[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.

                          ____________________