[Congressional Record Volume 144, Number 108 (Tuesday, August 4, 1998)]
[House]
[Pages H7002-H7003]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PATIENT PROTECTION LEGISLATION
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 21, 1997, the gentleman from Iowa (Mr. Ganske) is recognized
during morning hour debates for 5 minutes.
Mr. GANSKE. Madam Speaker, a week ago we had a debate on the floor of
Congress here concerning patient protection legislation. It has been
clear all along that there were major differences that needed to be
worked out between the Patient Bill of Rights, the bill that I
supported, a bipartisan bill, sometimes referred to as the Democratic
bill, and the Republican bill, the Patient Protection Act. But it
seemed as if at least there was some consensus on some of the basic
fundamentals. For instance, a layperson's definition of emergency; or,
for instance, provisions related to privacy.
However, as I warned several of my GOP colleagues, be careful in
voting for the Republican bill, the Patient Protection Act. We may find
that it is a pig in a poke because of the legislative language.
Today I would draw my colleagues' attention to an article in The New
York Times by Robert Pear: ``Common Ground on Patient Rights Hides a
Chasm.'' Looking at the details of the House Republican plan shows that
there are major differences even in areas where it seemed as if the two
sides were in agreement. For instance, both sides were saying we are
for a layperson's definition for emergency care; we both agree in the
privacy of patient records.
When Members start to read the details of the Republican plan, I
think they are going to be surprised. For instance, it would have
seemed easy to have achieved consensus on a layperson's definition of
an emergency. After all, this Congress passed a year ago, or in the
104th Congress, a provision on the layperson's definition for Medicare,
a Federal health program that provides for 38 million people. But when
we read the fine print of the House Republican's bill, the Patient
Protection Act, which was introduced by the gentleman from Georgia (Mr.
Gingrich) and passed 8 days later by a vote of 216-to-10, we find out
that there are some significant differences.
The Patient Bill of Rights would require HMOs and insurance companies
to cover emergency services for subscribers ``without the need for any
prior authorization,'' regardless of whether the doctor or hospital was
affiliated with the patient's health plan.
Emergency services as defined in the bill include a medical screening
examination to evaluate the patient and further treatment that may be
required to stabilize that patient's conditions. The HMO would have to
cover those services if ``A prudent layperson who possesses an average
knowledge of health and medicine could reasonably expect an absence of
immediate medical attention to cause serious harm.''
By contrast, the House and Senate Republican bills would establish a
two-step test. An HMO or insurance company would have to cover the
initial screening examination if a prudent layperson would consider it
necessary. But, the health plan would have to pay for additional
emergencies only if ``A prudent emergency medical professional'' would
judge them necessary. And under the GOP bill, the Patient Protection
Act, the need for such services must be certified in writing by ``an
appropriate physician.''
The Speaker said the Republican bill would guarantee coverage for
``anyone who has a practical layman's feeling that they need emergency
care.'' But that is not what is really in the bill.
That bill was rushed through at the last minute, there were no
hearings on the bill, and so what we have is a situation where the
provisions that we passed in Medicare for a layperson's definition have
been significantly watered down. There is no guarantee in the
Republican bill that the cost ultimately for a patient going to the
emergency room with crushing chest pain, severe pain, would, in the
end, be covered by their HMO.
The Congressional Budget Office estimates that the Patient Bill of
Rights would require HMOs to pay for emergency room visits in half the
cases where they now deny payment. It says, the charge for emergency
care outside the HMO is typically 50 percent higher than hospitals in
the HMO network. Remember, when we look at the details of the GOP plan,
there is a provision in there that says, one has to go to the HMO
hospital or else one could be left with a large, large bill.
Look at the details, I say to my colleagues, and let us try to fix
this in the long run.
[From the New York Times, Aug. 4, 1998]
Common Ground on Patient Rights Hides a Chasm
(By Robert Pear)
Washington, August 3.--It has been clear that there are
major differences to be worked out between the Democratic and
Republic bills on patient rights.
But a look at the details of the House Republic plan shows
that there are also major differences in important areas on
which the two sides had seemed to agree.
The disagreements are illustrated in two areas: emergency
medical services and the privacy of patients' medical
records.
At first, it appeared that members of Congress agreed that
health maintenance organizations should be required pay for
emergency medical care. And they seemed to
[[Page H7003]]
agree on a standard, promising ready access to emergency care
whenever ``a prudent lay person'' would consider it
necessary. After all, that was the standard set by Congress
last year for Medicare, the Federal health program for 38
million people who are elderly or disabled.
But the consensus dissolved when emergency physicians read
the fine print of the House Republicans' bill, the Patient
Protection Act, which was introduced on July 16 by Speaker
Newt Gingrich and passed eight days later by a vote of 216 to
210.
Since 1986, the Government has required hospitals to
provide emergency care for anyone who needs and requests it.
But the question of who should pay for such care has provoked
many disputes among insurers, hospitals and patients.
The Democratic bill would require H.M.O.'s and insurance
companies to cover emergency services for subscribers,
``without the need for any prior authorization,'' regardless
of whether the doctor or hospital was affiliated with the
patient's health plan. Emergency services, as defined in the
bill, include a medical screening examination to evaluate the
patient and any further treatment that may be required to
stabilize the patient's condition.
The H.M.O. would have to cover these services if ``a
prudent lay person, who possesses an average knowledge of
health and medicine, could reasonably expect the absence of
immediate medical attention'' to cause serious harm.
By contrast, the House and Senate Republican bills would
establish a two-step test. An H.M.O. or an insurance company
would have to cover the initial screening examination if a
prudent lay person would consider it necessary. But the
health plan would have to pay for additional emergency
services only if ``a prudent emergency medical professional''
would judge them necessary. And under the House Republican
bill, the need for such services must be certified in writing
by ``an appropriate physician.''
Mr Gingrich said the Republicans' bill would guarantee
coverage for ``anybody who has a practical layman's feeling
that they need emergency care.''
But Representative Benjamin L. Cardin, Democrat of
Maryland, said the bill ``is not going to do what they are
advertising.''
One reason, Mr. Cardin said, is that the bill was rushed
through the House. ``There have been no hearings on the
Republican bill,'' he said. ``It did not go through any of
the committees of jurisdiction for the purpose of markup or
to try to get the drafting done correctly.''
Under the Democratic bill, H.M.O. patients who receive
emergency care outside their health plan--whether in a
different city or close to home--may be charged no more than
they would have to pay for using a hospital affiliated with
the H.M.O. There is no such guarantee in the Republican
bills. And the cost to patients could be substantial.
The Congressional Budget Office estimates that the
Democratic bill would require H.M.O.'s to pay for emergency
room visits in half the cases where they now deny payment.
And it says that the charge for emergency care outside the
H.M.O. is typically 50 percent higher than at hospitals in
the H.M.O. network.
John H. Scott, director of the Washington office of the
American College of Emergency Physicians, said the
protections for patients were much weaker under the
Republican bills than under the Democratic bill or the 1997
Medicare law.
``We have more than a century of common law and court
decisions interpreting the standard of a prudent lay person,
or reasonable man, as it used to be called,'' Mr. Scott said.
``But this new standard of a prudent emergency medical
professional was invented out of thin air. It creates new
opportunities for H.M.O.'s to second-guess the treating
physician and to deny payment for emergency services. It
would introduce a whole new level of dispute.''
Dr. Charlotte S. Yeh, chief of emergency medicine at the
New England Medical Center in Boston, said, ``The Republicans
performed some unnecessary surgery on the `prudent lay
person' standard, to the point that it's hardly recognizable
as the consumer protection we envisioned.''
The Senate adjourned on Friday for its summer vacation
without debating the legislation, but leaders of both parties
said they hoped to take it up in September. Senate
Republicans intend to take their bill directly to the floor,
bypassing committees, which normally scrutinize the details
of legislation.
There was, and still is, plenty of common ground if
Republicans and Democrats want to compromise. Both parties'
bills would, for example, require H.M.O.'s to establish
safeguards to protect the confidentiality of medical records.
But on this issue too, the details have provoked a furor.
When privacy advocates read the fine print of the House
Republican bill, they were surprised to find a provision that
explicitly authorizes the disclosure of information from a
person's medical records for the purpose of ``health care
operations.'' In the bill, that phrase is broadly defined to
include risk assessment, quality assessment, disease
management, underwriting, auditing and ``coordinating health
care.''
Moreover, the House Republican bill would override state
laws that limit the use or disclosure of medical records for
those purposes.
The House Republican bill says patients may inspect and
copy their records. But it stipulates that the patients must
ordinarily go to the original source--a laboratory, X-ray
clinic or pharmacy, for example--rather than to their health
plan for such information.
Representative Bill Thomas, the California Republican who
is chairman of the Ways and Means Subcommittee on Health,
said the bill ``prohibits health care providers and health
plans from selling individually identifiable patient medical
records.''
Still, privacy advocates say the bill would allow many uses
of personal health care data without the patients' consent.
Robert M. Gellman, an expert on privacy and information
policy, said: ``The House-passed bill gives the appearance of
providing privacy rights. But it may actually take away
rights that people have today under state law or common
practice.''
____________________