Congressional Record, Volume 144 Issue 101 (Friday, July 24, 1998)

[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

[[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.

____________________