[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[Senate]
[Pages S12125-S12128]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
BLOCKING HMO REFORM
Mr. DASCHLE. First, let me say that I would not have required leader
time had we been following what I understand is normal procedure on the
Senate floor: The majority leader is recognized first, the Democratic
leader is recognized second. I was not recognized following the motion
that I made, and I am very disappointed--
Mr. LEAHY. The Senate is not in order. I think the leader is entitled
to be heard.
The PRESIDING OFFICER. The Senate will be in order. Please take all
extraneous conversations to the cloakroom.
Mr. DASCHLE. I thank the Senator from Vermont.
I would clarify my comments by adding that the current Presiding
Officer was not in the chair, nor was the current Parliamentarian. So
it could have
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been an accident, and I will accept it as that, but I would hope that
the Chair--not this particular Presiding Officer--but the Chair would
always recognize the importance of following Senate rules. And Senate
rules oblige the Chair to recognize either leader before any other
Member.
Mr. President, I wanted the opportunity to talk about why we raised
HMO reform today and why it was important that we have a vote. We had
the vote on almost a partisan basis--there were a couple of our
Republican colleagues who joined us, but it was largely on a partisan
basis. Once again, our efforts to bring forth a bill and a debate on
the Patients' Bill of Rights failed. I am disappointed because this may
be the last opportunity we have to consider this issue.
We have considered a lot of items over the last couple of weeks. I
have reported to the distinguished majority leader that I have heard
from many of my Members on a daily basis why it is important to bring
up HMO reform if we are going to bring up so many other issues. As the
sponsor of the legislation, frankly, I feel much the same with regard
to the priority this legislation should have.
We have attempted to deal with H.R. 10, and I have supported that
effort. We have successfully dealt with Internet tax, and I supported
that. We dealt with bankruptcy, and, unfortunately, that bill will be
vetoed in large measure because we weren't able to come to some
successful conclusion in the negotiations, but I supported that. We had
time for all of those measures. That our Senate colleagues do not have
the time or are unwilling to provide the priority to this legislation
speaks volumes about where their real priorities are.
Democrats have said over and over again there is nothing more
important than this legislation, that there is nothing more important
on our agenda than passing a Patients' Bill of Rights this year.
We have held hearings throughout the year. We introduced our bill in
March, S. 1890. We attempted over the last 9 months, through myriad
parliamentary procedures, to be able to come to some conclusion on this
issue. We even proposed working overtime, a second shift, to be able to
address a Patients' Bill of Rights in a meaningful way. We even offered
the bill as an amendment. We have been thwarted in every single
scenario that has presented itself to the Senate to date.
Frankly, the priority that this legislation should have is probably
as great a dividing line as there is between our Republican colleagues
and Democratic Senators. Our Republican colleagues first urged insurers
to ``get out their wallets'' and fight protections as though it were a
war.
In April, they voted against the sense-of-the-Senate resolution
regarding patients' rights--a vote against access to specialists,
against protection from drive-through mastectomies, against an end to
the practice of medicine by insurance company bureaucrats.
By July they had read polls and, frankly, I think they were concerned
about the political implications of this issue. Then they introduced a
bill, strikingly different from ours but using exactly the same title.
The fact is there are now two bills entitled a Patients' Bill of
Rights--one that is real and one that is not. Their bill is filled with
loopholes that benefit the insurance industry. And today, once again,
they have refused to debate the real issues and our real differences
regarding this legislation.
Passage of real patient protections should have been the highest
priority of this session of Congress. We should have ended this session
celebrating bipartisan cooperation on a bill of this import.
Instead, our colleagues have thwarted us at every turn. They have
ignored how real people get hurt. Over the past year, we have heard
story after story of abuses that should have been addressed.
We heard about a 6-month-old by the name of James Adams, who was
burning with a 105-degree fever, and his HMO forced his parents to
drive to an emergency room over an hour away, even though there was a
hospital closer by. Young James suffered cardiac arrest, and lost his
hands and feet.
We also heard about forty-five-year-old Buddy Kuhl who died after his
HMO denied and delayed heart surgery. He left a wife and two young
children. We could go on with these tragedies that occur every day
outside this chamber.
The tragedy within this chamber is, with all of these stories and
millions and millions of people abused every year, this Congress has
ignored and thwarted every effort to address the problem. There is no
explanation, no excuse, no way it can be explained away.
One-hundred and eighty different groups, as disparate as they can
be--from doctors and nurses organizations, to organizations
representing consumers and workers, to the American Cancer Society--
urged the Congress, in as strong terms as they could, to do something,
resolve this problem, address it in a comprehensive way. Don't pass a
sham bill. Don't say you passed something and falsely raise
expectations. Don't talk about how serious the problem is and then not
address it.
We have lost an opportunity to address this issue. We have lost the
opportunity to provide critical protections to those who need emergency
care, to those who need access to specialists, and to those who have
ongoing illnesses who recognize the abuses by HMOs and are increasingly
frustrated with Congress' unwillingness to deal with this issue. These
are the people who recognize the importance of access to the
prescription drugs a doctor prescribes as necessary. They recognize the
importance of access to clinical trials. They recognize that the
protection against retaliation for doctors and nurses who advocate for
patients is critical. They recognize that protection from insurance
companies who interfere with a doctor's best judgment is necessary.
With all the recognition of the problems that exist, with all that
realization, we had an opportunity to work in a bipartisan way to
resolve these matters. To leave the issue on the calendar, to leave
that work undone is indeed a tragedy.
I acknowledge that our prospects for passing something this year are
not good. But I will state as unequivocally as I can that this will
continue to be an issue until it is resolved. This will continue to be
something we will force on the Senate agenda in whatever way we can--as
an amendment, moving to a motion to proceed, finding ways to reach out
to the millions of Americans who need our help this year and who will
certainly need it next year.
We must act responsibly. We must act comprehensively. I hope we do it
sooner rather than later.
I yield the floor.
The PRESIDING OFFICER. The majority leader.
Mr. LOTT. Mr. President, I will say at the beginning that I agree
with Senator Daschle that this is something we should address and I
believe we will address because there are some legitimate concerns and
problems in this area that need to be dealt with. I am very hopeful we
can do that next year.
I want to thank Senator Nickles and our task force that worked on
this issue. I want to thank Dr. Bill Frist, a Member of the Senate, who
worked on this issue. I think it is great that we actually have a
doctor involved that understands what happens in this area.
I have told people, you can take your choice here of which bill is
really the best bill--the one proposed by the Democratic side, led by
Senator Kennedy, or the one proposed over on the Republican side led by
Dr. Bill Frist. I think the choice is pretty clear. But thank you for
your work. I do believe that we are going to address this next year. I
believe we will do it in, hopefully, a responsible way and, eventually,
it can be a bipartisan bill.
This effort today was clearly a planned PR effort because we were
able to accidentally come across some e-mail that indicated that this
was in preparation for a big hoopla down at the White House.
We have tried to get this issue up in a fair way--on June 18, three
different times; on July 15, twice; on June 25, and on other occasions,
I had offered a very fair process to bring this up. The Democratic
proposal, sponsored by Senators Daschle, Kennedy, and others, would
have been offered. Our alternative proposal, the Republican proposal,
would have been offered. We could have debated them both, with three
amendments on both sides. It
[[Page S12127]]
could be small amendments or big amendments--that is up to either
side--and we could have had the votes and been done with it, and sent
it to conference with the House. We could have completed this in June
or July.
But, no, the Democrats objected. They didn't want to have the two
bills head to head and amendments in order because they knew what the
result would be. We had a good proposal; it was going to pass. By the
way, we might actually have gotten something done.
They don't want this issue to pass. They want a political issue. We
could have done this in June or July, but they objected, saying, no, we
must have 20 amendments on each side. Twenty amendments; forty
amendments total--days. The whole plan was to try to find a way to have
the Members have to cast repeated votes on an issue that would
obfuscate the difference between the two bills in reality.
So we have made an effort. We are ready to go. We would have been
happy to do it in June or July. We are going to be looking for a way to
do it next year. When the time comes, it won't be the Kennedy-Daschle
bill. The American people don't want or need that. What we need is a
fair bill. We need access. What we don't need is something that will
lead to more costs and more lawsuits--hallelujah.
Is this about the patients and the doctors and health care, or is
this so my brother-in-law can file another lawsuit? I have the answer.
The answer is that we ought to be worrying about the patients and the
health care providers in America. We have a good bill. I am proud to
have supported it and to have been willing to bring it up in a fair
way. We will do it, I hope, early next year.
I would be glad to yield to the assistant majority leader, Senator
Nickles, who has done great work on this.
Mr. NICKLES. Mr. President, I am disappointed that our colleagues on
the Democrat side of the aisle really have tried to play politics with
this issue. Many of us were very, very serious about trying to pass a
positive bill that dealt with HMO organizations, with health care. We
studied the issue for a long time. Senator Daschle said after they
realized the polls, they introduced the bill in July. We worked 7 or 8
months trying to put a bill together that would be a responsible,
positive bill to meet certain objectives. One, not increase the number
of people in the uninsured category. Unfortunately, I think that would
have happened under the Kennedy bill. It would have dramatically
increased the cost of insurance and, therefore, dramatically increase
the number of people who are uninsured. We said, What can we do that
would be a positive impact on helping people have affordable health
care and maybe provide some coverage and protections for those people
who don't have it from their States, and so we put together a package
to do that.
We didn't come up and say, hey, trial lawyers, what would you like?
Under the Democrats' bill, really, it was a bill that would greatly
enhance attorney fees. It gave people the right not only to sue the HMO
and the health care provider, but also the employer as well. The net
result is that lots of employers would have dropped plans, increased
the number of uninsured. That would not have helped anybody. It would
have been a serious mistake. We didn't want to pass legislation that
would increase the number of uninsured by 1 million people. That would
have been a mistake.
So we were willing to take it up. Our colleagues have said, wait a
minute, we want to vote today. Today may be the last or second to last
day we are going to be in session. In June or July, we offered to do
this. Or we tried to get it done this September where we would have a
reasonable time limit, where we would vote and pass legislation.
Unfortunately, I think Senator Kennedy and others didn't want to do
that because they didn't have the votes.
Their proposal didn't have the votes. It had a lot of rhetoric, but
it didn't have the votes. They never would take yes for an answer. We
were willing to take up their proposal. We were willing to take up our
proposal. We were willing to have a couple of amendments on each side.
They could have drafted those amendments any way they wanted to. They
could have addressed every issue they wanted to, and we could have
passed legislation. We could have done it in time to go to conference
with the House and maybe work out a responsible and reasonable bill
that could be enacted into law. Unfortunately, they wouldn't take yes
for an answer.
So they played games trying to turn it into an election year issue. I
can see it right now. People will try to run ads--maybe in my State--
and say, ``Nickles opposed Patients' Bill of Rights.'' But the truth
is, we had 50 cosponsors on this side of the aisle who cosponsored a
Patients' Bill of Rights that, in my opinion, and the belief of the
majority of the body, was far superior to the bill that was proffered
by our colleagues on the Democratic side of the aisle. It is
unfortunate to me that they wouldn't take yes for an answer. They
wouldn't agree to a unanimous consent request that would have allowed
us to pass legislation and, instead, resorted to some type of
shenanigan where they tried to get a vote and then have the galleries
filled with people in the House.
And so, ``Oh, yes, we are really working to do this,'' when all they
were looking for was an election year ad not to pass real legislation.
Mr. KENNEDY. Will the Senator yield?
Mr. President, I listened with interest to the attempts of my good
friends Senators Lott and Nickles to rewrite the history of the
Patients' Bill of Rights in this Congress. No amount of rhetoric and
disinformation can disguise the fact that the Republicans in Congress
have abused the rules of the Senate to prevent passage of strong
patient protections this year. The vote today was the latest
installment payment to powerful special interests opposed to change.
The Republican leadership could have called the Patients' Bill of
Rights at any time for a full and fair debate. Instead, proposed a
series of phony ``consent'' agreements that would prevent fair debate
and make passage of real reform impossible. These stalling tactics were
clearly meant to run out the clock, so that managed care reforms cannot
be passed before Congress adjourns, and so that the Republican
leadership can avoid responsibility for its defeat.
The record of Republican attempts to avoid the blame for inaction
would be laughable, if the consequences for patients across the country
were not so serious.
On June 18, Senator Lott proposed to bring up the bill, but on terms
that made a mockery of the legislative process. His proposal would have
allowed the Senate to start considering HMO reform, but he would have
been permitted to end the debate at any time. The proposal also barred
the Senate from considering any other health care legislation for the
rest of the year. So if Senator Lott did not like the direction the
bill was headed, he could kill it and tie the Senate's hands on HMO
reform for the remainder of the year.
On June 23, 43 Democratic Senators wrote to Senator Lott to urge that
he allow a debate and votes on the merits of the Patient's Bill of
Rights. We requested that the Senate take up this issue before the
August recess.
In response, on June 24, Senator Lott repeated his earlier
unacceptable offer.
On June 25, Senator Daschle proposed an agreement in which Senator
Lott would bring up a Republican health care bill by July 6, so that
Senator Daschle could offer the Democratic Patients' Bill of Rights,
and other Senators could offer amendments on HMO reform. We would agree
to avoid amendments on any other subject. Only amendments related to
the Patients Bill of Rights would be eligible for consideration.
Senator Lott rejected this offer as well.
On June 26, he offered once again an agreement that allowed him to
withdraw the legislation at any time, and bar any further consideration
of any health care legislation for the remainder of the year.
On July 15, Senator Lott made yet another offer. This time, he
proposed an agreement that permitted only one amendment. He could bring
up bill. We could bring up ours. And that would be it--all or nothing.
No votes on key issues.
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On July 29 and on September 1, the Republican leadership offered
variations of this proposal, with amendments restricted to three for
Democrats and three for Republicans.
Senator Daschle offered yet another reasonable approach to resolve
the impasse that Senator Lott had created by his efforts to prevent
meaningful reform. He offered to agree to let the Senate debate other
bills during the day, and use evenings to debate the Patients' Bill of
Rights--but the Republican leadership said, ``no.''
Our patients' Bill of Rights was introduced in March--and a
predecessor bill was introduced by Congressman Dingell and myself more
than eighteen months ago, at the beginning of this Congress.
Senator Daschle, in an effort to be responsive to the Republican
Leader's ultimatum that an agreement on the terms of the debate must be
reached before the debate can begin, has offered reasonable proposal
after reasonable propsal--and every one was rejected.
Yet the Republican leader has allowed the Senate to debate many other
bills this year, with ample time and ample opportunity for amendments.
We had 7 days of debate on the budget resolution, and considered 105
amendments. Two of those were offered by Senator Nickles.
We had 6 days of debate on the defense authorization bill, and
considered 150 amendments. Two of those were offered by Senator Lott
and he cosponsored 10 others. We had 8 days of debate on IRS reform and
considered 13 amendments.
We had 17 days of debate on tobacco legislation--a bill we never
completed--and considered 18 amendments.
We had 5 days of debate on the agriculture appropriations bill and 55
amendments.
We had 19 days of debate on the highway bill, with 100 amendments.
The Republican leadership has allowed 5 days of debate and 24
amendments to the bankruptcy bill.
They have allowed 36 amendments and 2 days of debate on the FAA bill.
All these bills were important, and all deserved reasonable debate
and opportunities for amendments. They were brought up without any
undue restrictions on debate. That is the normal way of doing business
on important pieces of legislation in the Senate.
The Republican leadership was willing to have an adequate opportunity
to debate and vote on these other important measures. But when the
issue is protecting American families instead of insurance industry
profits, different ground rules apply to protect the industry and deny
the rights of patients.
The reason the Republican leadership was unwilling to engage in a
fair debate is obvious. Senator Lott knows his legislation is deeply
flawed, and that it cannot possibly be fixed with just three
amendments. He believes that he and his special interest friends can
hold most of the Republican Senators for a few votes, but he feared
that the would not be willing to stand before the American people on
the Senate floor and cast vote after vote for the special interests and
against the interests of American families. The fundamental flaws in
the Republican bill mean greater profits for insurance companies and
lesser care for American patients. Senator Lott does not want the
Senate to vote to fix these flaws. He does not want a vote: on whether
all Americans should be covered, or just one third of Americans as the
Republicans shamefully propose; on whether there should be genuine
access to emergency room care; on whether patients should have access
to the specialists they need when they are seriously ill; on whether
doctors should be free to give the medical advice they deem
appropriate, without fear of being fired by their HMO; on whether
patients with incurable cancer or Alzheimer's disease or other serious
illnesses should have access to quality clinical trials where
conventional treatments offer no hope; on whether patients in the
middle of a course of treatment can keep their doctor if their health
plan drops them from its network, or their employer changes health
plans; on whether the special health needs of the disabled, and women,
and children should be met; on whether patients should be able to
obtain timely independent review of plan decisions that deny care; or
on whether health plans should be held responsible in court for
decisions that kill or injure patients.
The list of flaws in the Republican bill goes on and on.
The Republican leadership's record on this issue is painfully clear.
Their cynical strategy is to protect the insurance industry at all
costs, by blocking any reform at all, or by passing only a minimalist
bill so weak that it would be worse than no bill at all. And today,
they finally ended the charade--by moving to table a motion to bring
the bill passed by Republicans in the House before the Senate.
Last Friday, the Wall Street Journal reported that the Republican
Congressional Campaign Committee held a $25,000-a-person fundraiser for
a ``select group'' of health care industry executives. The heading for
the article was, ``Politicians seek to profit from the debate over
health care policies.''
The American people are sick of health insurance companies that
profit by abusing patients. And it is equally unacceptable that
politicians should profit by protecting those exorbitant industry
profits.
Every family in this country knows that it will some day have to
confront the challenge of serious illness for a parent, or grandparent,
or a child. When that day comes, all of us want the best possible
medical care for our loved ones. Members of the ?Senate deserve good
medical care for their loved ones--and we generally get it. Every other
family is equally deserving of good quality care--but too often they do
not get it, because their insurance plan is more interested in profits
than patients.
The Patients' Bill of Rights provides simple justice and basic
protection for every one of the 160 million Americans with private
insurance. It is supported by the American Medical Association, the
Consortium of Citizens with Disabilities, the American Cancer Society,
the American Heart Association, the National Alliance for the Mentally
Ill, the National Partnership for Women and Families, the National
Association of Children's Hospitals, the AFL-CIO, and many other groups
representing physicians and other health care providers, children,
women, families, consumers, persons with disabilities, Americans with
serious illnesses, small businesses, and working families.
It is rare for such a broad and diverse coalition to come together in
support of legislation. Both they have done so to end these flagrant
abuses that hurt so many families.
We serve notice today that this struggle is not over. The Republicans
in Congress and their friends in the insurance industry may have won
this year's battle, but they will lose in the end.
Democrats in Congress intend to make the Patients' Bill of Rights the
first order of business when the new Congress convenes next January. We
will continue to fight for meaningful patient protections until they
are signed into law. We will not give up this struggle until every
family can be confident that a child or parent or grandparent who is
ill will receive the best care that American medicine can provide.
Mr. LOTT addressed the Chair.
The PRESIDING OFFICER. The majority leader.
Mr. LOTT. Mr. President, I ask for the yeas and nays on the pending
committee substitute.
The PRESIDING OFFICER. Will the Senator withhold?
____________________