[Congressional Record Volume 144, Number 119 (Thursday, September 10, 1998)]
[House]
[Pages H7560-H7562]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MANAGED CARE REFORM
The SPEAKER pro tempore (Mr. Blunt). Under the Speaker's announced
policy of January 7, 1997, the gentleman from New Jersey (Mr. Pallone)
is recognized for 15 minutes as the designee of the minority leader.
Parliamentary Inquiry
Mr. PALLONE. Mr. Speaker, can I just clarify again, is that because
it is understood that the other 45 minutes of the hour will be
dedicated to the gentleman from Iowa (Mr. Ganske)?
The SPEAKER pro tempore. That is the Chair's understanding.
Mr. PALLONE. Mr. Speaker, tonight I want to talk about the prospects
of passing a managed care reform bill in the time Congress has left
before it adjourns for the year in October. Last evening, I mentioned
how over the August break I had many town meetings and outreach
programs throughout my district and continually the issue of managed
care reform was the number one concern that my constituents had.
I know, having talked to many of my colleagues since we returned this
week, that many of them say the same thing; that this is the issue that
the average American or that most Americans want this Congress to
address before we adjourn in October. Although there is not much time
left, I am hopeful that we can reach an agreement with our Republican
colleagues and send the President a managed care reform bill that he
can sign.
Now, we know that the full House took up the issue of managed care
reform before the August recess and the Republican leadership's bill
narrowly passed and the bipartisan Patients' Bill of Rights, which I
support, unfortunately was narrowly defeated.
I want to stress again how important it is to pass the bipartisan
Patients' Bill of Rights or at least something very much like it
because of the valuable patient protections that are included therein,
such as the return of medical decision-making to patients and health
care professionals, not insurance company bureaucrats; access to
specialists, including access to pediatrics specialists for children;
coverage for emergency room care; the right to talk freely with doctors
and nurses about every medical option; an appeals process and real
legal accountability for insurance company decisions and, finally, an
end to financial incentives for doctors and nurses to limit the care
that they provide.
If Congress is going to get a bill to the President that is like the
Patients' Bill of Rights, then the Senate must act very swiftly. We
passed the Republican leadership bill, which I think was a bad bill, in
the House but now it is up to the Senate to pass a strong bill so that
we can go to conference and get something to the President's desk that
both Houses agree on. The House Republican bill, I would point out, is
considerably different from the Senate Republican bill, for one thing,
but more importantly both Republican bills fail to address a number of
provisions that the President and congressional Democrats believe must
be part of any managed care reform legislation.
[[Page H7561]]
Just as an example, both the House and Senate Republican bills let
HMOs, not health professionals, define medical necessity. They both
fail to guarantee access to specialists. They both fail to assure
continuity of care and they both weaken the standards for emergency
care which needs to be strengthened. Both Republican bills allow
financial incentives to jeopardize patient care. They both fail to hold
HMOs accountable when the decisions harm patients, and they both are
loaded with poison pills. Issues such as medical malpractice reform,
expanding medical savings accounts, expanding health insurance pools,
whether or not we agree or disagree on these issues, they are just
issues that are very controversial that are going to kill the
legislation because they take away from the issue of managed care
reform.
I just wanted to say this evening, because I want to yield some time
to my colleague, the gentleman from Ohio (Mr. Strickland), that the
President has already said that he would veto the House bill if it was
sent to him in its current form.
In a letter which I have here, and I would like to introduce into the
Record dated September 1, that the President sent to Senate Majority
Leader Trent Lott, he reiterates that he would veto a bill that does
not address the serious flaws that I have just mentioned in these
Republican bills.
The text of the letter is as follows:
[Transmitted from Moscow.]
The White House,
Washington, DC,
September 1, 1998.
Hon. Trent Lott,
Majority Leader, Senate,
Washington, DC.
Dear Senator Lott: Thank you for your letter regarding the
patients' bill of rights. I am pleased to reiterate my
commitment to working with you--and all Republicans and
Democrats in the Congress--to pass long overdue legislation
this year.
Since last November, I have called on the Congress to pass
a strong, enforceable, and bipartisan patients' bill of
rights. During this time, I signed an Executive Memorandum to
ensure that the 85 million Americans in federal health plans
receive the patient protections they need, and I have
indicated my support for bipartisan legislation that would
extend these protections to all Americans. With precious few
weeks remaining before the Congress adjourns, we must work
together to respond to the nation's call for us to improve
the quality of health care American are receiving.
As I mentioned in my radio address this past Saturday,
ensuring basic patient protections is not and should not be a
political issue. I was therefore disappointed by the partisan
manner in which the Senate Republican Leadership bill was
developed. The lack of consultation with the White House or
any Democrats during the drafting of your legislation
contributed to its serious shortcomings and the fact it has
failed to receive the support of either patients or doctors.
The bill leaves millions of Americans without critical
patient protections, contains provisions that are more
rhetorical than substantive, completely omits patient
protections that virtually every expert in the field believes
are basic and essential, and includes ``poison pill''
provisions that have nothing to do with a patient's bill of
rights. More specifically, the bill;
Does not cover all health plans and leaves more than 100
million Americans completely unprotected. The provisions in
the Senate Republican Leadership bill apply only to self-
insured plans. As a consequence, the bill leaves out more
than 100 million Americans, including millions of workers in
small businesses. This approach contrasts with the bipartisan
Kassebaum-Kennedy insurance reform law, which provided a set
of basic protections for all Americans.
Let HMOs, not health professionals, define medical
necessity. The External appeals process provision in the
Senate Republican Leadership bill makes the appeals process
meaningless by allowing the HMOs themselves, rather than
informed health professionals, to define what services are
medically necessary. This loophole will make it very
difficult for patients to prevail on appeals to get the
treatment doctors believe they need.
Fails to guarantee direct access to specialists. The Senate
Republican Leadership proposal fails to ensure that patients
with serious health problems have direct access to the
specialists they need. We believe that patients with
conditions like cancer or heart disease should not be denied
access to the doctors they need to treat their conditions.
Fails to protect patients from abrupt changes in care in
the middle of treatment. The Senate Republican Leadership
bill fails to assure continuity-of-care protections when an
employer changes health plans. This deficiency means that,
for example, pregnant women or individuals undergoing care
for a chronic illness may have their care suddenly altered
mid course, potentially causing serious health consequences.
Reverses course on emergency room protections. The Senate
Republican Leadership bill backs away from the emergency room
protections that Congress implemented in a bipartisan manner
for Medicare and Medicaid beneficiaries in the Balanced
Budget Act of 1997. The bill includes a watered-down
provision that does not require health plans to cover
patients who go to an emergency room outside their network
and does not ensure coverage for any treatment beyond an
initial screening. These provisions put patients at risk for
the huge costs associated with critical emergency treatment.
Allows financial incentives to threaten critical patient
care. The Senate Republican Leadership bill fails to prohibit
secret financial incentives to providers. This would leave
patients vulnerable to financial incentives that limit
patient care.
Fails to hold health plans accountable when their actions
cause patients serious harm. The proposed per-day penalties
in the Senate Republican Leadership bill fail to hold health
plans accountable when patients suffer serious harm or even
death because of a plan's wrongful action. For example, if a
health plan improperly denies a lifesaving cancer treatment
to a child, it will incur a penalty only for the number of
days it takes to reverse its decision; it will not have to
pay the family for all the damages the family will suffer as
the result of having a child with a now untreatable disease.
And because the plan will not pay for all the harm it causes,
it will have insufficient incentive to change its health care
practices in the future.
Includes a ``poison pill'' provisions that have nothing to
do with a patients' bill of rights. For example, expanding
Medical Savings Accounts (MSAs) before studying the current
demonstration is premature, at best, and could undermine an
already unstable insurance market.
As I have said before, I would veto a bill that does not
address these serious flaws. I could not sanction presenting
a bill to the American people that is nothing more than an
empty promise.
At the same time, as I have repeatedly made clear, I remain
fully committed to working with you, as well as the
Democratic Leadership, to pass a meaningful patients' bill of
rights before the Congress adjourns. We can make progress in
this area if, and only if, we work together to provide needed
health care protections to ensure Americans have much needed
confidence in their health care system.
Producing a patients' bill of rights that can attract
bipartisan support and receive my signature will require a
full and open debate on the Senate floor. There must be
adequate time and a sufficient number of amendments to ensure
that the bill gives patients the basic protections they need
and deserve. I am confident that you and Senator Daschle can
work out a process that accommodates the scheduling needs of
the Senate and allows you to address fully the health care
needs of the American public.
Last year, we worked together in a bipartisan manner to
pass a balanced budget including historic Medicare reforms
and the largest investment in children's health care since
the enactment of Medicaid. This year, we have another
opportunity to work together to improve health care for
millions of Americans.
I urge you to make the patients' bill of rights the first
order of business for the Senate. Further delay threatens the
ability of the Congress to pass a bill that I can sign into
law this year. I stand ready to work with you and Senator
Daschle to ensure that patients--not politics--are our first
priority.
Sincerely,
Bill Clinton,
President.
He goes on to say, however, that as he has repeatedly made clear, he
remains fully committed to working with the Republicans, as well as the
democratic leadership, to pass a meaningful Patients' Bill of Rights
before Congress adjourns. What the President is saying, and I will say
again, is that this issue should not be viewed as a partisan issue.
That is why I was, and the President states that he was, disappointed
by the partisan manner in which the Senate Republican and the House
Republican leadership were developed.
We need to have bipartisan support. We cannot have that if the
President and the House Democrats are not involved, if you will, in the
final bill that goes to the President's desk.
I just want to say that probably the best way that we can illustrate
why the flaws that the President and the Democrats have identified in
the House and Senate Republican bills need to be addressed is through
real life examples. One of the things that we have done many times on
the floor of this House, over the last 6 months, is the Democrats and
some of our Republican colleagues, like the gentleman from Iowa (Mr.
Ganske), who is going to speak after me tonight, we are yielding the
time to him that the Democrats have because we know that he supports
this bipartisan Patients' Bill of Rights. In fact, he is the chief
sponsor of the bipartisan Patients' Bill of Rights.
The best way that we can illustrate the problems that we have now and
[[Page H7562]]
how we can correct them with a good bill, like the Patients' Bill of
Rights, is by giving some real life examples.
Mr. Speaker, I yield to the gentleman from Ohio (Mr. Strickland), who
would like to give us some examples of the problems that we face. After
that, we are going to have the gentleman from Iowa (Mr. Ganske) go on
and explain why we need real form.
Mr. STRICKLAND. Mr. Speaker, I thank my colleague for yielding.
Mr. Speaker, it is true that patients in this country are being
deprived of essential and necessary health care, oftentimes resulting
in their death, because managed care companies are placing profits
above the needs of patients. I would like to share with my colleagues
two stories, two real-life stories from my district. One involved a
long-time friend of mine, and I will use his name, because before his
death he gave me permission to talk about his situation on the floor of
this House. His name was Jim Bartee.
He was a person younger than I am, someone that I had known for many,
many years. Jim grew up in Portsmouth, Ohio. He went to Florida and
became a publisher of a small newspaper. He developed leukemia, and he
came back home for treatments. While he was in the hospital, getting
chemotherapy, he called his managed care case manager and he was
talking about his situation.
She said to him, ``How are you doing, Jim?''
He said to her, ``Well, I am feeling a little sick now because of the
chemotherapy.''
She said, ``Well, if you need a couple of more days in the hospital,
I can approve that for you.''
He said, ``Well, what I really needed to talk with you about was a
conversation I had with my doctor this morning.'' He said, ``My doctor
came in and told me that I have perhaps as little as 3 weeks to live,
and that my only hope for survival may be a bone marrow transplant.''
She responded, this managed care case manager responded, by saying,
``Oh, we could never get it approved that quickly.''
He said to her, ``How much would it cost?''
She said, ``Probably somewhere in the vicinity of $120,000.'' She
said, ``Jim, we just could not get it approved that quickly.''
So, my friend, who had been a newspaper publisher, called his
newspaper in Florida and told them what his managed care case manager
had said to him. They said to him, ``Jim, whatever you need, medically,
do not worry about the cost. We will make sure it is paid for.''
As it turned out, a bone marrow transplant was not indicated,
according to his doctor, eventually, and so Jim passed away. I spoke at
his funeral. He was one of the bravest, one of the kindest people I
have ever known in my life.
I would say to my colleague, the gentleman from New Jersey, my reason
for sharing this story is this: No one facing a death threatening
medical set of circumstances should be told by an insurance bureaucrat,
we cannot approve this treatment in time. That is a decision that ought
to be made by a physician and the patient.
I share this story because before Jim Bartee died, he told me that he
would like for me to share with others what his experience had been.
Then a second circumstance that occurred in my district was a young
man who grew up in one of my counties and went to California to go to
college, and he affiliated with a managed care organization out there.
He came back home for a visit and went hiking and fell some 80-some
feet and damaged his brain, and he has been in a coma ever since.
After the fall, he was immediately taken to surgery in Cincinnati,
Ohio, and a few days after surgery the managed care company informed
his parents that they would no longer provide medical coverage unless
he was in one of their facilities. So the patients allowed this young
man to be air transported to California. The mother took a leave of
absence. She is a schoolteacher. She took a leave of absence to go to
California to be near her son.
The week before Christmas, they contacted my office and they told me
the care that he had received there: Lack of physical therapy, his
teeth rarely being brushed, his body not being turned every two hours
as it needed to be turned in order to keep him from getting bed sores.
When they contacted me, they told me that the managed care company told
them that his coverage would expire on January 1, and that thereafter
they would be responsible for his medical costs.
At that point, they asked if he would be returned to Ohio. They said
it is against our company policy. It was not until my office got
involved and we literally threatened to make this the Christmas story
of 1997 that on Christmas Eve day they finally relinquished and told
his parents that they would fly him back to Ohio.
He is now in Ohio in a nursing home and he remains in a coma.
I talked to the father recently, and he said while his son was in
California, a large swollen area developed on his skull and that they
tried to get the managed care company to have him seen by a specialist,
and it was put off and put off and put off until his coverage expired.
Once he got back to Ohio and the physician saw him in Ohio, they said,
this needs immediate attention.
They discovered that he had an existing serious infection that had
been neglected for a long, long time. The father believes that that
managed care company refused to evaluate his condition simply because
they did not want to bear the cost of the necessary treatment.
These are the things that are happening to my constituents and to
real Americans, and every Member of this House, Republican and Democrat
alike, should stand together to say, we are no longer going to tolerate
American citizens being abused in these kinds of ways. That is why I am
really proud of the gentleman from Iowa (Mr. Ganske).
Many people may not know that the gentleman from Iowa (Mr. Ganske) is
himself a physician. He has joined with some of the rest of us to fight
this fight to make sure that patients come first, and that profits,
while essential and necessary for any corporation or any business,
should not be put first and patient needs put second or third or
fourth.
So I am pleased that you have given me the time to talk about my
constituents and the problems they have had. I encourage you, my
colleague, the gentleman from New Jersey, to continue your fight for
all of us.
Mr. PALLONE. Mr. Speaker, we have very little time left, but I want
to thank the gentleman from Ohio (Mr. Strickland) for giving us those
two examples. All I can say again, and I am sure that the gentleman
from Iowa (Mr. Ganske) will say the same, is that this is happening on
a regular basis. These are not isolated instances. We are getting these
kinds of problems on a daily basis in our districts, and that is why it
is so important that we pass the Patients' Bill of Rights.
____________________