[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

[[Page S12126]]

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.

[[Page S12128]]

  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?

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