[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.
____________________