[Congressional Record Volume 144, Number 133 (Tuesday, September 29, 1998)]
[Senate]
[Pages S11109-S11110]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mr. REED. Mr. President, I rise today in strong support of the 
Patients' Bill of Rights and join my colleagues, Senator Kennedy, 
Senator Graham, Senator Harkin, and many others in urging that this 
very important legislation be brought to this floor immediately, 
debated thoroughly, and passed.
  When I go back to my home State of Rhode Island, I encounter lots of 
issues. But there is no issue that is more important to my State and to 
this Nation than having a health care system that works for them, 
having a health care system that is governed by rules which require 
that people get what they pay for. There are thousands and thousands of 
individuals who are paying for managed care coverage, thousands and 
thousands and thousands of companies that are providing coverage. The 
shocking thing is that many times people discover they really do not 
have the coverage they need when they need it. With the Patients' Bill 
of Rights, we are going to provide a framework of sensible rules which 
will guarantee access to quality health care coverage for the vast 
majority of Americans.
  The Democratic bill, S. 1890, does that. In stark contrast to the 
Republican proposal, it will provide broad coverage to the American 
people. As illustrated by this chart, the only group of people covered 
by the Republican proposal are just those who are covered through a 
self-funded employer plan, only 48 million Americans. The Republican 
bill leaves out 113 million Americans. It leaves out people whose 
employer provides coverage through an insurance policy or an HMO 
directly. It leaves out State and local government workers and people 
buying individual health insurance policies.
  I hope that we can at least agree that if we are going to do 
something with respect to reforming managed care in the United States, 
we will do something that covers all people who are insured by HMOs 
throughout the United States.
  As my colleague from Massachusetts, Senator Kennedy, just pointed 
out, when you leave out State and local government workers, you are 
leaving out police officers, firefighters--those people who not only do 
we depend upon, but people who we hope will have access to high-quality 
care. That is just one example of groups of people who are denied 
protections under the Republican version but will be provided these 
protections under the Democratic bill, S. 1890.
  Throughout this debate, we have heard a lot about what we must do 
with respect to health care. Again, as my colleague from Massachusetts, 
Senator Kennedy, pointed out, the Democratic bill is supported by the 
broadest possible coalition of health care organizations. Here is a 
partial list of those organizations: The American Medical Association, 
the American Cancer Society, the National Association of Children's 
Hospitals. Every major health care organization in the United States 
has recognized the need for protections with respect to managed care 
and has recognized the value of S. 1890, the Democratic bill, and is 
strongly supportive of this proposal.
  We have people throughout this country demanding that we take 
appropriate action. We have every major organization committed to the 
health and welfare of this country and its people--all of them--
together asking us to act. And yet here we find inaction; we are not 
able to bring this bill to the floor for a thorough debate and for a 
vote. I think that is wrong, and I think we are not doing our job as 
representatives of the American people. Congress is not responding to 
one of the critical needs of every family in this country: Providing 
high quality health care for all families.
  My focus throughout the debate has been to ensure particularly that 
children are treated fairly by managed care health care plans. If a 
family has a problem with a managed care plan, it is serious. When it 
is an adult, a mother or father, it is serious. But it is particularly 
serious, and many times tragic, when it involves a child.
  Earlier this year, I introduced legislation that deals specifically 
with the issue of children in managed care. This legislation was 
prompted by my own observations and advice I received from the American 
Academy of Pediatrics, by the National Association of Childrens 
Hospitals, by many pediatric specialty organizations--all of these 
groups together pointed out to me that we just can't consider children 
as small adults. If a child has a particular condition, the expertise 
needed to deal with that pediatric condition is not something gained 
generally in medical education. Pediatric specialists are vital to our 
health care system because they can treat the unique needs of children. 
Children often need access to these specialists, and frequently they 
are denied that type of care.
  Earlier this year in the Labor Committee, we heard the story of 
Melissa Froelich. I have a picture of Melissa right here. She is 2 
years old and has become the poster child for the American Red Cross. 
As this poster describes, ``Melissa spent her first 18 months in a 
hospital clinging to life. Thanks to medical miracles and blood donors 
like you, she is finally home and doing well.'' I would imagine her 
parents would hasten to add something along the lines of, ``No thanks 
to the managed care plan'' because her medical ordeal was matched by a 
bureaucratic ordeal waged by her parents, particularly her mother, on 
her behalf.
  Melissa was born with serious congenital heart defects. In the first 
2 years of her life, she spent a great deal of time in and out of 
hospitals. Her mother, Staci Froelich, had to fight a battle every day, 
a relentless battle to get Melissa the kind of care she needed and 
deserved and that they had paid for.
  Staci Froelich is a registered nurse, a licensed nursing home 
administrator. She is someone very sophisticated in the way the system 
operates. I hesitate to speculate what would have happened if Melissa's 
mother hadn't had that kind of expertise--if she were, like so many 
Americans, not prepared to deal with all the bureaucratic red tape, all 
the hurdles that HMOs can throw up when they deny coverage and deny 
care.
  She persevered, and she did it day in and day out. In her words, this 
is what her struggle was like:


[[Page S11110]]


       My husband and I are responsible middle-class American 
     citizens. We were both employed and had two healthy children. 
     We took out the best health insurance policies our places of 
     employment had to offer. We believed if there were ever a 
     medical emergency, we would be covered. After all, we had 
     done everything in our power to have the necessary coverage 
     should that occur. We were in for a rude awakening.

  With the birth of Melissa, with her serious heart problems, they 
found out that literally that their HMO didn't provide much coverage at 
all when they needed it most. This HMO forced this family to jump 
through repeated hurdles. For example, after Melissa's first open heart 
surgery, the HMO wanted to transfer her to a nursing center for senior 
citizens. Can you imagine that, an infant being sent to a senior 
citizens nursing home facility where the only specialists are 
geriatricians, not pediatricians? That is what the HMO wanted to do to 
save some money. Of course, her mother had to fight tooth and nail to 
prevent that from happening.
  This example illustrates something else that underlies my concerns: 
The presumption by many HMOs that a child is no different from an 
adult, and if there is an open bed in a senior nursing center, send the 
child there. That is not the type of care that those parents expected 
to get for their child when they paid their premiums and when they 
sought out the best coverage they could.
  During the course of Melissa's illness, oftentimes the HMO would try 
to switch her specialist or try to suggest she didn't need pediatric 
specialists. All of this added up to an ordeal on top of the basic 
ordeal of a very sick child. In this country, we should not tolerate 
that situation.
  I am happy to say, as Melissa's picture demonstrates, she is a 
thriving, beautiful child of 2 years--the result of her family's 
efforts, the result of many people, but certainly not the result of a 
health care system that was out there to assist her and to provide for 
her family.
  Her story illustrates all too well what we hear constantly: every day 
consumers face difficulties to get the services that they need, they 
face delays, complex rules and regulations which an average lay person 
can't understand. We can change this situation if we act promptly and 
timely, and if we act immediately to bring this legislation to the 
floor.
  Managed care has provided great benefits to our country, particularly 
when it comes to preventive services. The emphasis on prevention is 
good. But all too often we hear stories like Melissa's story, and other 
stories, where the system is not working to the benefit of the public, 
and where people are not getting the health care services they've paid 
for. It is our responsibility to make sure that this situation does not 
continue.
  We also sometimes look at HMOs and think, ``Well, maybe they've got 
some problems, but maybe the problems are not really being addressed 
here.'' There was a study done at the University of California at San 
Francisco by Elizabeth Jameson at the University of California. She 
compared the pediatric care provided to children by private and public 
managed care plans.
  Frequently people consider Medicaid and say, ``Well, that's not top-
grade health care because that's a public health care program for low-
income Americans and, you know, it is not good compared to some of the 
large employer programs, the blue chip HMOs.'' Her study was very 
revealing though. It found that low-income children in California s 
Medicaid program received age-appropriate care that is consistent with 
recognized clinical guidelines, while those in private health care 
plans often did not.
  In effect, there was a better chance for a child in the California 
Medicaid system to have access to a pediatric specialist, to have the 
kind of focused specialized care that we assume would be found in the 
HMOs. Certainly, both the employer and the employee are paying a lot of 
money for those HMO premiums. I assume that he or she believes that all 
that money is buying care at least as good and probably better than 
what you would find in a public program. But the reality is, that is 
not the case. This is another indication that we should act to improve 
the quality of health care that is delivered by HMOs throughout this 
country. That is, we should pass a Patients' Bill of Rights.
  This study in California also found that some managed care plans 
impose restrictions on referrals to pediatric specialists. Jameson also 
found that complex pediatric diseases are being treated by providers 
without pediatric expertise when, in fact, a pediatric specialist would 
provide more appropriate care. All of this, again, suggests that we 
have to act promptly to pass this bill to ensure that the American 
public gets what it is paying for: Good quality care through managed 
care plans.
  Again, I am particularly pleased that the Democratic bill 
incorporates many of the provisions from my legislation that would deal 
particularly with the problems of children and managed care. The 
Democratic bill includes, for example, a guarantee of access to 
necessary pediatric services, and appeal rights that address the 
special needs of children, such as an expedited review if the child's 
life or development is in jeopardy.
  Again, here is another example where adults and children differ. 
Children have special needs, not just with their present health state 
like adults, but also with their development. And if our insurance 
plans are not keenly attuned to the developmental aspects of children, 
they are going to provide inferior care. So this legislation would 
require HMOs, in the context of appeals rights, to consider not just 
the present health status of the child as they do with adults, but also 
with the child s development.
  Also, the Democratic bill would require pediatric expertise in staff 
performing utilization review. Under our proposal, when the HMO is 
examining the use of services for a child, the HMO would have to ensure 
that reviewers had pediatric expertise. Too often today HMO plans' 
utilization review is solely in the context of adults. This practice 
overlooks our children, and overlooks the fact that children often have 
very different health care needs than adults.
  The bill would also require that HMOs give information to parents 
about quality and satisfaction related to the treatment of children. 
This information should be easily obtainable so that when a parent 
signs up for a health care plan, they will know upfront what to expect 
for their children. They will not have to wait until that child has a 
serious, serious illness.
  All of these provisions are incorporated in the legislation that we 
should be debating here in the Senate today. All of this is 
incorporated in the legislation that has been endorsed by over 18 
organizations whose sole commitment is to the health care quality of 
the American people.
  The Patients Bill of Rights legislation, too, will cover the vast 
majority of Americans. It will cover all who are in private health care 
plans, unlike the Republican alternative. In the days ahead, we have to 
make critical choices. I can think of no more important issue to 
debate, to discuss, and to act upon than improving the quality of 
health care in the United States, passing the Patients' Bill of Rights, 
giving each American family an opportunity to know what they are 
getting, and ensure that they are getting the health care they are 
paying for.
  I hope we can do that. I hope that this debate will begin. I hope 
that we can go back to our states in a very few weeks and report to the 
American people that we have listened to their concerns, we have 
listened to what they feel is important and that we have acted in their 
best interests by passing the Patients' Bill of Rights.
  I yield the floor.
  Mr. DORGAN addressed the Chair.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. Mr. President, I know that we are in a 30-hour 
postcloture debate on the motion to bring to the floor the Internet tax 
bill. I believe I am correct in that.
  The PRESIDING OFFICER. The Senator is correct.

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