diseases has not been 
found yet.
  Their hope is their ability to participate with others in the search 
for medical answers. The Democratic plan promotes access to clinical 
trials that may provide people access to new, life-saving therapies. 
The Republican plan fails to do this.
  Third, the Dingell-Ganske substitute, but not the Republican bill, 
permits individuals to sue the health plans under State law for 
personal injury or wrongful death.

[[Page H6403]]

  We need health care legislation that puts patients, not HMOs, first. 
And we need enforcement mechanisms that make those protections real. 
The Republican plan falls far short on both counts. It is cover for the 
health industry and for Republicans, not tangible protection for 
consumers.
  I urge my colleagues to support real protection for patients by 
voting for the Democratic substitute.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Rhode Island (Mr. Weygand).
  (Mr. WEYGAND asked and was given permission to revise and extend his 
remarks.)
  Mr. WEYGAND. Mr. Speaker, I thank the gentleman for yielding me this 
time.
  I was just very interested, being a former small business owner, when 
the gentleman just came up a little while ago and mentioned that this 
bill does not preclude many of the State requirements that the 
gentlewoman from Oregon (Ms. Hooley) just mentioned.
  Let me tell my colleagues what this bill does. It shifts small 
businesses who, like myself, belong to an association health care plan. 
It took all of the care of my employees and puts it now into ERISA.
  This is what it is going to do for those people in the State of Rhode 
Island. It is going to remove the requirement that there be a well 
child care program, mammography screening, minimum maternity stays, 
minimum mastectomy stays, breast cancer reconstruction, cervical cancer 
screening, diabetic supplies, alcoholism treatment, drug abuse 
treatment, home health care, off-label drug use, newborn sickle cell 
testing and blood lead screening, removes patient rights from small 
business owners and employees of small businesses. This bill does that. 
The Ganske-Dingell bill does not. Please support the Ganske-Dingell 
bill.
  Mr. HASTERT. Mr. Speaker, I yield 2 minutes to the gentleman from 
Arizona (Mr. Shadegg).
  Mr. SHADEGG. Mr. Speaker, I thank the gentleman for yielding me this 
time. I would like to engage in a colloquy with the gentleman from 
California (Mr. Thomas), the chairman of the Subcommittee on Health 
from the Committee on Commerce.
  It is my understanding that the gentleman, along with most of our 
Republican colleagues and leaders, would agree with me that the biggest 
problem with health care today is that the Tax Code encourages 
employers, and not individuals, to be the purchasers of health care. 
Indeed, employers have a tax incentive to offer health care benefits 
for their employees, and individuals do not have that same benefit, so 
they are discouraged from purchasing their own health care.
  Mr. THOMAS. Mr. Speaker, will the gentleman yield?
  Mr. SHADEGG. I yield to the gentleman from California.
  Mr. THOMAS. Mr. Speaker, I would inform the gentleman that the 
Subcommittee on Health is a subcommittee of the Committee on Ways and 
Means.
  In looking at the Tax Code, we are very concerned about what has 
happened. Clearly, there are some advantages to managed care and HMOs 
in dealing with treating the patient, but I think it is fairly obvious 
that most employers turned to a controlled cost structure, as well. The 
employed had no ability to control the rising costs, 18\1/2\ percent a 
year in 1988. What they did was determine, I will take a health care 
that gives me a fixed dollar amount per employee.
  Mr. SHADEGG. Mr. Speaker, I know the gentleman would agree with me 
that this legislation today, the Republican legislation before us 
today, takes important steps toward solving these problems, but that 
there is also agreement on the part of the gentleman and on the part of 
our Republican leadership that the best long-term solution would be to 
adopt reforms which make it possible, and indeed, encourage, 
individuals, whether they are employees of a company or the self-
employed, or for that matter unemployed, to purchase their own health 
insurance without having to go through their employer and get the same 
tax advantage as their employer currently gets under the law.
  Mr. THOMAS. Mr. Speaker, if the gentleman will continue to yield, I 
could not agree with the gentleman more. The current system is fatally 
flawed. What we are doing is simply working on the edges. The only way 
to fundamentally deal with the problems in our health insurance area is 
to empower consumers, empower them with the wherewithal to purchase the 
insurance, and just as importantly, empower them with the knowledge to 
make choices. They have neither of those in today's current system. It 
needs fundamental reform beginning with the Tax Code, and with the 
collection of data, to make those changes possible.
  Mr. SHADEGG. Mr. Speaker, I understand there is a commitment on the 
part of the Members to move that as soon as possible.
  Mr. THOMAS. Mr. Speaker, I would tell the gentleman that I have no 
interest in playing on the margin; I want to go to the heart of the 
problem and change it.
  Mr. SHADEGG. Mr. Speaker, I thank the gentleman very much.
  The SPEAKER pro tempore. The gentleman from Illinois (Mr. Hastert) 
has 2 minutes remaining and has the right to close; the gentleman from 
Michigan (Mr. Dingell) has 8 minutes remaining.
  Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the 
distinguished gentleman from New York (Mr. Engel).
  (Mr. ENGEL asked and was given permission to revise and extend his 
remarks.)
  Mr. ENGEL. Mr. Speaker, I rise in strong support of the Ganske-
Dingell bill and in opposition to the Republican bill.
  The Democratic Patients' Bill of Rights takes health care decisions 
away from insurance company bureaucrats and gives them back to doctors 
and patients.
  The Republican bill is a sham--it will actually turn the clock back 
on health care consumers and is another empty political promise from 
this GOP Congress.
  The Republican bill covers too few people, provides too few patient 
protections and contains unnecessary and irrelevant provisions.
  The Democratic bill:
  First, returns health care decisions to health care professionals and 
their patients. The Republican bill does not.
  Second, the Democratic plan guarantees patients the right to see a 
specialist when they need to do so. The Republican bill does not.
  Third, the Democratic bill guarantees an end to financial incentives 
to limit medical care. The Republican bill does not.
  Fourth, the Democratic bill guarantees tough enforcement that will 
hold insurance companies responsible for their actions. The Republican 
bill does not.
  Fifth, the Democratic bill guarantees emergency care. The Republic 
bill does not.
  Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the 
distinguished gentleman from Illinois (Mr. Poshard).
  (Mr. POSHARD asked and was given permission to revise and extend his 
remarks.)
  Mr. POSHARD. Mr. Speaker, I rise in strong support of the Ganske-
Dingell bill.

                              {time}  1315

  Mr. DINGELL. Mr. Speaker, I yield such time as she may consume to the 
distinguished gentlewoman from Texas (Ms. Jackson-Lee).
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise in strong support of 
the Ganske-Dingell bill that does not hurt Texas.
  Mr. Speaker, thank you for the opportunity to speak on this important 
issue today. Mr. Speaker, I am deeply concerned that after spending the 
last full year blocking any type of adequate health care reform the 
legislation that is on the floor today is an unacceptable proposal to 
Americans' very real health care reform concerns. Once again, Mr. 
Speaker, the House Republican leadership has allowed the insurance 
industry and its powerful lobbyists to make the rules!
  H.R. 4250 may give the appearance of reform, but there is no 
substance to this bill. There is no provision for specialty care, no 
provision for needed drugs and clinical trials, and no effective 
mechanism to hold plans responsible when plan abuse inevitably kills or 
injures someone.
  Instead of protecting patients who desperately need help, the bill 
here on the floor protects the insurance industry! H.R. 4250 has 
serious and apparent flaws and I urge my colleagues to oppose this 
bill.
  This bill does not provide enforceable guarantees to protect 
consumers from bureaucratic abuses. It does not allow patients to seek 
recourse for denial of care which may result in

[[Page H6404]]

injury or death. In addition, the Republican bill which would be more 
aptly named as the Patient Propaganda Act, Insurance Industry 
Protection Act or the Profit Protection Act does not guarantee patients 
access to needed care outside of their managed care plan, does not 
guarantee the right of patients to see a specialist and does not 
guarantee access to all necessary prescription drugs. Unfortunately, 
this bill does nothing to prohibit or prevent HMOs from offering 
bonuses to doctors for denying necessary care. By contrast the 
Patients' Bill of Rights Act allows patients access to specialists, and 
protects the doctor-patient relationship.
  The Democratic Patients' Bill of Rights, in contrast is supported by 
over 300 health related organizations including the Children's Defense 
Fund, the National Partnership for Women and Families, the National 
Association of Children's Hospitals, the American Medical Association, 
and the National Breast Cancer Association. In addition, the American 
Public Health Association who represents more than 50,000 public health 
professionals, believes that H.R. 4250 provides inadequate protection 
of personal health data and may lead to undesirable uses of private 
information.
  H.R. 4250 will allow health insurance companies, not doctors to 
decide what is medically necessary. In testimony before the House 
Commerce Committee, Dr. Linda Peeno, a former HMO medical director 
described the control that health insurance companies would have over 
our health as ``a health plan's smart bomb capability.'' External 
appeals will be of no value if the health plan itself is always allowed 
to decide and define what is medically necessary or appropriate. By 
contrast, our democratic bill specifically prohibits health plans from 
practicing medicine by substituting their decisions for the doctors.
  And what about the gag rule? H.R. 4250 does not adequately protect 
the broadest possible range of ``medical communications'' and it would 
not ensure necessary emergency care! Because H.R. 4250 does not include 
the words ``otherwise restrict'' medical communications, because of 
this important omission, health plans can continue to silence 
physicians. Imagine, even with severe pain, there is no requirement for 
an insurance plan to allow treatment! In fact, this bill still does not 
deal with Americans' concerns with gag clauses, yet the bipartisan 
Ganske-Dingell bill extends the prohibition on gag clauses to 
subcontracts--in other words, assuring that health care professionals 
in all types of managed care will be protected and that patients will 
be protected.
  Because we are about women's health concerns, the Dingell-Ganske bill 
prohibits drive-through mastectomies and requires coverage for 
reconstructive surgery after a mastectomy. H.R. 4250 does not even 
include anything close to this type of protection for women. As an 
advocate of women's rights, I am concerned that the Republican plan 
does not allow women to choose their obstetrician or gynecologist as a 
primary care physician, and it also does not allow a woman undergoing 
an active cause of treatment in her last trimester of pregnancy to 
continue with her doctor if her employer changes plans.
  As a concerned parent and Chair of the Congressional Children's 
Caucus, I wonder about the children that would not receive adequate 
care under the Republican bill, in that it does not guarantee access to 
pediatric specialists.
  I urge my colleagues to oppose the Republican plan. We must provide 
our country's citizens with adequate health care. Our President 
strongly endorses this plan, and as an article in the July 3, New York 
Times states, doctors and advocates for consumer groups prefer the 
Patients' Bill of Rights over the Republican plan, and the New York 
Times itself said that the Democratic bill seems to be far more 
prescriptive.
  One of the letters I received recently is from a Texas woman, a 
senior citizen who has worked a lifetime in the medical profession. She 
told me that she had worked during an era when a doctor saved a gravely 
ill child--sutured bleeding patients--sat at the bedside of someone's 
dying loved one knowing there was nothing further he could do except to 
be there--and then see those same physicians feeling badly in accepting 
fresh garden vegetables or a dozen eggs with a pound of butter as a 
payment for his services.
  She spoke of a time when doctors were able to act for the benefits of 
their patients alone, when insurance companies could not deny sick and 
dying patients their only hope for treatment and cure, based only on 
greed and profit. The Democratic Patients' Bill of Rights is the only 
plan guaranteeing that doctors and patients make medical decisions, not 
insurance bureaucrats!
  Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to my 
good friend, the gentleman from Pennsylvania (Mr. Doyle).
  (Mr. DOYLE asked and was given permission to revise and extend his 
remarks.)
  Mr. DOYLE. Mr. Speaker, I urge my colleagues to vote for Dingell-
Ganske.
  Mr. Speaker, I rise to urge my colleagues to vote for real patient 
protection legislation, in the form of the Dingell-Ganske Patients' 
Bill of Rights.
  The Dingell-Ganske bill is a bipartisan effort to put healthcare 
decisions back into the hands of doctors and nurses, not insurance 
companies. It would guarantee emergency care and access to specialists, 
and retain for doctors the right to speak freely with patients about 
their medical treatment.
  Contrary to the claims of the insurance industry, these important 
patient protections can be guaranteed without radically increasing 
costs. We need to continue to get the news out about the recent 
Congressional Budget Office study, showing that the average 
policyholder will pay only an additional two dollars a month for these 
protections.
  The Republican leadership bill would leave treatment decisions in the 
hands of the insurance companies and would not guarantee the right to 
see a specialist. This is not real reform at all.
  I'm sorry to say that the Republican leadership bill still bears the 
faint aroma of something drafted by industry lobbyists behind closed 
doors. Even after last-minute changes last night, the Republican bill 
would still work to actually tear down existing patient protections. In 
my home state of Pennsylvania, and around the country, existing state 
patient protection laws would be preempted by this Republican 
leadership bill.
  For example, H.R. 4250, the Republican leadership bill, would 
override Pennsylvania's medical records confidentiality law. There 
would be nothing to stop your health plan from sharing your medical 
information with other organizations, such as your employer. Should an 
employer have unfettered access, or any access at all, to every 
employee's health information? I don't think so. On this and a number 
of other issues, H.R. 4250 is more than just a sop to the issue of HMO 
reform, it's a bad bill, and we must vote to reject it.
  Today, we have a choice between real reform, or a watered-down, half-
hearted motion designed simply to provide political cover to the 
Republican party. I urge my colleagues on both sides of the aisle to 
support the bipartisan Patients' Bill of Rights. Thank you, and I yield 
the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from New Jersey (Mr. Menendez).
  Mr. MENENDEZ. Mr. Speaker, I thank the gentleman from Michigan (Mr. 
Dingell) for yielding me this time.
  Mr. Speaker, when Republicans seek to avoid reform, they raise the 
specter of Big Government. Yet it is the Republican majority's lack of 
governmental intervention that has let the abuses take place over the 
years of their majority in the HMOs across the country. It is only when 
Democrats clamored for patient protection that they came forth with the 
fig leaf they produced today.
  One mother in my district came to me because her child had been 
denied necessary rehabilitative treatment after surgery, and now that 
child will live with the damaging effects of this denial for the rest 
of his life. The Republicans' bill gives that family no relief, no 
enforcement mechanism. That is not family values.
  Today HMOs have all of the protection and none of the responsibility. 
We want to give patients protection. We want to make sure HMOs are 
responsible for their actions. We want to preserve what is trusted by 
Americans, their relationship with their doctor. We want to give them 
those choices. We want to make sure that a doctor is making those 
decisions.
  Mr. Speaker, that is why I join the gentleman from Iowa (Mr. Ganske), 
a Republican, in supporting the Ganske-Dingell bill.
  Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the 
distinguished gentleman from Indiana (Mr. Visclosky).
  (Mr. VISCLOSKY asked and was given permission to revise and extend 
his remarks.)
  Mr. VISCLOSKY. Mr. Speaker, I rise in support of the Ganske-Dingell 
substitute.
  Mr. Speaker, I rise this morning as a co-sponsor of the bipartisan 
Patients' Bill of Rights and a believer in the notion that doctors 
should make decisions about their patients' medical treatments, not 
insurance companies. Today's managed care plans are run by insurance 
industry bureaucrats whose first

[[Page H6405]]

concern is the bottom line for insurance companies, not quality care 
for patients. These insurance industry bureaucrats seek to maximize 
profits for insurance companies by restricting treatment to patients 
and preventing doctors from providing proper care.
  In addressing this situation, the bipartisan bill, which is the basis 
of the Dingell/Ganske substitute, offers its protections to patients, 
who need to know that their insurance companies are not interfering 
with their access to quality health care. This bill is dramatically 
different than the Republican bill which seeks only to protect the 
insurance industry.
  Currently, 125 million Americans are enrolled through their employers 
in self-insured health plans, in which the insurance companies cannot 
be held liable for their decisions to restrict medical treatment, even 
if those decisions directly result in the death or maiming of the 
patient. The Congress should eliminate this legal protection for 
insurance companies, so that insurance companies can be held legally 
accountable for their decisions, just like everyone else. The 
bipartisan bill would offer Americans the legal protections of their 
individual states in holding insurance companies accountable for their 
decisions. The Republican bill on the other hand, would go the other 
way by restricting patients' legal rights and increasing the number of 
patients who are not protected by state malpractice laws from insurance 
companies.
  Americans need to know that they have access to adequate internal and 
external appeals processes if their insurance company denies them 
coverage for a treatment. While the bipartisan bill provides for an 
external review that is truly independent and bases the definition of 
medical necessity on ``generally accepted principles of professional 
medical practice,'' the Republican bill would allow the insurance 
company to determine what is considered medically necessary and who 
performs the external review.
  Americans need to know that they have access to emergency care when 
it is necessary, and we should encourage people to go to the emergency 
room when they experience severe chest pain--a sign of a possible heart 
attack. But the Republican bill fails to guarantee payment for care in 
such cases, leaving the health of Americans at risk. That's why the 
President of the American College of Emergency Physicians has said that 
the Republican bill ``will not bring peace of mind to anyone seeking 
emergency care when they need it.''
  Americans need to know that their insurance companies are not 
restricting the range of treatments that their doctors are allowed to 
discuss, and are not offering financial incentives to doctors to limit 
patient care. While the bipartisan bill provides strong protections to 
patients in both of these circumstances, the Republican anti-gag 
provision is riddled with loopholes, and their bill doesn't even 
address the problem of financial incentives designed to limit care.
  Americans need to know that they will have access to a specialist 
when it is needed and not become a victim of managed care bureaucrats. 
The bipartisan bill provides this protection to patients; the 
Republican bill does not.
  With a set of consumer protections so weak as to be almost 
meaningless, the Republican bill is a cynical attempt to include 
erroneous provisions that have absolutely nothing to do with the 
problems of managed care such as provisions that would allow companies 
unrestricted access to your personal, confidential medical information 
and that would allow wealthy Americans to set up tax shelters through 
medical savings accounts.
  Mr. Speaker, the American people deserve strong protections from the 
insurance bureaucrats who seek to do nothing more than maximize profits 
by restricting care. Please join me in voting for real protections for 
patients and against further protections for insurance companies, and 
vote for the bipartisan substitute and against the Republican bill.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Georgia (Mr. Lewis).
  Mr. LEWIS of Georgia. Mr. Speaker, we need a real Patients' Bill of 
Rights. I know because I have heard from the people in my district.
  A mother told me her daughter had a mastectomy. The mother begged, 
pleaded to keep her daughter in the hospital for just one night. She 
needed to be there, but the insurance company sent her home.
  I have heard from a doctor, a doctor who had to fight the insurance 
company to get coverage to treat his cancer.
  Mr. Speaker, too many patients are paying more and are getting less. 
Under the present system, too many patients are getting a raw deal. 
They need a fair deal. They need a good deal. They need a better deal.
  The differences are clear. Democrats are concerned about protecting 
patients. Republicans are concerned with protecting big business and 
insurance companies. The system is broken. It needs help. It needs a 
doctor. The Republicans are only offering a Band-Aid.
  We need a bill to let doctors make medical decisions. The Democratic 
bill makes sense. If we can choose who fixes our car when it is broken, 
then we should be able to choose who would care for us when we are 
sick.
  If insurance companies want to tell us that we cannot see a doctor, 
that we cannot get treatment, then they must be held accountable. The 
doctors and nurses on Main Street should make the decisions about our 
health care, not the insurance company and wheelers and dealers on Wall 
Street.
  The Democratic bill protects patients. The Republican bill does not. 
Mr. Speaker, we need a real patient's protection act and we need it 
now. Not tomorrow, not next week, not next year, but now.
  Mr. Speaker, we should vote for a real patient protection bill and we 
need it now. Vote for the Ganske-Dingell bill.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Michigan (Mr. Bonior).
  Mr. BONIOR. Mr. Speaker, after ignoring the public outcry for months, 
the Republicans have rushed to the floor with a midnight deal that does 
nothing to end HMO abuses. We might as well call the Republican bill 
the Insurance Company Protection Act, because that is all it does. It 
does not protect patients.
  These are the same insurance companies that have spent millions on TV 
ads to kill HMO reform and the same insurance companies that cut 
corners with people's lives. When insurance companies play doctor, and 
that is what they are doing, people get hurt, people die.
  Under the Republican bill, many HMOs can still limit what doctors can 
tell their patients. Under the Republican bill, HMOs can still restrict 
patients' access to emergency rooms. If patients have a heart attack 
and the ambulance speeds to a hospital close by but outside their 
network, they can get stuck with a $4,000, $5,000, $6,000 emergency 
room bill. It is enough to give them another heart attack.
  Under the Republican bill, patients have little access to specialists 
or freedom to choose their own doctor. Under the Republican bill, HMOs 
can release private medical records without the patient's permission.
  Under the Republican bill, it even gives HMOs the authority to define 
``medical necessity.'' And if an HMO denies necessary medical care, the 
HMO cannot be sued for damages. That is not reform. That is 
reprehensible. But that is what the Republicans propose. They are 
telling our constituents: Take two aspirins and call us after the 
election.
  The President has made it very clear, he will veto this sham reform. 
I urge my colleagues to stand firm today. Support the Dingell-Ganske 
bill for real HMO reform and patient protections.
  Mr. DINGELL. Mr. Speaker, I yield such time as he may consume to the 
distinguished gentleman from Illinois (Mr. Davis).
  (Mr. DAVIS of Illinois asked and was given permission to revise and 
extend his remarks.)
  Mr. DAVIS of Illinois. Mr. Speaker, I rise in favor of the Dingell-
Ganske bill.
  Mr. DINGELL. Mr. Speaker, I yield 3 minutes to the distinguished 
gentleman from Missouri (Mr. Gephardt) the minority leader, for 
purposes of concluding debate.
  (Mr. GEPHARDT asked and was given permission to revise and extend his 
remarks.)
  Mr. GEPHARDT. Mr. Speaker, the bill that the Republican leadership 
has brought to the floor is what happens when they bring a bill that 
they really do not believe in, when they bring a bill that is really 
designed to be political cover to address an area they really genuinely 
do not believe needs to be treated with legislation.
  It is a fake. It is a fig leaf. It is a sham. It is a subterfuge. It 
is a charade. It is cosmetic. It is ineffective. And it will not work 
to solve the real problems and the real concerns that the American 
people have in this area.
  If Republicans really believed in their bill and thought that it had 
merit, they would have had extensive hearings in the committee and 
allowed doctors and nurses, senior citizens and

[[Page H6406]]

patients, consumers, health care company officials and others to come 
and testify and tell us in the Congress their feelings, pro and con, 
about the bill.
  If they really believed in their bill and what it did, they would not 
have been writing it at midnight last night, changing it, trying to 
shove things into it to try to attract the last few votes on their side 
to be able to pass the bill. They would have proudly stood for their 
bill as an effective answer.
  Mr. Speaker, I just ask Members today to ask themselves one simple 
question: Where are the doctors and nurses on this piece of 
legislation? Which piece of legislation do they support, the people 
who, on a daily basis, give their lives and their careers to help get 
people well?
  Mr. Speaker, they are for the Patients' Bill of Rights, the patient 
protection act written by the gentleman from Michigan (Mr. Dingell) and 
the gentleman from Iowa (Mr. Ganske). They are against this sham, this 
political fig leaf that has been put up on the other side.
  Why is that the case? Let me give just three quick, simple reasons. 
First, the Republican bill does not guarantee that if our doctor says 
we need to see a specialist, that we will actually be able to see that 
specialist. Just imagine if a patient has cancer and their doctor says 
they need to see an oncologist. If the Republican bill passes, there 
will be no guarantee in the law that patient will be able to see that 
oncologist.
  Secondly, the idea of what is medically necessary will still, under 
the Republican bill, be up to bureaucrats in insurance companies who 
have their eyes on the bottom line, the profit line, and not on what is 
good medical care.
  Finally, no enforcement. No enforcement. This is a bill with rhetoric 
but without a remedy. What we need in this area is to be able to know 
that if the medical necessity is not observed, if the guarantee of the 
plan is not observed, that patients have some place to go to get a 
remedy.
  What physicians say to me is, ``I am accountable for my health care 
decisions every day, every minute of every day. But now we have some 
bureaucrat at the end of an 800-number who can make medical decisions 
that are just as important as my decisions, and they are not in any way 
accountable to anybody for the decisions they make.'' That is the heart 
of this bill, and that is why the Democratic bill is the only good bill 
before us today.
  Let me end with this. Members are voting today on the rights and the 
ability of flesh and blood human beings in their district. Make no 
mistake about this, they care about this bill. This really counts in 
their lives. When Americans need the Bill of Rights, they need it.
  Mr. Speaker, I sat with my son when he was sick in the hospital and 
talked to other parents of kids who had cancer and they would say, ``My 
policy did not cover, my policy did not work on the treatment, the 
experimental treatment that my son or daughter needed.'' Let me tell my 
colleagues that when one is sitting in that hospital room and they have 
a loved one in front of them who is dying because they cannot get the 
treatment that they have paid for, they will want this Patients' Bill 
of Rights and they will want it now.
  Mr. Speaker, I urge my colleagues to vote against this fig leaf. Vote 
for a good bill.
  Mr. HASTERT. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Florida (Mr. Mica).
  (Mr. MICA asked and was given permission to revise and extend his 
remarks.)
  Mr. MICA. Mr. Speaker, I rise in support of the Republican 
alternative and against the Democrat, more regulatory, bureaucratic, 
and more litigious approach.
  Mr. HASTERT. Mr. Speaker, I yield such time as he may consume to the 
gentleman from Georgia (Mr. Linder).
  (Mr. LINDER asked and was given permission to revise and extend his 
remarks.)
  Mr. LINDER. Mr. Speaker, I rise in favor of the Republican 
alternative.
  Mr. HASTERT. Mr. Speaker, I yield the balance of my time to the 
gentleman from Georgia (Mr. Gingrich), Speaker of the House.
  Mr. GINGRICH. Mr. Speaker, let me thank my colleagues and let me 
thank the gentleman from Illinois (Mr. Hastert) and everyone who served 
on the Health Task Force for developing the Patients' Protection Act.
  Let me remind everyone that this is not a new process for us. We 
founded the Health Reform Task Force in 1991. We developed a series of 
reforms which included Medical Savings Accounts, which included 
preventive care for diabetes, for prostate cancer, for colorectal 
cancer, for breast cancer.
  We have moved a series of initiatives on child health. We moved a 
series of initiatives to expand access to health insurance for small 
business. And now we are back working in the same general direction 
which is really to do three things: To make sure that every citizen has 
access to health care; to make sure that it is the most modern and best 
health care in the world; and to lower its costs.
  Let us be clear about the choices here. The Dingell bill is a well-
meaning bill, if one is a trial lawyer.

                              {time}  1330

  The Dingell bill is terrific for trial lawyers. The Dingell bill is 
about trial lawyer enrichment. We are better on every count. We save 
money. The Dingell bill costs money. So we make it easier to buy health 
insurance and expand the coverage. We have provisions so that more 
people can get covered by health insurance.
  The Dingell bill will actually take a million and a half people out 
of health insurance and put them on the taxpayer. So they have less 
health insurance for fewer people at greater cost.
  Our bill says if someone gets sick and they have a reasonable 
layman's standard, they go to the emergency room and they are 
automatically covered. It then says if that individual is not in an 
emergency situation, but that individual does not agree, they can get, 
within 72 hours, an internal review. And if they do not agree with 
that, they can get, within 72 hours, an external review. They do not 
have to go to a trial lawyer.
  And the review, by the way, is done by appropriate medical 
professionals of comparable specialties. So medical people make medical 
choices in our bill. Trial lawyers make litigation choices in the 
Dingell bill.
  This is not a complicated issue. This is an issue of the trial 
lawyers seeking to enrich themselves at the expense of everybody else 
in this country by having more lawsuits over a longer period of time 
and a more jammed courtroom. We have a proposal which says more 
patients have more rights by appealing against the HMO, appealing 
against the insurance company, and appealing directly to an independent 
council of medical professionals.
  Now, let us say the medical professionals decide, yes, the patient 
deserves the coverage, and the HMO says we are not going to do it. At 
that point, under our plan, that individual goes to court with a 
presumption that the HMO is guilty. The judge is now looking at an 
independent medical panel having said, yes, the patient should get this 
treatment. So we give the American people better treatment, faster, 
with medical specialties, at lower cost.
  But we do one thing that our good friends cannot stand: We do not 
make the trial lawyers richer. We also have malpractice reform, which 
is what every doctor has told us for 20 years they want.
  So I would say the vote on Dingell is very simple: If we want better 
patient protection, vote ``no''. If we want lower cost, vote ``no''. If 
we want more people covered by health insurance, vote ``no''. If we 
want medical doctors making medical decisions, vote ``no''. But if 
Members really think they owe it to the trial lawyers to give them a 
new chance to get richer, vote ``yes''.
  Mr. SERRANO. Mr. Speaker, I rise in strong support of H.R. 3605, the 
Dingell-Ganske Patients' Bill of Rights, and in equally strong 
opposition to H.R. 4250, the pale shadow of reform offered by the 
Republican leadership.
  The American people have called on us to rein in the managed care 
companies that are putting profits ahead of people, denying and 
delaying care and causing real harm. We have heard from patients with 
terrible stories of injury and death caused by the decisions of 
arrogant, unfeeling insurance company bureaucrats intent on their 
corporate bottom line. We have heard from doctors who have been forced 
to beg for permission to treat their patients according to their 
professional judgment. We have heard from nurses who daily see

[[Page H6407]]

and deal with the results of denial and delay. We have even heard from 
former HMO employees about what they had to do--until they couldn't 
stomach it any more--to keep their jobs.
  While it is gratifying that Republican leaders have finally listened 
to the American people and scheduled floor debate on managed care 
reform, this is a holly exercise. Their useless bill, which is likely 
to pass, will be vetoed. We know that already. So this is not serious 
attempt to accomplish meaningful reform, it is an attempt to give 
Republican candidates cover on an issue that is critical to millions of 
Americans, to permit Republicans to claim they have done something 
about health care.
  In stark contrast, the Dingell-Ganske bill would provide meaningful, 
enforceable patient protections and quality health care. It would let 
doctors and patients make medical decisions and end financial 
incentives to limit medical care. It would guarantee access to 
specialists outside the HMO, to emergency services, to the full range 
of prescription drugs, and to clinical trials. It would end excessive 
use of cost-cutting devices such as outpatient mastectomies and drive-
by deliveries. Most important, it would be enforceable.
  The Interreligious Health Care Working Group supports legislation 
that includes ``patient access to information; choice of providers and 
plans; access to emergency services; participation in treatment 
decisions; respect and nondiscrimination; confidentiality of health 
information; and complaint and appeal procedures'' as well as credible 
means of enforcing those rights. H.R. 3605 meets this standard. H.R. 
4250 does not.
  The Consumer Federation of America supports legislation that includes 
``holding managed care companies accountable; requiring an external 
grievance and appeals system; comprehensive information disclosure; 
quality assurance programs; and protection of the doctor-patient 
relationship in a manner that allows advocacy on behalf of patients and 
prohibits improper physician incentive plans.'' H.R. 3605 meets this 
standard. H.R. 4205 does not.
  Similarly, the American Federation of Teachers, Families USA, the 
Lutheran Office for Governmental Affairs, Consumers Union, and others 
that have outlined principles for addressing problems in the managed 
care industry find H.R. 4250 sadly lacking in both protections and 
enforcement. They all support H.R. 3605.
  The American Medical Association--the AMA, Mr. Speaker--lists 10 
reasons to vote against the Republican leadership's bill and for the 
Patients' Bill of Rights. I won't list them all, but I should mention a 
couple of key issues. AMA Reason No. 9 is ``H.R. 4250 would allow 
health insurance companies to decide what is medically necessary * * 
*'' AMA Reasion No. 7 is ``H.R. 4250 would require patients to pay for 
the privilege of an external review of treatment denial; H.R. 3605 
imposes on such fees * * *'' AMA Reason No. 4 is ``H.R. 4250 would 
delay the effective date of patient protection for up to 2 years * * * 
H.R. 3605 would peovide for nearly immediate implementation * * *''. 
Finally, and perhaps most importantly, AMA Reason No. 1 is ``H.R. 4250 
does not hold health plans properly accountable for making medical 
treatment decisions that result in patient injury or death.''
  Of course, Mr. Speaker, the Republican leadership doesn't stop at 
offending the American people by offering only a hollow promise of 
reform, it throws in posion pills that have been considered and 
rejected before. Exempting Association Health Plans (AHAs) and Multiple 
Employer Welfare Arrangements (MEWAs) from state law would deny 
millions of Americans coverage under many of the patient protection 
laws already enacted by 43 states. That includes my own state of New 
York, which has been a pioneer in establishing patient protections. 
Expanding the availability of medical savings accounts (MSAs) would 
give tax breaks to the healthy and wealthy while increasing costs of 
health insurance for the sicker and poorer.
  It is obvious that this is a political exercise. The Republican 
leadership's bill was introduced only last week and has not been 
examined in a single hearing or subjected to amendment by any 
committee. It hasn't been scored by the Congressional Budget Office. As 
the AMA writes, ``In fact, Members of Congress have not had time to 
fully understand critical differences in the two bills since last 
Friday's introduction of the House Republican bill''. Not surprisingly, 
then, the bill has been a work in progress, subjected to numerous 
changes--changes that sound like improvements but are largely 
cosmetic--in attempts to attract enough votes to pass the bill without 
actually accomplishing anything that would annoy the Republicans' 
friends in the insurance industry.
  I urge my colleagues to support meaningful, enforceable reform, not 
posturing. Support the Dingell-Ganske Patients' Bill of Rights and 
reject the Republican leadership's Managed Care Reform Lite.
  Mr. TURNER. Mr. Speaker, Democrats initiated the effort in this 
Congress to protect patients and their doctors from interference by 
insurance company bureaucrats. The Dingell-Ganske bill provides these 
protections and eliminates the complete exemption from accountability 
that many HMOs enjoy today under the Federal ERISA law.
  The Republican bill, on the other hand, is an effort to preserve the 
insurance companies' shield of protection from accountability for their 
mistakes. It creates a Federal bureaucracy in the Department of Labor 
and a complex appeals process diagrammed here on this chart to my 
right. Look at this. And endless maze of bureaucratic nightmare is 
created by the Republican bill.
  Consider the example of Phyllis Cannon. In September of 1991, Ms. 
Cannon was diagnosed with leukemia. On August 10 of 1992, her doctor 
sought approval from her HMO for a bone marrow treatment. 43 days 
later, her doctor pleaded for authorization to treat her life-
threatening condition and it was again denied. By the time the HMO 
finally agreed to authorize treatment, it was too late and Phyllis 
Cannon died.
  Could she have gone through this maze under the Republican bill and 
done any better? I think not. And if she had made it through the maze 
under the Republican bill, after her death she would have been entitled 
to only $500 per day. Under the Republican bill, the total recovery for 
her family would have amounted to only $20,000.
  Is this what we call protecting patients? Vote against this 
Republican bill. Vote for the Ganske-Dingell bill and prevent this kind 
of endless bureaucratic interference with medical decisions from 
happening to the patients of this country.
  Mr. THOMPSON. Mr. Speaker, I rise today as the Representative from 
Mississippi's 2d Congressional District in support of H.R. 3605, the 
bipartisan Dingell-Ganske Patients' Bill of Rights. This bill 
guarantees that decisions will remain in the hands of doctors and 
nurses, not insurance companies; that people will have access to 
specialists; that there will be protection for women after mastectomy 
(minimum hospital stay); and the ability to hold plans accountable when 
abusive practices kills or injure patients.
  I oppose the Republican HMO health care bill. Mr. Speaker, I am in 
support and committed to passing major managed care legislation. 
However, I do not support the Republican bill that covers too few 
people, provides limited patient protections, and contains unnecessary 
and irrelevant provisions. It undermines existing state consumer 
protections, leaves patients and small businesses with fewer 
protections than they already have. The Republican bill is being pushed 
through the House with almost no debate and virtually no amendments 
allowed in an attempt to stop the only real bipartisan managed care 
reform bill--the Dingell-Ganske Patients' Bill of Rights--from passing. 
Mr. Speaker, the Republicans are playing politics with the lives of 
Americans. Let's stop this ridiculous rhetoric and pass some meaningful 
legislation.
  As I close, I would like to once again express my support for H.R. 
3605 and thank Representative Dingell and Representative Ganske for 
their work in bringing this legislation forth to protect the interests 
of patients. I urge my colleagues to support this bill.
  Mr. COYNE. Mr. Speaker, I rise in support of H.R. 3605, the 
bipartisan Patients' Bill of Rights. Today we have a tremendous 
opportunity to protect our constituents' right to receive quality 
health care.
  More than half of all Americans are not offered a choice of health 
care providers by their employer. Under current law, many consumers 
have little recourse if their HMOs or insurance companies do not 
protect their most basic health care rights. I believe Congress must 
act to guarantee these rights.
  I am proud to be an original cosponsor of the bipartisan Ganske-
Dingell bill (H.R. 3605). It would ban ``gag rules'' and contracts in 
which doctors are paid less if they refer to needed specialists or 
suggest expensive treatment, guarantee access to specialty and 
emergency care, protected medical confidentiality, and give patients 
access to a free, timely appeals process if their HMOs deny them 
benefits. If patients are harmed by decisions made by their HMOs, they 
will be allowed to take the HMO to court and recover damages. H.R. 3605 
also provides for speedy implementation. Americans need relief from 
badly managed care now, not 2 years from now.
  On the other hand, H.R. 4250, the Republican alternative, is a step 
in the wrong direction. It actually weakens the protections patients 
have under current law. The association health plan proposal would 
increase the number of patients who are not allowed to sue their health 
plans if they are harmed or killed by decisions made by the plan. The 
bill also undermines current laws which protect medical 
confidentiality, allowing almost any insurance company official access 
to a wide range of personal medical records. By expanding medical 
savings accounts, they encourage

[[Page H6408]]

wealthy, healthy people to ``opt out'' of the current health insurance 
coverage insurance system, increasing the price of health insurance for 
everyone else. Finally, the Republican bill would maintain the status 
quo in which insurance companies, not doctors, decide what is 
``medically necessary,'' and health plans can continue giving doctors 
financial incentives to deny necessary care.
  I urge my colleagues to join me in supporting H.R. 3605, the 
Patients' Bill of Rights. We owe it to our constituents to use this 
opportunity to enact real reform.
  Mr. BENTSEN. Mr. Speaker, I rise today to express my strong support 
for H.R. 3605, the bipartisan Patients' Bill of Rights, that is 
sponsored by Representatives Dingell and Ganske. Today, we will 
consider two different approaches to reform managed health care plans. 
I am a strong supporter and co-sponsor of H.R. 3605 because I believe 
that this bill provides essential consumer protections to all 
Americans. I urge my colleagues to reject the Republican leadership 
sponsored legislation, H.R. 4250, and vote for the real Patients' Bill 
of Rights.
  Today, there are more than 160 million Americans enrolled in managed 
care plans, such as health maintenance organizations (HMOs). Of these 
enrollees, approximately 125 million Americans are enrolled in managed 
care health plans that are governed by federal law, the Employee 
Retirement and Insurance Security Act (ERISA). Under ERISA, these 
Americans cannot seek legal remedy if their health plans denies or 
delays access to care. In a time when many Americans believe that their 
health plans are arbitrarily denying care and services, the Dingell-
Ganske substitute bill would ensure that health plans must provide an 
appeals process to their decisions. Under the Dingell-Ganske bill, 
patients would be guaranteed the right to seek both an internal and 
external appeals process with a deadline for decisions to be made. If 
both of these appeals are denied, consumers would have the right to 
hold their plans accountable for their decisions through a legal case 
in our court system. In my state of Texas, where a new law has recently 
been approved to provide this legal right for consumers under state-
based health plans. This legislation would simply ensure that ERISA-
based health plans are held accountable by consumers.
  The Dingell-Ganske bill provides critical reforms that patients need. 
It guarantees that decisions will remain in the hands of doctors and 
nurses, not insurance companies. It guarantees access to specialists 
and ensures that doctors and nurses can talk freely with patients 
without interference from their health plans. The Dingell-Ganske bill 
also prohibits the use of financial incentives to limit medical care. 
The Dingell-Ganske bill also ensures that patients can seek care in 
emergency rooms without prior approval and when they are suffering 
severe pain.
  I would like to highlight one main difference between these bills. 
The Dingell-Ganske substitute includes an important provision to ensure 
that all Americans can enroll in cutting-edge clinical trials if they 
need them. As the sponsor of legislation to ensure that Medicare 
beneficiaries can enroll in clinical trials, I believe we must 
guarantee this right to ensure that patients have access to the best, 
most-advanced care. As the Representative for the Texas Medical Center, 
where many of these clinical trials are conducted, I believe that this 
guarantee must be included as any consumer-protection legislation. The 
Dingell-Ganske substitute would require managed care plans to pay for 
the routine costs associated with clinical trials. The Republican 
majority legislation does not include this critical provision.
  Finally, I would like to highlight one other critical point about the 
Patients' Bill of Rights. I believe the Patients' Bill of Rights is a 
cost-effective, reasonable approach to provide uniform federal 
standards for managed care health plans. I believe that consumers are 
willing to pay for these protections. The Congressional Budget Office 
has estimated that the Patients' Bill of Rights would add a total of $2 
per month for these protections. Let me repeat that, for $2 per month, 
patients can be guaranteed real protections. I believe that consumers 
believe that this small price is worth its guarantees to ensure that 
consumers receive the health care services they need and deserve.
  I urge my colleagues to reject the Republican leadership bill and 
vote for the Patients' Bill of Rights.
  Mr. COSTELLO. Mr. Speaker, I rise today in strong support of the 
Dingell Patients' Bill of Rights. The Republican plan tries to give the 
appearance of reform without actually doing so. The Republican plan 
does not limit HMOs' and insurance companies' use of improper financial 
incentives to limit needed care, does not give access to specialists, 
does not allow women to choose their obstetrician or gynecologist as a 
primary care doctor and what is most important, the Republican bill 
provides no effective mechanism to hold HMOs accountable when a patient 
is killed or injured.
  The American people have waited long enough to be granted the ability 
to sue HMO's when a patient or family member is injured or killed due 
to the negligence of their health plan. They deserve the right to take 
legal action. HMO's should not be exempted from legal liability. Most 
industries in the U.S. today have responsibility to provide safe 
products and safe work places and can be subjected to legal recourse if 
they intentionally harm an individual. HMO's are no different; we must 
pass legislation to make them responsible for their actions!
  The Republicans use of scare tactics claiming that the Democratic 
bill will escalate the cost of managed care plans is bogus. Last week, 
the Republicans' own Congressional Budget Office (CBO) released an 
analysis of the Patients' Bill of Rights discrediting Republican 
claims. The CBO estimates that the Democratic proposal costs only $2 
more a month for patients with managed care plans. The CBO also 
estimates that the Democratic provision allowing patients to sue their 
health plans will increase premiums by just 1.2%. That is a small price 
to pay to make sure HMO's understand they will face legal liability.
  The Democratic bill has been endorsed by the American Medical 
Association, American Nurses Association, American Cancer Society, and 
the American Trial Lawyers Association. It's time we hold health plans 
accountable for their actions and give the American public back their 
right to quality health care. I strongly urge my colleagues to support 
the Ganske-Dingell substitute.
  Ms. McCARTHY of Missouri. Mr. Speaker, I rise today to speak in favor 
of H.R. 3605, the Dingell-Ganske Patients' Bill of Rights, of which I 
am a co-sponsor. I urge my colleagues on both sides of the aisle to 
join me in support of this bipartisan bill. This bill guarantees that 
medical decisions will be made by doctors and their patients, not by 
insurance companies. It ensures that doctors can inform patients of all 
of the treatment options available to them so that patients can make 
educated choices regarding their health care. It guarantees that a 
patient who goes to an emergency room with severe pain will be treated.
  The Patients' Bill of Rights also extends important protections to 
women. This bill allows women direct access to obstetric and 
gynecological care, and it allows women to designate their own 
gynecologist as their primary care provider. This provision allows a 
woman to continue to be treated by a doctor with whom she has become 
comfortable and who knows her personal medical history.
  Further, the Dingell-Ganske bill provides patient protection at an 
affordable price. The Congressional Budget Office has reported that 
most individuals would only pay about $2 more per month in premiums as 
a result of the Patients' Bill of Rights. The peace of mind and 
security that will result from this bill are well worth this small 
amount.
  Last year, my home state of Missouri enacted legislation that ensure 
a patient's right to emergency room care, to choose a doctor, and to 
know about all of the options available to them for treatment, 
regardless of the cost. In addition, the Missouri law provides for 
well-child care, mammography screening, drug abuse and alcohol 
treatment, bone marrow transplants, and breast reconstruction.
  With this legislation, Missouri took great strides to guarantee 
access to specialists and provide more rights for patients. If the 
Gingrich-Hastert bill is enacted, Missouri's law will be over-ridden, 
and the rights of the people of my state will be taken away. We must 
not let this happen. Instead, we should recognize successful efforts 
like Missouri's at the state level to guarantee patients basic rights 
and follow this lead by passing the Dingell-Ganske bill.
  We must guarantee that insurance companies are held accountable for 
their actions when they deny patients the health care they need. We 
must guarantee that when patients need to go to the emergency room, 
they can go without worrying whether their insurance will allow them to 
be treated for their medical emergency. We must guarantee that doctors 
and not insurance companies are making the decisions about what is 
medically necessary for their patients.
  In my district, at the Children's Mercy Hospital, social workers are 
fighting the current system to ensure that patients receive the care 
they need. For example, one little boy with an amputated arm needed a 
special kind of prosthesis. His insurance company deemed the special 
arm not medically necessary and refused to pay. The social worker at 
Children's Mercy was able to secure outside charitable funding for this 
little boy to get the arm he needed, but not all hospitals are able to 
provide this service, and frankly, they shouldn't have to.
  Join with me in supporting H.R. 3605 and grant America's patients the 
basic medical rights they deserve.
  Mr. OWENS. Mr. Speaker, I rise to oppose H.R. 4250, the Republican 
so-called Patient

[[Page H6409]]

Protection Act and to voice my enthusiastic support for H.R. 3605, the 
Patients' Bill of Rights Act. H.R. 4250 was conceived in the back room 
of the Speaker's special 15-member Task Force on Health Care and 
unveiled just last week. Although the bill was referred to several 
committees, in a transparently desperate political maneuver, the 
Republican leadership has put the bill on a fast-track basis and side 
stepped the traditional deliberative process. I am pleased, however, 
that many of the provisions that are included in several Democratic 
bills, including my own bill (H.R. 1191, the Patient and Health Care 
Professional Protection Act), have been included in today's Patient 
Protection Act. Yet, this bill, H.R. 4250, falls disgracefully short on 
``protections'' for patients and health care workers. The authors of 
H.R. 4250 took great care to ensure the protection of the owners of the 
commerce of health care--managed care companies. At a time when the 
health care industry is completely re-engineering itself and a record 
160 million Americans have fallen susceptible to the cost-saving 
strategies characterized by too many managed care plans, we must not 
support this phony ``Patients' Bill of Rights.'' We wish to note also 
that irrational Medicaid rate reductions by state Governors are also 
jeopardizing the health of patients.
  Disappointingly, most of the new Federal protections in H.R. 4250, 
would cover merely 48 million Americans in self-insured, employer-
sponsored health plans that fall under the purview of ERISA (the 
Employee Retirement Income Security Act of 1974). However, there are 
more than 160 million Americans who have private health insurance. 
Congress must act to ensure the protection of a broader range of health 
care consumers, including Medicaid recipients.
  In addition, H.R. 4250 contains a bogus grievance mechanism for 
patients who my have disputes with their HMOs. Under the bill, a so-
called internal and external appeals process would be established, Upon 
first glance, it appears that H.R. 4250 adequately provides for a fair 
process whereby patients can appeal any denials of care. However, upon 
a closer look at the bill language, it is clear that the so-called 
external process is not very independent of the HMO with whom the 
patient is in dispute. H.R. 4250 would stack the cards in favor of the 
HMO from the onset. An independent medical expert would be required to 
examine the dispute on the merits of whether or not the HMO followed 
its own rules. The independent medical expert would not be authorized 
to determine that the medical procedure is indeed, necessary. To add 
insult to injury, the bill would permit health plans to charge up to 
$100 to a patient who pursues the external appeals route.
  Unlike the Democratic substitute (H.R. 3605 sponsored by 
Representatives Dingell and Ganske), H.R. 4250 would not allow patients 
to sue their health plans. (Currently ERISA does not permit patients in 
employer-sponsored plans to sue their health plans.) Republicans have 
demonized the right to sue as some kind of payoff to the trial lawyers 
of America. On the contrary, the right to sue is an appropriate remedy 
which allows for maximum enforcement against health plans, especially 
when great injury or death results from their cost-cutting decisions. 
Any true patient protection bill and patient advocacy language would 
arm the patient with this basic tool of American civil rights.

  Moreover, H.R. 4250 contains no protection for the very individuals 
who are on the front lines of the health care delivery system--nurses, 
doctors, and other health care professionals. The bill does not have 
whistleblower protections for health care workers who are in the best 
position to witness and report patient safety concerns. The Service 
Employees International Union, the organization that represents the 
largest number of health care professionals in the country (1.3 million 
members) states, ``In a recent national survey of health care 
professionals, nearly 1 out of 4 reported that `employees are penalized 
for, or afraid to speak up about problems in their workplace' '' Yet, 
H.R. 4250 ignores this fact by not protecting workers from discharge, 
demotion, or harassment when they decide to stand up for patient care.
  It should be noted that my bill, H.R. 1191 which was originally 
introduced in the 104th Congress and reintroduced on March 20, 1997, 
addresses these issues and accomplishes the following: Provides strong 
whistleblower protection for nurses and doctors; ensures that managed 
care plans mandate that adequate staffing guidelines are implemented in 
every hospital across the country (This would stop the current practice 
of replacing registered nurses and licensed practical nurses with 
unlicensed aides.); mandates the compilation of public, uniform, 
national patient-outcome data collection and analysis; assures than no 
patient is denied care for non-medical reasons; establishes a Federal 
mechanism for the emergency investigation of egregious hospital cases 
involving death or life-threatening situations; and establishes well-
funded, consumer-dominated, non-governmental genuine health care 
advocacy groups in each state.
  Finally, H.R. 4250 would prematurely expand access to medical savings 
accounts (MSA). MSAs are tax-exempt savings accounts which may be used 
to pay for medical expenses. The Health Insurance Portability and 
Accountability Act of 1996 (Public Law 104-191) authorized a limited 
number of MSAs (750,000) under a demonstration program beginning on 
January 1, 1997. Many Members and consumer groups were vehemently 
opposed to the demonstration program, citing that MSAs work for those 
that are more healthy and more rich. The vast expansion of MSAs under 
H.R. 4250 is reckless and extreme given that the impact of the 1997 
demonstration program has yet to be studied.
  Health care is big business. Spending for health care totals 
approximately $1 trillion every year in the United States. Competition 
within the health care industry is fierce, and Congress has the 
unequivocal role in assuring that cutting costs and increasing one's 
profits are not priorities at the expense of patient care quality and 
safety. When I recently convened an extensive health care empowerment 
conference in my district, my constituents demanded reform. The 11th 
Congressional District Advisory Committee and the HMO Consumer Advisory 
Committee called for the formation of an ``HMO Certification Council'' 
to give a seal of approval to managed care plans. The conference 
participants stated their desire for greater access to doctors. The 
conference participants also called for the passage of state 
legislation that would hold managed care companies accountable and 
permit wronged patients to sue these companies. And when a group of 
nurses visited me two years ago and conducted a rally at the Capitol, 
they demanded protection for themselves and their colleagues and 
freedom to advocate on behalf of their patients. I urge my colleagues 
to carry out the will of the American people, and not the wishes of 
greedy American businesses. Vote ``no'' on H.R. 4250, and vote ``yes'' 
on H.R. 3605, the Democratic Dingell-Ganske substitute.
  Mr. PAYNE. Mr. Speaker, I rise in support of the Patients' Bill of 
Rights, the Dingell-Ganske substitute. I do so because the substitute 
lives up to its name. Improving health care quality is what this debate 
is supposed to be about and that is what the Patients' Bill of Rights 
does.
  This measure enjoys broad bipartisan support from the AFL-CIO to the 
American Medical Association. Unlike H.R. 4250, the Patients' Bill of 
Rights allows states to continue on their current course of expanding 
health care coverage to the uninsured and improving health care 
quality.
  The bill ensures that treatment discussions stay between the doctor 
and their patient. It also requires that health plans have an adequate 
number and variety of health providers. This provision is especially 
important to me because African Americans and other minorities are 
consistently discriminated against in the treatment and provisions of 
care.
  The Patients' Bill of Rights has critical safeguards to protect 
patients and providers from discrimination. Mr. Speaker, I urge my 
colleagues to protect the public health and support the Patients' Bill 
of Rights. Vote yes on the Dingell-Ganske substitute.
  Mr. SANDLIN. Mr. Speaker, I rise in strong support of the Dingell-
Ganske substitute and in opposition to H.R. 4250, the so-called Patient 
Protection Act. That bill does not protect patients. In fact, several 
provisions of their bill would harm patients. H.R. 4250 was rushed to 
the floor with no hearings, no markup, and not even so much as a CBO 
cost estimate until minutes ago.
  One of the most critical differences in the two alternatives before 
us is who makes decisions. As we increase access to health care, we 
must not allow unqualified parties to make critical decisions about 
patient treatment. Patients need to feel confident that their doctors 
are giving them all necessary information and not restricting 
information because of requirements issued by a health insurance 
provider. Patients should make critical decisions about their health 
care with the advice of their doctor. These decisions should not be 
overridden or limited by insurance company bureaucrats. The Patients' 
Bill of Rights allows patients to make their critical care decisions.
  As a strong supporter of local control, I support the Dingell-Ganske 
substitute because, unlike H.R. 4250, it will not override protections 
already enacted by the states. In my home state of Texas, the following 
protections would be overridden by H.R. 4250: well-child care; 
mammography screening; minimum maternity stays; breast reconstruction; 
diabetic supplies; prostate cancer screening; home health care; mental 
health care; alcoholism treatment; drug abuse treatment; Alzheimer's 
disease; formula for PKU; TMJ disorders; and bone mass measurement. The 
federal government should not be in the business of overriding state 
legislatures' decisions about consumer protections.
  Recently, I received a letter from two Republican members of the 
Texas legislature

[[Page H6410]]

who were instrumental in the passage of recent Texas laws that provide 
strong consumer protections. I quote from that letter:

       In 1995 managed care reform opponents called the patient 
     protection act a billion-dollar health care tax, and in 1997 
     they claimed health care costs would skyrocket upwards of 30 
     percent. However, multiple independent studies, including an 
     actuarial analysis by Milliman and Robertson, of Scott and 
     White's HMO, show costs have increased by about 34 cents per 
     member per month.
       H.R. 4250, the House GOP bill, would weaken Texas' 
     independent review provisions. Apparently, H.R. 4250's 
     independent review is not binding compared to the Texas law 
     that requires managed care organizations to provide care 
     deemed appropriate by the independent review organization.
       We also are concerned that H.R. 4250 weakens current Texas 
     law regarding emergency care and gag clauses. As we 
     understand it, the bill waters down Texas' prudent lay person 
     by allowing a health plan to override the treatment decision 
     by the emergency department physician. The gag clause 
     provision does not protect health care providers from 
     retaliation when they act as advocates for their patients.

  One of the most important provisions of this legislation ensures that 
a new Texas law will not be overturned. That provision declares that 
the Employee Retirement Income Security Act of 1974 does not prevent a 
patient from suing his or her HMO in state court for personal injury or 
wrongful death damages. This provision makes insurance companies 
accountable for their actions. The laws in this country make every 
other industry accountable for their actions. If automobile 
manufacturers produce an inferior product that harms people, they are 
accountable for that damage. Doctors are accountable for the medical 
decisions they make that harm their patients. Why then are insurance 
companies not accountable for the decisions they make that harm the 
health of patients?
  Allegations that the Dingell-Ganske substitute would make employers 
liable are simply not true. Clearly, employers cannot be held liable 
for the decisions of insurance companies and/or the decisions of 
others. The Dingell-Ganske substitute does not create a new right of 
action. It simply removes the provision of ERISA that protects 
insurance companies from being sued. It specifically states that 
employers cannot be held liable unless they exercise discretionary 
authority to make a decision on a claim for benefits covered under the 
plan. During the course of the last six months, I have met with many 
representatives of the business community. I have repeatedly asked them 
to bring me language that they believe would prevent employers from 
being sued and assured them that I would work with Mr. Dingell and Mr. 
Ganske to address their concerns. Not one of those people has taken me 
up on my offer. That is because there is no employer liability in the 
bill. Their answer instead is to oppose the entire bill and support 
H.R. 4250, and threaten Members who support Dingell-Ganske.
  One of the most disturbing provisions of H.R. 4250 will severely 
undermine the patient's right to private medical records. This bill 
allows for the release and use of confidential health information 
without the patient's consent. Once that information is released, it 
can be sold without the patient's consent or knowledge. And once again, 
H.R. 4250 would preempt state laws that already have strong medical 
privacy protections. That's wrong and this Congress should not be 
subjecting the American people to such an outrageous position.
  Mr. Speaker, I urge my colleagues to support the Dingell-Ganske 
substitute and oppose the disingenuous attempt by supporters of H.R. 
4250 to pull the wool over the eyes of the American people.
  Mr. MORAN of Virginia. Mr. Speaker, there must be certain provisions 
included in patients rights legislation in order to ensure true 
protections. For all health plans, there should be an outside review 
appeals mechanism. Patients should have the right to appeal adverse 
coverage decisions made by their health plans. Women should be able to 
choose their OBGYNs as their primary care physician, and chronically 
ill patients should not have to get referral from a primary care 
physician every time they need to see the specialist who treats their 
chronic illness. States should be able to protect consumers from 
breaches to consumer privacy. The Ganske-Dingell substitute provides 
these vital protections and more.
  Although I have concerns about a provision in the bill which deals 
with the certification of class action law suits, I feel that the true 
protections the Ganske-Dingell substitute would provide are of greater 
benefit to health care consumers, our constituents, than my concerns 
could justify opposing the substitute. I am hopeful that the authors of 
this legislation would consider working to address these concerns in 
conference, but with the assurance of the patient protections 
guaranteed in the Ganske-Dingell substitute I am pleased to support its 
passage.
  Ms. CHRISTIAN-GREEN. Mr. Speaker, as a physician, it is very 
important to me that we pass meaningful managed care reform, and that 
means passing the Ganske-Dingell bill.
  Anyone who has heard me speak on health care issues has heard my 
concern about those Americans who are under or un-insured, because they 
are denied access to medical care.
  Well Mr. Speaker, what the current managed care system has done is 
made a bad system worse.
  Now even people who have insurance under managed care are being 
denied access to needed and appropriate medical care.
  Mr. Speaker this has to change and the Ganske-Dingell bill--the 
Patients' Bill of Rights is the bill which will provide that access.
  Further Mr. Speaker, if a health plan makes a decision about patient 
care and something goes wrong, it must be liable. To do anything less 
is patently unfair.
  Mr. Speaker and colleagues, lets fix the mangled care system. Pass 
the Ganske-Dingell bipartisan bill.
  Mr. CONYERS. Mr. Speaker, I rise today to oppose the Republican 
attack on the health care of millions of Americans. The Republican 
bill, which had no public hearings, no committee markup, and no CBO 
estimate of its costs is a slapdash, thrown together, cynical attempt 
to satisfy the American people's hunger for real managed care reform.
  This Republican bill is a lie. It is titled the Patient Protection 
Act, but it has nothing to do with patient protection. This bill is all 
about protecting insurance companies from angry and injured patients 
who have been denied care because, in the view of their insurance 
company, their treatment was not ``medically necessary.'' Why are the 
Republicans trying to keep insurance companies from being held 
accountable for their mistakes? No other industry has the right to the 
same immunity from suit that insurance companies have, and no other 
industry should have that immunity. The thousands of men, women, and 
children across this country who have been hurt by an insurance company 
decision are crying out for justice, and we as their representatives 
should provide them with a way to achieve that justice.
  The Dingell bill provides them with this justice. This bill will 
ensure that the next time an insurance bureaucrat has to decide whether 
a child he has never seen needs life saving treatment, he will think 
twice, instead of denying the treatment out of hand.
  We need to reform the insurance industry, and make insurance 
companies care about the health of the patients that they cover. Our 
bill does this. Don't vote for the Republican's cynical lie. I urge my 
colleagues to support the Dingell bill, and provide Americans with the 
health justice they need and deserve.
  Ms. LEE. Mr. Speaker, I rise in strong support of H.R. 3605, The 
Patients' Bill of Rights. Today we see appalling, devastating problems 
with HMO's. Instead of concern for patients, too many HMO's focus on 
making money at the expense of quality health care. They have denied 
medical procedures that they decide ``unnecessary'', even though 
patients' lives may have depended on them. They have refused to pay for 
medical procedures for children with terrible deformities, calling the 
operations ``cosmetic''. They have even taken away a doctor's right to 
authorize crucial procedures, dangerously yielding the most important 
decision-making responsibilities to a bureaucrat in an office building 
3,000 miles away.
  The Patients' Bill of Rights is a comprehensive bill which makes 
certain that health care providers do what is in the best interests of 
their customers, not their profits. It guarantees basic rights for all 
patients, placing health, well-being, and safety above all else, and 
valuing the patient-doctor relationship. Among the most important 
aspects of the bill is that it allows doctors, not insurance companies, 
to make crucial decisions regarding the health of patients. Another 
important safeguard in the bill guarantees that individuals are covered 
for all emergency services. No one should have to worry about insurance 
coverage for life-saving emergency care.
  Furthermore, and very significant, the Patients' Bill of Rights calls 
for internal and external appeals processes to adequately address 
patients' grievances. These processes are crucial because they ensure 
that insurance companies are held accountable for providing quality 
care to people, or required to pay the consequence.
  In contrast, H.R. 4250, the Republican version of a healthcare bill, 
is a vague and inadequate measure that fails to address many of the 
vital problems in the healthcare industry. Failing to focus on the 
needs of patients, it favors the multibillion-dollar insurance 
industry. Under H.R. 4250, insurance companies will not be held 
accountable for decisions that cause injury to a patient. Crucial 
health decisions will continue to be made by the patient's insurance 
company rather than the doctor. The Republican plan does not put 
patients first, but rather, serves insurance companies' interests at 
the cost of quality health care.

[[Page H6411]]

  Furthermore, whereas the Patients' Bill of Rights expands healthcare 
to include provisions for patients who are seriously ill or require the 
expertise of the specialist, such as victims of HIV and cancer, the 
Republican plan puts at risk even the most basic and necessary 
measures. In my home state of California, current benefits such as 
mammography and cervical cancer screening, prenatal care, and mental 
health care could be overridden by H.R. 4250. It is unthinkable to me 
that these essential, preventative measures are threatened in this 
legislation. This would be a drastic step backward in caring for our 
people, and a further example of cutting cost at the expense of patient 
care.
  Mr. Speaker, I have heard some of my colleagues on the other side of 
the aisle connect our current U.S. health care system to capitalism, 
stating that capitalism produces excellence in health care. This 
misguided mentality is frightening to me. Capitalism affords excellent 
healthcare only to the select few who are able to pay the most for it, 
and leaves all others without. This principle of the profit-making, 
market system is a devastating policy for health care. Health care is 
not a luxury to be afforded to the highest bidder. Providing health 
care is not about striving to make the greatest amount of money.
  Health care is a basic right that all Americans deserve, yet the 
United States is the only Western industrialized country that does not 
have a national health program. In a wealthy nation such as ours, it is 
incredible to me that there are so many who lack access to this 
fundamental necessity. The Republican plan will serve only to increase 
the rift between those who have access to health care and those who are 
left behind, neglected and trapped without adequate care.
  I urge your opposition of H.R. 4250 and support of H.R. 3605, the 
Patients' Bill of Rights.
  Mr. ALLEN. Mr. Speaker, I rise in support of the Ganske-Dingell 
substitute to H.R. 4250, the Republican HMO health care bill.
  We have an opportunity in this Congress to enact real reform in our 
health care system. Months ago, Democrats introduced the Patients' Bill 
of Rights Act to protect patients against HMO abuses. Now that we are a 
few months away from an election, the Republicans have decided that 
they need their own version of a managed care ``reform'' bill.
  This republican bill is being rushed to the House floor without the 
benefit of even one public hearing or any committee mark-up. As of 1 
a.m. this morning, this bill was still being drafted.
  While the Republican leadership has been willing to spend more than a 
year and millions of dollars on committee investigations, they are not 
willing to allow even one hearing on legislation which could 
significantly affect Americans' lives.
  Health care financing is in transition. Private and public purchasers 
of health care are turning to managed care.
  The shift to managed care has raised concerns about the implications 
for health care quality. I believe that managed care must be more than 
managed cost.
  Last month I held community health care forums in my district. This 
was an opportunity for my constituents to come and share their 
experiences. I wanted to hear from them about health care costs, 
quality and access for Maine children and families.
  I did not hear the managed care horror stories to the extent that 
many of my colleagues have heard. Maine has been slow to move to 
managed care. People did, however, express their fears about this 
system.
  I heard from a mother who works an extra job to pay for an indemnity 
health insurance policy for her daughter who has a severe disability. 
It was clear that purchasing this health plan was a financial hardship 
for this family. This mother was too fearful to move to a managed care 
plan which may be less expensive because it could limit the care that 
her daughter needs.
  Others also shared their concerns about managed care. Could some of 
the same horror stories that they hear about on the national news 
happen to them?
  My constituents are not alone in their fears about managed care. 
There is a crisis of confidence in American health care:
  Eighty percent of all consumers believe that insurance plans often 
compromise the quality of care to save money.
  The worst problems are often reported by those who need good care the 
most--those with chronic conditions who experienced an illness serious 
enough to require hospitalization. More than one half of this group 
reported problems with their health insurance.
  36 percent said that their condition worsened as a result of the 
insurance problem.
  35 percent said the problem led to an additional condition,
  And 17 percent developed permanent disabilities. Problems ranged from 
delays in care to failure to refer to a specialist to problems with 
payment, billing, and coverage.
  As I mentioned, Maine has not moved to managed care as rapidly as 
other areas. Furthermore, strong patient protections have been enacted 
at the state level. However, because of federal preemptions to state 
protections, at least 250,000 people in Maine are left unprotected. My 
constituents recognize that we need a national solution to a national 
problem.
  The Republican legislation only applies to Americans in self insured 
plans. They ignore two-thirds of Americans with private health 
insurance. This means that Americans with individual policies, state 
and local government employees and people whose employers purchase 
coverage through an HMO or insurance policy are left unprotected. 113 
million Americans are left out in the cold by the Republican bill.
  The Republican bill is clearly designed for political cover rather 
than real patient protections. For example, the Republican bill does 
not:
  Provide patients with access to clinical trials;
  Permit doctors to prescribe prescription drugs that are not on an 
HMO's predetermined list;
  Provide ongoing access to specialty care;
  Protect health care workers who report quality problems;
  Provide choice of doctors within a plan; or
  Hold managed care plans accountable when a patient is injured by a 
plan's decision to withhold or limit care.
  By contrast, the Patients' Bill of Rights Act does provide all of 
these protections.
  In addition to empty promises, the Republican bill is laced with 
poison pills such as healthmarts and malpractice limits.
  I plan to hold more community health care forums in my district 
during the August in district work period. It is my sincere hope that I 
will be able to assure my constituents that they do not need to fear 
the health care system in this country.
  The American people have been clear. They want real protections. They 
do not want a watered down bill. They want the Ganske-Dingell 
substitute, the Patients' Bill of Rights Act.
  Ms. KILPATRICK. Mr. Speaker, I rise today in strong, unequivocal and 
clear support of H.R. 3605, the Democratic Patient Protection Act, and 
oppose H.R. 4250, the Republican Politician Protection Act. The 
Republican Politician Protection Act provides too few patient 
protections, undermines existing state consumer protections, has not 
had a single hearing or mark-up, and contains unnecessary and 
irrelevant provisions. It is time that we, the Congress, stopped 
playing games with the health care of our constituents and get down to 
the real business of providing both doctors and patients with the 
protections that they need and deserve. I recently had a meeting with 
the Michigan State Medical Society, an organization made up of doctors 
in the State of Michigan, and they wholeheartedly endorse the 
Democratic Patient Protection Act, among more than 50 consumer 
protection, labor union, and health care organizations.
  Let me take a minute to explain to you three key differences between 
the Democratic Patient Protection Act and the Republican Politician 
Protection Act:
  The Republican Politician Protection Act allows medical insurance 
companies to give your confidential medical records to another agency--
another insurance company, mortgage company, credit bureau, pharmacy, 
or health care bureaucrat--without your consent. This means that 
anyone--a person applying for a mortgage, someone looking to peer 
through your medical history before you start a job, a person looking 
for negative health information against a potential candidate for 
Congress--could have access to your medical records. The Democratic 
Patient Protection Act protects the confidentiality of your medical 
records. No one would be allowed to review or transfer your records 
without your express and written consent.
  The Politician Protection Act usurps and supersedes state consumer 
protections. Mr. Speaker, before I was elected to this august body, I 
served for 18 years as a state legislator in the great State of 
Michigan. I abhorred and detested those rules, laws and regulations 
that superseded our rules, laws and regulations that were 
democratically arrived at and after many hearings, debate, and votes. 
Ostensibly, the Republican Party is one of respecting the rights of 
states to make the best decisions for themselves--or has posited 
themselves as such. The Republican Politician Protection Act would not 
allow states to decide for themselves the best consumer protections for 
their citizens. The Democratic Patient Protection Act does not usurp 
state law.
  The Republican Politician Protection Act does not allow patients to 
sue their health insurance plans for wrongdoing. The Republican 
Politician protection act allows persons to sue for fiduciary damages, 
but not for pain and suffering or punitive damages. What does this 
mean? Well, it means that if your doctor in a managed care plan 
recommends that you have an additional mammogram, but the plan refuses 
to pay for it and the patient dies as a result, the family could sue 
for the cost of the

[[Page H6412]]

mammogram. The Democratic Patient Protection Act will ensure that 
patients can sue for compensatory and punitive damages, and let a 
jury--the same juries who register to vote and send us to Congress--
decide the merits of these issues.
  Adoption of the Democratic Patient Protection Act would be only a 
first step toward solving our health care crisis. We still need to 
address the more than 4 million families, women, children and adults 
over the past decade who do not have any health insurance. Guess who is 
footing the bill when these uninsured women, children and adults show 
up at the hospitals of our nation? That's right, you and I. Access to 
quality health care, before catastrophic diseases attack, has been 
proven to prolong the length and quality of life of Americans. The 
challenge of serving those persons who do not have access to health 
care is one of the many unfinished tasks facing us as a Congress and as 
a nation as we consider the reform of our health care system.
  If you think that you don't know someone who is medically 
underserved, think again. The usual person who is defined as 
``medically underserved'' is poor, elderly, has no health care, and 
does not have access to primary care physicians. In our land of plenty, 
over 43 million people are medically underserved, and only 24 percent 
of those persons are served through community health centers. What 
happens to more than three quarters of these people who do not have 
access to health care is simply this: immunizations are not given, and 
babies fall ill to preventable diseases; elderly citizens do not get 
their high blood pressure or diabetes cared for, and end up in the 
hospital, or women do not get a life-saving mammogram. Not having any 
health care, in our land of plenty, is almost criminal.
  Taxpayers want, and need, long-range solutions to the challenge of 
access to affordable, quality health care. Taxpayers deserve an 
investment of resources and commitment to the goal of health care for 
all. It is the job and duty of Congress to address this issue now. The 
doors of health care must remain open to protect the public health, 
prevent disease, improve our quality of life and save scarce taxpayer 
dollars. Congress can, and must, improve access to health care for all. 
The Democratic Patient Protection Act is a strong, aggressive step 
toward the much needed reform of our health insurance system, but it is 
only a first step. I urge all of my colleagues to reject the Republican 
Politician Protection Act and vote for the Democratic Patient 
Protection Act.
  The SPEAKER pro tempore (Mr. Kolbe). The question is on the amendment 
in the nature of a substitute offered by the gentleman from Michigan 
(Mr. Dingell).
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. DINGELL. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Evidently a quorum is not present.
  The Sergeant at Arms will notify absent Members.
  The vote was taken by electronic device, and there were--yeas 212, 
nays 217, not voting 6, as follows:

                             [Roll No. 336]

                               YEAS--212

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baesler
     Baldacci
     Barcia
     Barrett (WI)
     Becerra
     Bentsen
     Berman
     Berry
     Bilbray
     Bishop
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brown (CA)
     Brown (FL)
     Brown (OH)
     Capps
     Cardin
     Carson
     Clay
     Clayton
     Clement
     Clyburn
     Condit
     Conyers
     Costello
     Coyne
     Cramer
     Cummings
     Danner
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doyle
     Edwards
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Fazio
     Filner
     Forbes
     Fox
     Frank (MA)
     Frost
     Furse
     Ganske
     Gejdenson
     Gephardt
     Goode
     Gordon
     Green
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hamilton
     Harman
     Hastings (FL)
     Hefner
     Hilliard
     Hinchey
     Holden
     Hooley
     Horn
     Hoyer
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     John
     Johnson (WI)
     Johnson, E. B.
     Kanjorski
     Kaptur
     Kennedy (MA)
     Kennedy (RI)
     Kennelly
     Kildee
     Kilpatrick
     Kind (WI)
     Kleczka
     Klink
     Kucinich
     LaFalce
     Lampson
     Lantos
     LaTourette
     Leach
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Luther
     Maloney (CT)
     Maloney (NY)
     Manton
     Martinez
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McHale
     McIntyre
     McKinney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller (CA)
     Minge
     Mink
     Moakley
     Mollohan
     Moran (VA)
     Morella
     Murtha
     Nadler
     Neal
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Peterson (MN)
     Pickett
     Pomeroy
     Poshard
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rivers
     Rodriguez
     Roemer
     Rothman
     Roukema
     Roybal-Allard
     Rush
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Schumer
     Scott
     Serrano
     Sherman
     Sisisky
     Skaggs
     Skelton
     Slaughter
     Smith, Adam
     Snyder
     Spratt
     Stabenow
     Stark
     Stenholm
     Stokes
     Strickland
     Stupak
     Tanner
     Tauscher
     Taylor (MS)
     Thompson
     Thurman
     Tierney
     Torres
     Towns
     Traficant
     Turner
     Velazquez
     Vento
     Visclosky
     Waters
     Watt (NC)
     Waxman
     Wexler
     Weygand
     Wise
     Woolsey
     Wynn

                               NAYS--217

     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bateman
     Bereuter
     Bilirakis
     Bliley
     Blunt
     Boehner
     Bonilla
     Bono
     Brady (TX)
     Bryant
     Bunning
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Cannon
     Castle
     Chabot
     Chambliss
     Chenoweth
     Christensen
     Coble
     Coburn
     Collins
     Combest
     Cook
     Cooksey
     Cox
     Crane
     Crapo
     Cubin
     Cunningham
     Davis (VA)
     Deal
     DeLay
     Diaz-Balart
     Dickey
     Doolittle
     Dreier
     Duncan
     Dunn
     Ehlers
     Ehrlich
     Emerson
     English
     Ensign
     Everett
     Ewing
     Fawell
     Foley
     Fossella
     Fowler
     Franks (NJ)
     Frelinghuysen
     Gallegly
     Gekas
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gingrich
     Goodlatte
     Goodling
     Goss
     Graham
     Granger
     Greenwood
     Gutknecht
     Hansen
     Hastert
     Hastings (WA)
     Hayworth
     Hefley
     Herger
     Hill
     Hilleary
     Hobson
     Hoekstra
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Inglis
     Istook
     Jenkins
     Johnson (CT)
     Johnson, Sam
     Jones
     Kasich
     Kelly
     Kim
     King (NY)
     Kingston
     Klug
     Knollenberg
     Kolbe
     LaHood
     Largent
     Latham
     Lazio
     Lewis (CA)
     Lewis (KY)
     Linder
     Livingston
     LoBiondo
     Lucas
     Manzullo
     McCollum
     McCrery
     McDade
     McHugh
     McInnis
     McIntosh
     McKeon
     Metcalf
     Mica
     Miller (FL)
     Moran (KS)
     Myrick
     Nethercutt
     Neumann
     Ney
     Northup
     Norwood
     Nussle
     Oxley
     Packard
     Pappas
     Parker
     Paul
     Paxon
     Pease
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Pombo
     Porter
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Ramstad
     Redmond
     Regula
     Riggs
     Riley
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Royce
     Ryun
     Salmon
     Sanford
     Saxton
     Scarborough
     Schaefer, Dan
     Schaffer, Bob
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Shimkus
     Shuster
     Skeen
     Smith (MI)
     Smith (NJ)
     Smith (OR)
     Smith (TX)
     Smith, Linda
     Snowbarger
     Solomon
     Souder
     Spence
     Stearns
     Stump
     Sununu
     Talent
     Tauzin
     Taylor (NC)
     Thomas
     Thornberry
     Thune
     Tiahrt
     Upton
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weldon (PA)
     Weller
     White
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)

                             NOT VOTING--6

     Ford
     Gonzalez
     Hinojosa
     Markey
     Yates
     Young (FL)

                              {time}  1352

  Messrs. WHITE and EHLERS changed their vote from ``yea'' to ``nay.''
  Ms. BROWN of Florida, Mr. SCHUMER and Mr. BOYD changed their vote 
from ``nay'' to ``yea.''
  So the amendment in the nature of a substitute was rejected.
  The result of the vote was announced as above recorded.


                          personal explanation

  Mr. HINOJOSA. Mr. Speaker, during rollcall vote No. 336, The Dingell 
Substitute to H.R. 4250, I was unavoidably detained. Had I been 
present, I would have voted ``yes.''
  The SPEAKER pro tempore (Mr. Kolbe). Pursuant to House Resolution 
509, the previous question is ordered on the bill, as amended.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


                Motion to Recommit Offered by Mr. Berry

  Mr. BERRY. Mr. Speaker, I offer a motion to recommit.
  The SPEAKER pro tempore. Is the gentleman from Arkansas opposed to 
the bill?
  Mr. BERRY. Yes, Mr. Speaker, in its current form.

[[Page H6413]]

  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:
       Mr. Berry moves to recommit the bill H.R. 4250 to the 
     Committee on Ways and Means and to the Committee on Education 
     and the Workforce with instructions to report back the same 
     to the House forthwith with the following amendments to the 
     portions of the same within their respective jurisdiction:
       Page 38, beginning on line 9, strike ``does not meet the 
     plan's requirements for medical appropriateness or 
     necessity'' and insert ``is not medically necessary and 
     appropriate''.
       Page 39, beginning on line 16, strike ``does not meet the 
     plan's requirements for medical appropriateness or 
     necessity'' and insert ``is not medically necessary and 
     appropriate''.
       Page 48, beginning on line 17, strike ``does not meet the 
     plan's requirements for medical appropriateness or 
     necessity'' and insert ``is not medically necessary and 
     appropriate''.
       Page 53, beginning on line 17, strike ``meets, under the 
     facts and circumstances at the time of the determination, the 
     plan's requirement for medical appropriateness or necessity'' 
     and insert ``is, under the facts and circumstances at the 
     time of the determination, medically necessary and 
     appropriate''.
       Page 60, line 17, strike all that follows the first period.
       Page 60, after line 17, insert the following new 
     subparagraph:
       ``(V) Medical necessity and appropriateness.--The term 
     `medically necessary and appropriate' means, with respect to 
     an item or service, an item or service determined by the 
     treating physician (who furnishes items and services under a 
     contract or other arrangement with the group health plan or 
     with a health insurance issuer providing health insurance 
     coverage in connection with such a plan), after consultation 
     with a participant or beneficiary, to be required, according 
     to generally accepted principles of good medical practice, 
     for the diagnosis or direct care and treatment of an illness 
     or injury of the participant or beneficiary.''.
       Page 227, strike line 1 and all that follows through page 
     233, line 3, and insert the following (and conform the table 
     of contents accordingly):

   Subtitle C--Deduction for Health Insurance Costs of Self-Employed 
                              Individuals

     SEC. 3201. DEDUCTION FOR HEALTH INSURANCE COSTS OF SELF-
                   EMPLOYED INDIVIDUALS.

       (a) In General.--The table contained in subparagraph (B) of 
     section 162(l)(1) of the Internal Revenue Code of 1986 is 
     amended to read as follows:

      In the case of taxable                                           
        years beginning in                               The applicable
        calendar year:                                   percentage is:
        1999, 2000, and 2001................................60 percent 
        2002................................................70 percent 
        2003 or thereafter...............................100 percent.''
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to taxable years beginning after December 31, 
     1998.

  Mr. BERRY (during the reading). Mr. Speaker, I ask unanimous consent 
that the motion to recommit be considered as read and printed in the 
Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arkansas?
  Mr. HASTERT. Mr. Speaker, I object.
  The SPEAKER pro tempore. Objection is heard.
  The Clerk will continue to read.
  The Clerk continued reading the motion to recommit.
  Mr. HASTERT. Mr. Speaker, I reserve all points of order.
  The SPEAKER pro tempore. The gentleman reserves a point of order.
  The gentleman from Arkansas (Mr. Berry) is recognized for 5 minutes.
  Mr. BERRY. Mr. Speaker, my motion makes the following two important 
changes: It strikes the Medical Savings Account provision from the 
Republican bill, saving billions of dollars a year.
  The money saved in the MSA will be used to accelerate the health 
insurance deduction for the self-employed. This helps small businessmen 
by increasing the deduction for expenditures on health insurance to 60 
percent in the next 3 years, 70 percent in the year 2002, and 100 
percent thereafter.
  The current deduction is 45 percent and will not increase to 100 
percent until the year 2006.
  It amends the Republican bill by putting the decision of ``medical 
necessity'' back in the hands of doctors. The new language allows for 
the doctor and the patient, not the insurance companies, to determine 
the proper care and treatment for the patient.

                              {time}  1400

  It also makes sure the care they receive is consistent with good 
medical practice, not insurance profits. The Republican version leaves 
this decision up to the insurance companies. The Republican bill would 
create a system where the insurance company would win every time. The 
deck is stacked against the patients before they even get in to see 
their doctor.
  The bill would allow insurers to develop their own definitions and 
methods for determining medical necessity, which would make it 
virtually impossible for enrollees to challenge the plan's decision. A 
plan could define medical necessity to essentially be nothing more than 
the care defined under whatever treatment guidelines and utilization 
protocols the plan adopts, even if the guidelines and protocols are not 
backed up by any clinical evidence or good professional practice. Plans 
would always win under this scenario. The Republican bill would allow 
insurers to overturn physicians' treatment decisions on the basis of 
completely arbitrary standards that are not based on any credible 
medical evidence.
  I do not think that that is the kind of care that we want for our 
families, our children, our parents or our friends. But that is just 
what this Republican bill would allow.
  I yield to the gentleman from Michigan (Mr. Dingell).
  Mr. DINGELL. Mr. Speaker, I thank the gentleman for yielding to me. I 
would observe that here we are discussing the fundamental difference 
between the two bills. If you want to provide protection for the 
doctor-patient relationship, vote for the motion to recommit, because 
the motion to recommit assures that it will be medical necessity 
decided by the doctor that determines the course of treatment of a 
patient of an HMO, not some curious, insurance-oriented approach which 
would be decided by the Republican plan.
  One of my friends who is one of the outstanding physicians and 
surgeons in the 16th District called me to tell me about something that 
happened to him recently. He was made an examiner of medical claims. He 
was fired by the HMO. The reason was that he was making medical 
decisions, not insurance decisions. That is exactly the issue which is 
before us.
  If you want the doctor to decide what you and your family and your 
constituents are going to receive in the way of medical care, vote for 
the motion to recommit. If you want to have an unelected, unaccountable 
health care bureaucrat appointed by a health insurance company or an 
HMO, then vote against it. And what you will be doing, you will be 
vesting in the HMO the power to make a medical decision instead of 
seeing to it that that medical decision is made by the doctor in 
concert with his patient. Medical necessity should be decided by a 
doctor who is trusted by the patient, not by an unknown voice on the 
telephone who is neither doctor nor accountable, a health care 
bureaucrat. That is the point of this amendment.
  If you believe in the doctor-patient relationship and if you believe 
it is worth protecting, then vote ``aye'' on the motion to recommit. 
That is what is at stake, the doctor-patient relationship, and the 
doctor making a decision with regard to what constitutes medical 
necessity and what constitutes the need of the patient. To vote ``no'' 
on this motion to recommit is to assure that medical necessity is 
decided by an anonymous voice on the telephone belonging to no one with 
a relationship to the patient.


                             Point of Order

  The SPEAKER pro tempore (Mr. Kolbe). Does the gentleman from Illinois 
insist on a point of order?
  Mr. HASTERT. Mr. Speaker, I insist on a point of order.
  The SPEAKER pro tempore. The gentleman will state his point of order.
  Mr. HASTERT. I yield to the gentleman from California (Mr. Thomas).
  The SPEAKER pro tempore. The Chair will recognize the gentleman from 
California (Mr. Thomas) on the point of order.
  Mr. THOMAS. Mr. Speaker, contained among the numerous provisions in 
the motion to recommit is striking the medical savings accounts. 
Notwithstanding the gentleman's representation that this will save 
billions of dollars a year, the Congressional Budget Office says that 
simply is not so. In fact, it will save less than $1 billion a year. 
That is the point on which the point of order turns, because the 
gentleman's addition of the acceleration of the self-employed deduction 
in fact scores more than $1 billion and therefore is subject to a 303 
Congressional Budget Act point of order. It in fact increases the 
budget before the final

[[Page H6414]]

budget is adopted in a given fiscal year. It applies clearly in this 
particular instance. A point of order, therefore, lies against the 
gentleman and I would urge the Chair to sustain the 303(a) 
Congressional Budget Act point of order.
  The SPEAKER pro tempore. The gentleman from California has made a 
point of order.
  Does the gentleman from Arkansas (Mr. Berry) wish to be heard on the 
point of order?
  Does the gentleman from Maryland (Mr. Cardin) wish to be heard on the 
point of order?
  Mr. CARDIN. Yes, I do, Mr. Speaker.
  The SPEAKER pro tempore. The gentleman from Maryland is recognized on 
the point of order.
  Mr. CARDIN. If I understand the gentleman from California's point is 
that the striking of the medical savings account provision would not 
save as much money as accelerating the self-employed insurance 
deduction by 4 years.
  Mr. Speaker, I would like to include in the Record a document that 
has been received from the Joint Committee on Taxation that shows that 
striking the medical savings account provision will save $4.1 billion, 
the self-employed health insurance deduction would cost $3.4 billion, 
for a net revenue savings to the treasury of $687 million.

  The SPEAKER pro tempore. The gentleman from Maryland may insert the 
documents after the point of order but not during debate on the point 
of order.
  Is there any other Member who wishes to be heard on the point of 
order?
  Mr. CARDIN. Mr. Speaker, on that point, if I am correct, the point of 
order is being raised as it relates to having----
  The SPEAKER pro tempore. That is correct. The Chair must rely on what 
is being said to the Chair and so insertion into the Record during the 
debate on the point of order is not in order at this time.
  Mr. CARDIN. I would just quote into the record the document from the 
Joint Committee on Taxation dated July 23, 1998, and would be glad to 
make it available to the Parliamentarian.
  The SPEAKER pro tempore. Does any other Member wish to be heard?
  Mr. THOMAS. Mr. Speaker, on the point just registered, this is the 
House and not the Senate. The Senate just read 10-year numbers, the 
House operates on 5-year numbers, and the point of order still stands.
  Mr. CARDIN. Mr. Speaker, let me put into the record the 5-year 
numbers. The 5-year numbers on striking the medical savings account 
provision would save $1.3 billion, the self-employed would cost $1.2 
billion, for a net savings to the treasury of $56 million.
  The SPEAKER pro tempore. Is there any other Member who wishes to be 
heard on the point of order? If not, the Chair is prepared to rule.
  Mr. THOMAS. Mr. Speaker, the gentleman is reading from a document 
that I do not believe is current. Would he cite the number and the 
date?
  Mr. CARDIN. If the gentleman would yield, it is dated July 23, 1998.
  Mr. THOMAS. I tell the gentleman the numbers I just read come from a 
Joint Tax Committee publication July 24, 1998. But the gentleman is not 
bad being only one day behind.
  Mr. CARDIN. Mr. Speaker, I have the July 25 numbers.
  The SPEAKER pro tempore. Does the gentleman from Illinois insist upon 
his point of order?
  Mr. HASTERT. Mr. Speaker, I insist on my point of order.
  The SPEAKER pro tempore. Does any other Member wish to be heard on 
the point of order? Is there anybody else who wishes to be heard on the 
point of order? If not, the Chair is prepared to rule.
  The amendment proposed in the motion to recommit would strike one of 
the revenue provisions from the bill. The amendment also would insert 
an alternate revenue change. In this latter respect, the amendment 
``provides an increase or decrease in revenues'' within the meaning of 
section 303 of the Budget Act.
  Because this revenue change would occur during fiscal year 1999, a 
year for which a budget resolution has yet to be finalized, the 
amendment violates section 303(a)(2) of the Act.
  The point of order is sustained.
  Mr. CARDIN. Mr. Speaker, this is not the point raised in the 
objection by the Member. I do not know how the Chair can on its own use 
as a basis for an appeal that was not raised and we did not have a 
chance to argue the point on. That is blatantly against the rules of 
the House, and I appeal the ruling of the Chair.
  The SPEAKER pro tempore. The question is, Shall the decision of the 
Chair stand as the judgment of the House?


                  Motion to Table Offered by Mr. Armey

  Mr. ARMEY. Mr. Speaker, I move to table the appeal.
  The SPEAKER pro tempore. The question is on the motion to table 
offered by the gentleman from Texas (Mr. Armey).
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mr. ACKERMAN. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 222, 
noes 204, not voting 9, as follows:

                             [Roll No. 337]

                               AYES--222

     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bateman
     Bereuter
     Bilbray
     Bilirakis
     Bliley
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bono
     Brady (TX)
     Bryant
     Bunning
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Cannon
     Castle
     Chabot
     Chambliss
     Chenoweth
     Christensen
     Coble
     Coburn
     Collins
     Combest
     Cook
     Cooksey
     Cox
     Crane
     Crapo
     Cubin
     Cunningham
     Davis (VA)
     Deal
     DeLay
     Diaz-Balart
     Dickey
     Doolittle
     Dreier
     Duncan
     Dunn
     Ehlers
     Ehrlich
     Emerson
     English
     Ensign
     Everett
     Ewing
     Fawell
     Foley
     Fossella
     Fowler
     Fox
     Franks (NJ)
     Frelinghuysen
     Gallegly
     Ganske
     Gekas
     Gibbons
     Gilchrest
     Gilman
     Gingrich
     Goodlatte
     Goodling
     Goss
     Graham
     Granger
     Greenwood
     Gutknecht
     Hansen
     Hastert
     Hastings (WA)
     Hayworth
     Hefley
     Herger
     Hill
     Hilleary
     Hobson
     Hoekstra
     Horn
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Inglis
     Istook
     Jenkins
     Johnson, Sam
     Jones
     Kasich
     Kelly
     Kim
     King (NY)
     Kingston
     Klug
     Knollenberg
     Kolbe
     LaHood
     Largent
     Latham
     LaTourette
     Lazio
     Leach
     Lewis (CA)
     Lewis (KY)
     Livingston
     LoBiondo
     Lucas
     Manzullo
     McCollum
     McCrery
     McDade
     McHugh
     McInnis
     McIntosh
     McKeon
     Metcalf
     Mica
     Miller (FL)
     Moran (KS)
     Morella
     Myrick
     Nethercutt
     Neumann
     Ney
     Northup
     Norwood
     Nussle
     Oxley
     Packard
     Pappas
     Parker
     Paul
     Paxon
     Pease
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Pombo
     Porter
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Ramstad
     Redmond
     Regula
     Riggs
     Riley
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Roukema
     Royce
     Ryun
     Salmon
     Sanford
     Saxton
     Scarborough
     Schaefer, Dan
     Schaffer, Bob
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Shimkus
     Shuster
     Skeen
     Smith (MI)
     Smith (NJ)
     Smith (OR)
     Smith (TX)
     Smith, Linda
     Snowbarger
     Solomon
     Souder
     Spence
     Stearns
     Stump
     Sununu
     Talent
     Tauzin
     Taylor (NC)
     Thomas
     Thornberry
     Thune
     Tiahrt
     Upton
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weller
     White
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)

                               NOES--204

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baesler
     Baldacci
     Barcia
     Barrett (WI)
     Becerra
     Bentsen
     Berman
     Berry
     Bishop
     Blagojevich
     Blumenauer
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brown (CA)
     Brown (FL)
     Brown (OH)
     Capps
     Cardin
     Carson
     Clay
     Clayton
     Clement
     Clyburn
     Condit
     Conyers
     Costello
     Coyne
     Cramer
     Cummings
     Danner
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doyle
     Edwards
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Fazio
     Filner
     Forbes
     Frank (MA)
     Frost
     Furse
     Gejdenson
     Gephardt
     Goode
     Gordon
     Green
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hamilton
     Harman
     Hastings (FL)
     Hefner
     Hilliard
     Hinchey
     Hinojosa
     Holden
     Hooley
     Hoyer
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     John
     Johnson (WI)
     Johnson, E. B.
     Kanjorski

[[Page H6415]]


     Kaptur
     Kennedy (MA)
     Kennedy (RI)
     Kennelly
     Kildee
     Kilpatrick
     Kind (WI)
     Kleczka
     Klink
     Kucinich
     LaFalce
     Lampson
     Lantos
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Luther
     Maloney (CT)
     Maloney (NY)
     Manton
     Martinez
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McHale
     McIntyre
     McKinney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller (CA)
     Minge
     Mink
     Moakley
     Mollohan
     Moran (VA)
     Murtha
     Nadler
     Neal
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Peterson (MN)
     Pickett
     Pomeroy
     Poshard
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rivers
     Rodriguez
     Roemer
     Rothman
     Roybal-Allard
     Rush
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Schumer
     Scott
     Serrano
     Sherman
     Sisisky
     Skaggs
     Skelton
     Slaughter
     Smith, Adam
     Snyder
     Spratt
     Stabenow
     Stark
     Stenholm
     Stokes
     Strickland
     Stupak
     Tanner
     Tauscher
     Taylor (MS)
     Thompson
     Thurman
     Tierney
     Torres
     Towns
     Traficant
     Turner
     Velazquez
     Vento
     Visclosky
     Waters
     Watt (NC)
     Waxman
     Wexler
     Weygand
     Wise
     Woolsey
     Wynn

                             NOT VOTING--9

     Ford
     Gillmor
     Gonzalez
     Johnson (CT)
     Linder
     Markey
     Weldon (PA)
     Yates
     Young (FL)

                              {time}  1428

  So the motion to table was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.


                Motion to Recommit Offered by Mr. Berry

  Mr. BERRY. Mr. Speaker, I offer a motion to recommit.
  The SPEAKER pro tempore (Mr. Kolbe). Is the gentleman still opposed 
to bill?
  Mr. BERRY. Mr. Speaker, in its current form, I am.
  The SPEAKER pro tempore. The Clerk will report the motion.
  The Clerk read as follows:

       Mr. Berry moves to recommit the bill H.R. 4250 to the 
     Committee on Education and the Workforce with instructions to 
     report back the same to the House forthwith with the 
     following amendments:
       Page 38, beginning on line 9, strike ``does not meet the 
     plan's requirements for medical appropriateness or 
     necessity'' and insert ``is not medically necessary and 
     appropriate''.
       Page 39, beginning on line 16, strike ``does not meet the 
     plan's requirements for medical appropriateness or 
     necessity'' and insert ``is not medically necessary and 
     appropriate''.
       Page 48, beginning on line 17, strike ``does not meet the 
     plan's requirements for medical appropriateness or 
     necessity'' and insert ``is not medically necessary and 
     appropriate''.
       Page 53, beginning on line 17, strike ``meets, under the 
     facts and circumstances at the time of the determination, the 
     plan's requirement for medical appropriateness or necessity'' 
     and insert ``is, under the facts and circumstances at the 
     time of the determination, medically necessary and 
     appropriate''.
       Page 60, line 17, strike all that follows the first period.
       Page 60, after line 17, insert the following new 
     subparagraph:
       ``(V) Medical necessity and appropriateness.--The term 
     `medically necessary and appropriate' means, with respect to 
     an item or service, an item or service determined by the 
     treating physician (who furnishes items and services under a 
     contract or other arrangement with the group health plan or 
     with a health insurance issuer providing health insurance 
     coverage in connection with such a plan), after consultation 
     with a participant or beneficiary, to be required, according 
     to generally accepted principles of good medical practice, 
     for the diagnosis or direct care and treatment of an illness 
     or injury of the participant or beneficiary.''.

  Mr. BERRY (during the reading). Mr. Speaker, I ask unanimous consent 
that the motion be considered as read and printed in the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arkansas?
  Mr. HASTERT. Mr. Speaker, I object.
  The SPEAKER pro tempore. Objection is heard.
  The Clerk will continue reading the motion.
  The Clerk continued reading the motion.
  Mr. HASTERT. Mr. Speaker, I reserve a point of order against the 
motion.
  The SPEAKER pro tempore. The gentleman from Arkansas (Mr. Berry) is 
recognized for five minutes on his motion to recommit.
  Mr. BERRY. Mr. Speaker, my motion to recommit is the same as the last 
motion, but deals solely with the definition of ``medical necessity.'' 
The motion to recommit will allow the doctor to determine what care is 
medically necessary. The doctor, not the insurance company, not a 
Federal bureaucrat, not a state bureaucrat, but the doctor, the person 
who went to medical school for many years to learn how to take care of 
you, would make that decision.
  The motion to recommit would make sure that the health care that they 
receive from their managed care company is consistent with good medical 
practice, not accounting profit principles.
  The motion to recommit will make sure that the decisions insurance 
companies are making regarding what it is or is not to be provided are 
supported by credible medical evidence. The motion to recommit puts 
medical care where it belongs, in the hands of doctors, not in the 
hands of Republican special interest friends.
  The SPEAKER pro tempore. Does the gentleman from Illinois (Mr. 
Hastert) insist on his point of order?
  Mr. HASTERT. Mr. Speaker, I withdraw my point of order.
  The SPEAKER pro tempore. Does the gentleman from Illinois (Mr. 
Hastert) wish to be heard on the motion to recommit?
  Mr. HASTERT. I do.
  The SPEAKER pro tempore. Is the gentleman opposed to the motion?
  Mr. HASTERT. I am opposed to the motion.
  The SPEAKER pro tempore. The gentleman from Illinois (Mr. Hastert) is 
recognized for five minutes.
  Mr. HASTERT. Mr. Speaker, I yield to the gentleman from Georgia (Mr. 
Gingrich), the Speaker of the House.
  Mr. GINGRICH. Mr. Speaker, let me recapture for everybody we were are 
at here, because I think you have to put in context this interesting 
and inventive motion to recommit.
  First of all, under the Patient Protection Act that will come to 
final passage, anybody who has a practical layman's feeling that they 
need emergency care, has a presumption they need it, automatically, you 
walk in, you say ``I have heart pain,'' or ``I have a chest pain,'' and 
you are covered.
  When you walk in, under the Patient Protection Act, a medical doctor 
on the site looking at the patient makes a decision, do you need 
further treatment? For example, if it turns out you over-ate and in 
fact need bicarbonate, you probably do not get an MRI. But if they 
think you have a severe heart problem or they think you might have 
cancer, you immediately have an opportunity for whatever emergency room 
treatment is necessary on a medical basis defined by the medical 
doctor.
  If you find out you have a longer-term problem, under the Patient 
Protection Act, if you happen to belong to an HMO that does not agree 
you should be treated, you immediately have an appeal internally, and 
within 72 hours they have to say ``yes,'' or ``no, you should get 
this.''
  If you do not agree when they say no, you have an immediate external 
appeal to a medically appropriate group of specialists who fit the same 
topic, and they, within 72 hours, have to say yes, in fact you have 
pancreatic cancer, you deserve and need chemotherapy, period.
  At that point, if the HMO is truly stupid, it can say they are not 
going to give it to you anyway, in which case you can go to court 
carrying with you the medical doctors who have already said you are 
right.
  Now, that is what we do, notice at every stage; medical doctor, 
medical doctor, medical doctor.
  But there is one hook, as I read this quite inventive proposal. I 
believe, and I am not a lawyer, I am just a historian, and for 
everybody who is grateful for a nonlawyer as Speaker, I understand it 
has been a rare event, but, anyway, as I understand this, from the 
brief few minutes we have had to look at it, this would in essence 
eliminate the concept of insurance coverage.
  This would allow you, as worded, to walk in and have a doctor say, 
``You know, I know you never paid for this insurance, I know you are 
not covered for this at all, but I am now going to do the following 12 
medically necessary things.'' A terrific idea. It bankrupts every 
insurance company in America, it eliminates the employer-based system, 
it guarantees you go to government health care, and, literally, I do 
not know why you guys wrote it this way, this has no meaning in the 
real

[[Page H6416]]

world, except that you would be required to get everything open-ended 
as long as you found a doctor somewhere who said you should get it.
  Now, this is in fact one of the nuttiest expansions of the right to 
charge for health care I have ever seen, and I am sure it is just 
because they got their earlier motion, which was clever and well-
crafted, ruled out of order and they had to rush something to the 
floor.
  I would encourage all of you, unless you want to bankrupt the whole 
country, just simply vote no. The details will come out later when they 
have a chance to rewrite it.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. BERRY. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 205, 
nays 221, not voting 9, as follows:

                             [Roll No. 338]

                               YEAS--205

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baesler
     Baldacci
     Barcia
     Barrett (WI)
     Becerra
     Bentsen
     Berman
     Berry
     Bishop
     Blagojevich
     Blumenauer
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brown (CA)
     Brown (FL)
     Brown (OH)
     Capps
     Cardin
     Carson
     Clay
     Clayton
     Clement
     Clyburn
     Condit
     Conyers
     Costello
     Coyne
     Cramer
     Cummings
     Danner
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doyle
     Edwards
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Fazio
     Filner
     Forbes
     Fox
     Frank (MA)
     Frost
     Furse
     Ganske
     Gejdenson
     Gephardt
     Goode
     Gordon
     Green
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hamilton
     Hastings (FL)
     Hefner
     Hilliard
     Hinchey
     Hinojosa
     Holden
     Hooley
     Hoyer
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (WI)
     Johnson, E. B.
     Kanjorski
     Kaptur
     Kennedy (MA)
     Kennedy (RI)
     Kennelly
     Kildee
     Kilpatrick
     Kind (WI)
     Kleczka
     Klink
     Kucinich
     LaFalce
     Lampson
     Lantos
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Luther
     Maloney (CT)
     Maloney (NY)
     Manton
     Martinez
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McHale
     McIntyre
     McKinney
     McNulty
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller (CA)
     Minge
     Mink
     Moakley
     Mollohan
     Moran (VA)
     Morella
     Murtha
     Nadler
     Neal
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Peterson (MN)
     Pickett
     Pomeroy
     Poshard
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rivers
     Rodriguez
     Roemer
     Rothman
     Roukema
     Roybal-Allard
     Rush
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Schumer
     Scott
     Serrano
     Sherman
     Sisisky
     Skaggs
     Skelton
     Slaughter
     Smith, Adam
     Snyder
     Spratt
     Stabenow
     Stark
     Stenholm
     Stokes
     Strickland
     Stupak
     Tanner
     Tauscher
     Taylor (MS)
     Thompson
     Thurman
     Tierney
     Torres
     Towns
     Traficant
     Turner
     Velazquez
     Vento
     Visclosky
     Waters
     Watt (NC)
     Waxman
     Wexler
     Weygand
     Wise
     Woolsey
     Wynn

                               NAYS--221

     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bateman
     Bereuter
     Bilbray
     Bilirakis
     Bliley
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bono
     Brady (TX)
     Bryant
     Bunning
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Cannon
     Castle
     Chabot
     Chambliss
     Chenoweth
     Christensen
     Coble
     Coburn
     Collins
     Combest
     Cook
     Cooksey
     Cox
     Crane
     Crapo
     Cubin
     Cunningham
     Davis (VA)
     Deal
     DeLay
     Diaz-Balart
     Dickey
     Doolittle
     Dreier
     Duncan
     Dunn
     Ehlers
     Ehrlich
     Emerson
     English
     Ensign
     Everett
     Ewing
     Fawell
     Foley
     Fossella
     Fowler
     Franks (NJ)
     Frelinghuysen
     Gallegly
     Gekas
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gingrich
     Goodlatte
     Goodling
     Goss
     Graham
     Granger
     Greenwood
     Gutknecht
     Hansen
     Harman
     Hastert
     Hastings (WA)
     Hayworth
     Hefley
     Herger
     Hill
     Hilleary
     Hobson
     Hoekstra
     Horn
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Inglis
     Istook
     Jenkins
     Johnson (CT)
     Johnson, Sam
     Jones
     Kasich
     Kelly
     Kim
     King (NY)
     Kingston
     Knollenberg
     Kolbe
     LaHood
     Largent
     Latham
     LaTourette
     Lazio
     Leach
     Lewis (CA)
     Lewis (KY)
     Livingston
     LoBiondo
     Lucas
     Manzullo
     McCollum
     McCrery
     McDade
     McHugh
     McInnis
     McIntosh
     McKeon
     Metcalf
     Mica
     Miller (FL)
     Moran (KS)
     Myrick
     Nethercutt
     Neumann
     Ney
     Northup
     Norwood
     Nussle
     Oxley
     Packard
     Pappas
     Parker
     Paul
     Paxon
     Pease
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Pombo
     Porter
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Ramstad
     Redmond
     Regula
     Riggs
     Riley
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Royce
     Ryun
     Salmon
     Sanford
     Saxton
     Scarborough
     Schaefer, Dan
     Schaffer, Bob
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Shimkus
     Shuster
     Skeen
     Smith (MI)
     Smith (NJ)
     Smith (OR)
     Smith (TX)
     Smith, Linda
     Snowbarger
     Solomon
     Souder
     Spence
     Stearns
     Stump
     Sununu
     Talent
     Tauzin
     Taylor (NC)
     Thomas
     Thornberry
     Thune
     Tiahrt
     Upton
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weldon (PA)
     Weller
     White
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)

                             NOT VOTING--9

     Ford
     Gonzalez
     John
     Klug
     Linder
     Markey
     Meehan
     Yates
     Young (FL)

                              {time}  1455

  Mr. BLAGOJEVICH changed his vote from ``nay'' to ``yea.''
  So the motion to table the appeal of the ruling of the Chair was 
rejected.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  The SPEAKER pro tempore (Mr. Kolbe). The question is on the passage 
of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. DINGELL. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The vote was taken by electronic device, and there were--yeas 216, 
nays 210, not voting 9, as follows:

                             [Roll No. 339]

                               YEAS--216

     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bateman
     Bereuter
     Bilbray
     Bilirakis
     Bliley
     Blunt
     Boehlert
     Boehner
     Bono
     Bryant
     Bunning
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Castle
     Chabot
     Chambliss
     Christensen
     Coble
     Coburn
     Collins
     Combest
     Cook
     Cooksey
     Cox
     Crane
     Cubin
     Cunningham
     Danner
     Davis (VA)
     Deal
     DeLay
     Diaz-Balart
     Dickey
     Doolittle
     Dreier
     Duncan
     Dunn
     Ehlers
     Ehrlich
     Emerson
     English
     Ensign
     Everett
     Ewing
     Fawell
     Foley
     Fossella
     Fowler
     Fox
     Franks (NJ)
     Frelinghuysen
     Gallegly
     Gekas
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gingrich
     Goode
     Goodlatte
     Goodling
     Goss
     Graham
     Granger
     Greenwood
     Gutknecht
     Hansen
     Hastert
     Hastings (WA)
     Hayworth
     Hefley
     Herger
     Hill
     Hilleary
     Hobson
     Hoekstra
     Horn
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Inglis
     Istook
     Jenkins
     Johnson (CT)
     Johnson, Sam
     Jones
     Kasich
     Kelly
     Kim
     King (NY)
     Kingston
     Knollenberg
     Kolbe
     LaHood
     Largent
     Latham
     LaTourette
     Lazio
     Leach
     Lewis (CA)
     Lewis (KY)
     Livingston
     LoBiondo
     Lucas
     Manzullo
     McCollum
     McCrery
     McDade
     McHugh
     McInnis
     McIntosh
     McKeon
     Metcalf
     Mica
     Miller (FL)
     Moran (KS)
     Myrick
     Nethercutt
     Neumann
     Ney
     Northup
     Norwood
     Nussle
     Oxley
     Packard
     Pappas
     Parker
     Paxon
     Pease
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Pombo
     Porter
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Ramstad
     Redmond
     Regula
     Riggs
     Riley
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Royce
     Ryun
     Salmon
     Saxton
     Scarborough
     Schaefer, Dan
     Schaffer, Bob
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Shimkus
     Shuster
     Skeen
     Smith (MI)
     Smith (NJ)
     Smith (OR)
     Smith (TX)
     Smith, Linda
     Snowbarger
     Solomon
     Souder
     Spence
     Stearns
     Stump
     Sununu
     Talent
     Tauzin
     Taylor (NC)
     Thomas
     Thornberry
     Thune
     Tiahrt
     Traficant
     Upton
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weldon (PA)
     Weller
     White
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)

[[Page H6417]]



                               NAYS--210

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baesler
     Baldacci
     Barcia
     Barr
     Barrett (WI)
     Becerra
     Bentsen
     Berman
     Berry
     Bishop
     Blagojevich
     Blumenauer
     Bonilla
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brady (TX)
     Brown (CA)
     Brown (FL)
     Brown (OH)
     Campbell
     Capps
     Cardin
     Carson
     Chenoweth
     Clay
     Clayton
     Clement
     Clyburn
     Condit
     Conyers
     Costello
     Coyne
     Cramer
     Crapo
     Cummings
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doyle
     Edwards
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Fazio
     Filner
     Forbes
     Frank (MA)
     Frost
     Furse
     Ganske
     Gejdenson
     Gephardt
     Gordon
     Green
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hamilton
     Harman
     Hastings (FL)
     Hefner
     Hilliard
     Hinchey
     Hinojosa
     Holden
     Hooley
     Hoyer
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (WI)
     Johnson, E. B.
     Kanjorski
     Kaptur
     Kennedy (MA)
     Kennedy (RI)
     Kennelly
     Kildee
     Kilpatrick
     Kind (WI)
     Kleczka
     Klink
     Kucinich
     LaFalce
     Lampson
     Lantos
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Luther
     Maloney (CT)
     Maloney (NY)
     Manton
     Martinez
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McHale
     McIntyre
     McKinney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller (CA)
     Minge
     Mink
     Moakley
     Mollohan
     Moran (VA)
     Morella
     Murtha
     Nadler
     Neal
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Peterson (MN)
     Pickett
     Pomeroy
     Poshard
     Price (NC)
     Rahall
     Rangel
     Reyes
     Rivers
     Roemer
     Rothman
     Roukema
     Roybal-Allard
     Rush
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sanford
     Sawyer
     Schumer
     Scott
     Serrano
     Sherman
     Sisisky
     Skaggs
     Skelton
     Slaughter
     Smith, Adam
     Snyder
     Spratt
     Stabenow
     Stark
     Stenholm
     Stokes
     Strickland
     Stupak
     Tanner
     Tauscher
     Taylor (MS)
     Thompson
     Thurman
     Tierney
     Torres
     Towns
     Turner
     Velazquez
     Vento
     Visclosky
     Waters
     Watt (NC)
     Waxman
     Wexler
     Weygand
     Wise
     Woolsey
     Wynn

                             NOT VOTING--9

     Ford
     Gonzalez
     John
     Klug
     Linder
     Markey
     Rodriguez
     Yates
     Young (FL)

                              {time}  1512

  Mr. PAUL changed his vote from ``present'' to ``nay.''
  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________