[Congressional Record Volume 144, Number 137 (Monday, October 5, 1998)]
[House]
[Pages H9510-H9514]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               HMO REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentleman from New

[[Page H9511]]

Jersey (Mr. Pallone) is recognized for 60 minutes as the designee of 
the minority leader.
  Mr. PALLONE. Mr. Speaker, I just want to mention at the outset that I 
intend to yield a significant portion of my time later to the gentleman 
from Missouri (Mr. Skelton).
  Mr. Speaker, tonight I want to talk about the Republicans and their 
successful effort to block managed care reform in this Congress. And I 
stress block managed care reform. Congress is now just a few days away 
from adjourning for the year, and managed care reform, or HMO reform, 
is essentially dead. And the reason is because the Senate, at this 
point, has simply refused to take up any HMO or managed care reform 
bill.
  To date, the House Republicans have dutifully carried the water, in 
my opinion, for the insurance industry. They did pass in the House of 
Representatives a bill which they labeled managed care reform, but it 
is a counterfeit bill, a reform bill that is worse than the current 
law. Of course, not to be out done, the Senate Republicans have 
rewarded the industry's loyalty to the Republican Party by doing 
nothing at all. Absolutely nothing. They simply refuse to take up the 
issue of managed care reform, and they are hopeful that the issue will 
simply die and everyone will forget about it.
  Well, I do not think people are going to forget about it. The 
Republicans are, in effect, touting their indifference to HMO reform in 
the public's face. I have to say when I go around in my district at 
town meetings or forums, or I just talk to people on the street, as we 
tend to do quite a bit; and now, of course, we are going to be running 
for election, all of us in the next few weeks, and so we see a lot of 
people, a lot more people maybe than we even would normally, and I say 
to my colleagues that the public, not only in my district but 
throughout the country, is clamoring for HMO reform.
  I do not really have to go too far. Today's New York Times. On the 
front page there was a story that said, ``Reality of the HMO System 
Doesn't Live Up to the Dream.'' It talks about places around the 
country where people had high expectations of HMOs and have been 
basically disappointed because of not only the quality of care that 
they have lost but also the fact that, in many cases, they have not 
even been able to get care that their physicians or their health care 
professional considered necessary.
  I am not going to read this whole article, but I just thought it was 
very interesting because it starts out by talking about Kansas City, 
Missouri, and how at the start of the 1990s, when employers' health 
insurance costs were going up, that the giant Sprint Corporation 
shifted its employees to HMOs in order to try to save money. And they 
saved a lot of money.
  And there is no reason why a corporation that is providing health 
care benefits for employees should not try to save money. I am not 
taking away from the fact that HMOs and managed care organizations 
often save a lot of money. But it is often at the cost of quality and 
even access to care.
  Just as an example, it says in here that Sprint's costs stabilized, 
and today the comprehensive health program stands as a model of what 
Congress and industry envisioned 4 years ago when they rejected 
President Clinton's health plan and left the health care system to the 
tides of the marketplace.
  So Sprint is happy with the fact that they have stabilized their 
costs. However, it says, and I am reading now from the New York Times 
story today, along the hallways at Sprint in Kansas City, the great 
expectations for managed care have dimmed. In a score of interviews 
with workers and managers, no one recounted the kind of HMO horror 
stories that make headlines, an example, the wrong leg amputated or a 
child denied a transplant, but, instead, they said they had found 
managed care to be exasperating, callous and sometimes just senseless.

  I have been on the floor of the House many times talking about some 
of the horror stories. But what the article is pointing out tonight is 
that regardless of some of the horror stories, the day-to-day activity 
of having to deal with HMOs, without the kind of patient protections 
that I think this Congress needs to put into place, are very difficult.
  It mentions in the article Kevin Leroy, a Sprint sales compensation 
manager, who says his HMO, Cigna, saved his 10-year-old daughter's life 
with months of hospitalization to help her conquer a mysterious immune 
system disorder, but it also required him to interrupt 3 days of work 
to get a third doctor's opinion before authorizing hernia surgery for 
him.
  What we are finding here is that even though in this case the HMO 
actually eventually authorized the particular procedure here that this 
individual needed, or that this individual needed for his 10-year-old 
daughter, he had to go through all kinds of hoops in order to get the 
procedure approved.
  This is another example. The toddler son of Elsa Wong, a project 
manager, suffered an ear infection for a year before her HMO primary 
care physician sent him to a specialist. When Phyllis Van Kamp, a 
secretary, had the fever and deep cough of bronchitis, a clinician told 
her over the phone to try aspirin for a few days.
  So what we are finding is that it is very difficult for people, on a 
regular basis, who have HMOs or managed care, to oftentimes get the 
care they need. They have to go through a lot of hoops. Sometimes the 
care is denied; sometimes it is postponed. In any case, they worry, 
because the system is not working the way it should be.
  And what the Democrats have been saying in the House of 
Representatives is that if we just put into law a few common sense 
protections for patients, nothing major, nothing dramatic, just a few 
common sense protections for patients, then we could make all the 
difference in the world in terms of HMOs and managed care 
organizations. Because right now they operate under so few rules and so 
few requirements and so few protections for individuals; whether they 
want to have access to a specialist, whether they want to be able to go 
to an emergency room and not have to fear that it will not be covered, 
whether or not they want to appeal the denial of a decision and have a 
very difficult time having a hearing or an opportunity even to be 
heard, whether or not they want to know what their policy contains and 
what is covered, and they do not have proper disclosure.
  These are the kind of common sense things that need to be corrected, 
and that is what the Democrats have been saying for the last year or 2 
when we put together our Patient's Bill of Rights and demanded that it 
be considered here in the House of Representatives. Unfortunately, what 
the House did was to stall and to stall.
  The Republicans essentially were not in favor of any kind of HMO 
reform. And, finally, when their backs were to the wall this summer, 
and they figured they had to do something, what they did was a bill 
that is basically a sham and actually takes us backward. And even that 
bill, the Senate, the other body, does not want to take it up and wants 
to let die before this session ends within the next few days.
  Well, I just wanted to mention again, with regard to The New York 
Times, in a New York Times poll that was conducted in July, 85 percent 
of respondents said that the health care system needs fundamental 
change, barely below the 90 percent who said the same thing in a Times-
CBS news poll in 1994, before President Clinton's health care plan 
died.
  This is all in this article that I was quoting from in The New York 
Times. The article says also, today's article on the front page, says 
that when asked about health maintenance organizations, 58 percent of 
respondents said the HMOs had impeded doctors' ability to control 
treatment, compared with 17 percent who said that they had improved it. 
And, basically, the article also makes reference to a 1995 Harris poll 
that found more people saying managed care would improve quality of 
care rather than harm it. If we compare that 3 years ago to the Times 
poll now, there was a sharp reversal; 50 percent saying care would be 
harmed and only 32 percent saying it would be improved. Again, from 
today's New York Times.
  I think the lesson we are seeing is that there was a great 
expectation that managed care was not only going to save money but even 
improve the quality of care, or at least not make the quality of care 
worse, or access to care

[[Page H9512]]

worse. And now, not only has the public found that, from their own 
example, that that is not true, but the polling that has been done and 
mentioned in this New York Times article today shows rather 
dramatically most people overwhelmingly feel there are problems with 
HMOs that need to be corrected.
  Almost 6 out of every 10 Americans are saying HMOs are impeding 
doctors' ability to treat patients, and the Republicans are simply 
going to let the clock run out on this issue. Basically, what the 
Republicans are saying to the American people is that they will have to 
wait until next year for the issue to be looked at again when the new 
Congress convenes in January. Sorry, they are telling parents of sick 
children who are trying to get their child to the appropriate 
specialist, they will have to wait until next year before Congress 
takes up the issue. Everyone, in fact, who was hoping Congress would 
pass legislation to improve managed care is out of luck for the 
indefinite future.

                              {time}  2115

  Now, I believe, Mr. Speaker, very strongly, and I know this sounds 
partisan, but I cannot help it because the Republicans are in control, 
they are in the majority, the adjournment of Congress without a managed 
care reform bill is without question, I think, the target that the 
gentleman from Georgia (Mr. Gingrich) and the Republican leadership 
have been aiming for all year. What little they have done on managed 
care has all been part of a smokescreen that the GOP has set up to 
create the illusion of serious interest in managed care reform.
  Consider now if we could, if I could just take a little time, Mr. 
Speaker, I would like to consider the GOP health task force original 
proposal to the gentleman from Georgia (Mr. Gingrich). I am actually 
the cochair, along with some of my Democratic colleagues, of our 
Democratic Health Care Task Force and we came up with the Patients' 
Bill of Rights as our Democratic proposal.
  Well, on the Republican side, there were some Republican Members who 
were very interested in managed care reform and wanted to come up with 
a decent bill that they figured would address some of the concerns that 
the public had to try to correct HMOs. But, if we remember, when that 
Republican Health Care Task Force came up with their original proposal 
just a few months ago, the gentleman from Georgia (Mr. Gingrich) 
scoffed at what his own colleagues had come up with, and he basically 
berated them for bringing him a patient protection bill that had too 
many protections on it, and he sent them back to the drawing board 
because he and the insurance industry did not like what they saw. They 
saw a proposal that was very much like our Patient Bills of Rights.
  So those Republicans, those colleagues on the other side of the aisle 
who wanted to do real patient protection, were basically told by the 
House Republican leadership, no, we do not want that. Go back to the 
drawing board and come back with something else.
  Well, they went back to the drawing board this summer. They came back 
with something else. But what they came back with, which this time was 
acceptable to the gentleman from Georgia (Mr. Gingrich) and the 
Republican leadership, was a bill loaded with provisions that were 
purposefully included to draw the President's veto. These are the so-
called poison pill measures.
  The House Republican leadership did not want a bill that could 
actually pass. They wanted a bill that was so loaded down with these 
extraneous provisions unrelated to HMO and managed care reform that 
they could be sure that the President would veto it. It turns out he 
did not even have the opportunity because they never sent it to him. 
But that was the idea. And these poison pills included expansion of the 
medical savings account, medical malpractice reform, and the subversion 
of State consumer protection laws through the expansion of health 
pools.
  Now, some of these things some people might even like, but the 
problem is that they did not belong in this managed care reform. In 
order to ensure that this bill would not be exposed for the sham that 
it is, the Republican leadership bypassed the committee process and 
brought it straight to the House floor only a week after it was 
introduced by the task force. And aside from the poison pills which I 
just mentioned, the Republican leadership's bill included a host of so-
called protections that are totally worthless.
  I just want to give some examples. Then I will yield to my colleague 
the gentleman from Texas (Mr. Green), who is very much involved in 
putting together this Patient Bill of Rights as part of our Democratic 
task force. But let me just give my colleagues some examples of why the 
Republican proposal that passed here was a sham.
  For example, the issue of medical necessity, which is really the 
chief catalyst of the managed care debate reform, in other words, who 
is going to decide what is medically necessary and needs to be covered 
by insurance company, is basically the key to what kind of care they 
are going to have.
  Well, again, in today's New York Times article it notes that nearly 6 
in 10 Americans believe managed care interferes with doctors' abilities 
to treat patients. The Republican solution for this problem was to lock 
the status quo in place. In the bill that House Republicans have 
already approved, your HMO is allowed to define what ``medical 
necessity'' means. And this means that if the Republican bill were 
signed into law, which they are not going to allow it to be, they are 
not even going to move on it, but if it were signed into law and they 
had a dispute with their HMO, if their HMO says the treatment they need 
is not medically necessary, they do not get it.
  That is exactly what the problem is. In other words, the solution the 
Republicans are proposing is to codify the source of the problem into 
law. What the Democrats do in our Patients Bill of Rights is to define 
``medical necessity'' based on generally accepted principles of 
professional medical practice. So, essentially, doctors are deciding 
what is medically necessary.
  The Republicans use the same kinds of tricks really for everything in 
their bill. Emergency room care is another example. While they could go 
to any emergency room under the Republican bill, there is no guarantee 
that their insurance company would pay for it. So it does not really 
help to have health insurance if they are not going to pay for it.
  Severe pain, for example, under the GOP bill is a standard a 
reasonable person could use to determine whether or not he or she could 
get him or herself to the emergency room. In other words, if they feel 
like they are having pain, the normal person would say, okay, that is a 
reasonable basis for them to go to the emergency room. But under the 
Republican bill, that is not a basis for saying that they are entitled 
to go to the emergency room. If the HMO decides that they do not want 
to define ``severe pain'' and say that is not a reason to go to the 
emergency room, then they do not cover it. They go to the emergency 
room, but they do not get the proper care.
  Under the Democratic bill, patients would have the guarantee that if 
they had severe pain, that would be a reason to go to the emergency 
room and have it covered.
  I do not want to keep going on because I see that my colleague is 
here, and he has been extremely helpful to us in the Democratic Caucus 
and to the Committee on Commerce in this effort. And if I could mention 
to my colleague that one of the things I mentioned here tonight is how 
this Republican proposal did not even go to committee. So we never even 
had the opportunity in the Committee on Commerce, which has 
jurisdiction over health care issues, to even consider this matter 
before it came to the floor.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Green).
  Mr. GREEN. Mr. Speaker, I would like to thank my colleague for 
yielding.
  Taking up that, we both serve on the Committee on Commerce, and I 
serve on the Subcommittee on Health and Environment, and I would look 
forward to being able to work on a bill bipartisanly for a real 
Patients' Bills of Rights. But my colleague is right, the bill did not 
come to our committee. It was drafted in a task force. And we drafted 
ours in a task force, too. But we do not have the ability to bring 
bills out to the floor as the minority party here, and so that is the 
problem.

[[Page H9513]]

  I want to make a few points about the Republican bill would do to 
State-passed patient protections and share with my colleagues concerns 
that have been raised by officials in my own home State. And, again, we 
discussed this before, that States all over the country have passed 
patient protection bills to deal with insurance policies that are 
licensed in that individual State.
  We have to pass a national bill because so many of our companies come 
under ERISA, the Federal law, and so they do not fall under State 
regulation. So we have really two regulations of health insurance 
depending on how the policy is drafted. It could be under the State of 
New Jersey or the State of Texas, or it could fall under ERISA on the 
Federal level.

  Very simply, the bill that we passed here on the floor, and I say 
``we'' because we are collectively here, but my colleague and I voted 
against it and spoke against it, the Republican so-called Patient 
Protection Act should really be called the Patient Protection 
Elimination Act.
  Texas State Comptroller John Sharp recently urged not only myself, 
but also Members of Congress from Texas to urge Congress to support the 
States and respect the work that they have done and not undermine them. 
Like so many States across the country, Texas has responded to the 
needs of its citizens and passed real managed care reform and true 
patient protections.
  Unfortunately, the bill that the Republicans recently rushed through 
the House without committee hearings would preempt these laws and re-
expose the very citizens to these laws that were passed to protect 
them. In other words, it not only does not help us, it actually goes 
against the reforms that were passed in individual States because it 
would re-expose us to problems in unregulated hazard health care that 
the States have been taken care of.
  This simply is not right, and each State has a need specific to that 
State. And while it is sometimes necessary to pass a uniform national 
law like we have to, we should not overrule what a local State is 
doing, particularly when they are dealing with their constituents.
  So often we hear from our colleagues on the Republican side that 
government closest to the people works most effectively and listens 
better. Well, I generally agree with that. Having served 20 years in 
the legislature, it was actually driven home to me every day. And in 
this case, I think it is true. The States ought to be able to deal with 
the insurance policies that are licensed in their State, and we should 
not, by the bill that we pass, overrule what the State legislatures 
have done. Doing so strips critical patient protections from the few 
people who actually have them now by the States passing them.
  And let us be clear about the Republican Patient Protection Act. It 
eliminates patients' protections. I know it does in my home State. And 
while they may try to tell my colleagues that they have included 
similar provisions in the bill, I have read the fine print when we had 
that day-long debate and it became mixed up in all those well-
intentioned protections or loopholes that we could literally drive a 
truck through.
  Another letter that my office recently received from State 
representative John Smithy and Mr. David Sibley, two Republican 
committee chairmen in the Texas Legislature, who were the sponsors of 
our Patient Protection Act that passed in the State legislature. As 
chairman of the committees of jurisdiction over insurance and managed 
care in Texas that recently passed legitimate patient protections, they 
have an understanding of these issues.
  While many Republicans here in Washington keep saying real reform is 
too expensive and would be too big a burden on insurance companies, it 
is important to note that the similar protections and provisions that 
were passed in Texas raised premiums only 34 cents per month, 34 cents 
per member per month. That is right. All those extravagant claims about 
increased costs are simply not true.
  We do not have to rely on partisan estimates or even the nonpartisan 
Congressional Budget Office. Just look at the demonstration project 
already underway in Texas where recent laws passed that allow patients 
to sue their HMO. If that HMO makes a decision on the health care, that 
puts the responsibility with the person who makes it. They have access 
to binding and independent review. They can communicate freely with 
their provider without fear of retaliation against their doctor. In 
other words, they eliminated the gag rule. And they can utilize 
emergency room services if they experience symptoms that a prudent lay 
person would consider an emergency, including extreme pain.
  And I have used this example before, and all of us particularly at 
our age smile about it, but how do I know at 10 or 11 o'clock at night 
when I am having chest pains that it may not be the pizza that I had at 
6 o'clock, it may actually be a heart attack. And if we are having 
extreme pain and discomfort, then that should be part of it, because, 
again, we are lay people. We are not practitioners of medicine.
  And what does that cost in Texas? Thirty-four cents. In fact, it is 
ironic that that is less than a cup of coffee here in the Capitol. I do 
not drink coffee, but that is what my staff tells me.
  What worries me is it may be too late this year, and I hope not. But 
this body should make a commitment to real managed care reform in the 
next Congress and make it one of the top priorities and not put it at 
the end of the session, but put it at the beginning of the session. 
And, hopefully, when our constituents go vote on November 3, they will 
remember who had the actual real Patient Protection Act, and it was 
Members of Congress who worked and tried to learn from what is going on 
in our local States and said, okay, let us provide that on a national 
basis so everybody, no matter if you have a State-licensed insurance 
plan or policy or one who comes under Federal law, they will still have 
the basic protections that they should have to protect them through 
their managed care, their HMO provider.
  I want to thank my colleague for, one, requesting this time tonight, 
because outside of education, there is no other issue that my 
constituents call about than health care. Managed care, Medicare, which 
also we have had some problems with some of the proposals under managed 
care that would be another special order some night that we may want to 
talk about under Medicare. But this is so important.
  I guess the frustration is that senior citizens under Medicare will 
have these protections because the President signed an Executive Order 
that covers both Medicare, retired military, and also government 
managed care plans that cover Federal employees, but the average 
citizen out there will not have it. And we need to provide for those 
citizens the same protections and the same insurance that my colleague 
and I have.
  I have heard that from my colleagues on the other side of the aisle, 
and what is good for the goose is good for the gander, and I think that 
is what important about it.
  Again, I thank my colleague for allowing us to have this special 
order and taking his time tonight.
  Mr. PALLONE. Mr. Speaker, reclaiming my time, I want to thank the 
gentleman from Texas (Mr. Green) not only because he has been so far 
out really bringing up this issue on a regular basis and making sure 
that it is addressed and then spending the time on our health care task 
force, but also because he brought out tonight that the cost of 
implementing these protections in his home State of Texas was so 
minimal.
  I remember New Jersey has patient protections that are basically 
similar to Texas from what I have seen, and I remember at the time when 
they were trying to pass it in New Jersey. And we are getting the same 
thing here in Washington. The whole drumbeat against it is it is going 
to cost so much money, and it is going to increase the price of 
insurance, and the managed care organizations say that our whole 
purpose was to bring down costs, now we are going to bring them up 
again. And I think the gentleman said it was 34 cents, which is 
basically a few pennies for these protections.
  Really, again, what we want to emphasize, and that is why I think it 
is important that my colleague brought up the minimal cost factor, is 
that these are just common-sense proposals and what they really amount 
to in most cases is just prevention.

[[Page H9514]]

  My colleague mentioned the gag rule, how under current law if the HMO 
decides that they do not want the physicians that are part of their 
network to tell patients about procedures that are not covered by the 
HMO, they essentially put in place a gag rule so that their own doctor, 
in this great democracy that we have, cannot tell them about the type 
of services that are available because the insurance company will not 
cover them.

                              {time}  2130

  That is a terrible thing to me, because I think most people when they 
go to a doctor, they think the doctor is going to educate them and tell 
them what kind of care they need. That is common sense. Yet they 
cannot. The doctors in many cases cannot. They are under this so-called 
gag rule. I think most people are shocked to find out that that is the 
case and that their doctor actually cannot tell them the truth 
essentially. That is really what we are all about. We are just trying 
to put in place what as you mentioned and I mentioned are just 
commonsense proposals.
  Before we conclude tonight, I just wanted to reiterate again so that 
everyone understands that you and I realize that this is not going to 
happen because the Republican leadership in the Senate will not even 
bring it up. But the fact of the matter is that we have a week left. 
You and I know that when the Republicans decided to bring up their bad 
bill in August, it only took them a day to do it. They did it in one 
day. They basically noticed it, they had the debate and they passed 
what was a very bad bill. So there is no question that if the Senate 
wanted to take it up, even with a week left, they could do it.
  Mr. GREEN. And the Senate could take up the bill number that we 
passed over there and put real reforms in that bill. What we did is 
wrong because it is a step backwards. But the Senate could change it 
and pass real patient protections and send it back to us and hopefully 
we would just concur in the Senate amendments to the bill and it would 
make it stronger, include an antigag rule, emergency room care and an 
outside appeals process.
  Mr. PALLONE. The bottom line is that we know that the Republican 
leadership is not going to do that. They not only do not want to bring 
up the bad bill, they do not want to bring up anything at all because 
they do not want to address it. So effectively the issue is dead for 
now.
  But I am worried about the individuals who are negatively impacted in 
the time before we get a chance to bring this up again. I know that it 
will come up again because the public as you said is just totally in 
favor of the kind of patient protections that we have put in our 
Democratic proposal. I may be unfair also in saying that it is just a 
Democratic proposal because the patients' bill of rights has Republican 
support as well but the Republican leadership refuses to bring it up.

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