[Congressional Record Volume 144, Number 142 (Saturday, October 10, 1998)]
[Senate]
[Pages S12350-S12351]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              THE REPUBLICAN PATIENTS' BILL OF RIGHTS ACT

 Mr. ENZI. Mr. President, I rise to speak in strong support of 
S. 2330, the Patients' Bill of Rights Act. As an original cosponsor, 
I'm confident that this legislation is the logical step to ensure 
Americans accessible and affordable healthcare.
  On January 13, 1998, the Majority Leader created the Republican 
Health Care Task Force to begin pouring the foundation for a 
comprehensive piece of legislation that would enhance the quality of 
care without dismantling access and affordability. For the last seven 
months, the task force met every Thursday--and other times as needed--
with scores of stakeholders prior to writing this bill. Such thorough 
steps in writing a bill have clearly paid off. We now have legislation 
that would provide patients' rights and quality healthcare without 
nationalized, bureaucratized, budget-busting, one-size-fits-all 
mandates.
  In 1993, President and Mrs. Clinton launched an aggressive campaign 
to nationalize the delivery of healthcare under the guise of modest 
reform. The sales pitch was backed with scores of anecdotes illustrated 
from Presidential podiums across the country. The stories pulled on the 
heartstrings of all Americans and were intentionally aimed at injecting 
fear and paranoia into all persons covered or not covered by private 
health insurance.
  I am quick to ask my constituents interested in the President's bill 
to carefully examine the fine print. It's no surprise to me that most 
of them already have. The American people haven't forgotten the last 
time this Administration tried to slip nationalized healthcare past 
their noses. Folks in this town may be surprised to learn that the 
American people aren't a bunch of pinheads. Anyone can put lipstick on 
a pig, give it a fancy Hollywood title, and hope for an election-year 
slam dunk. Expecting the public to close its eyes and kiss that pig, 
however, is an entirely different matter.
  The American people understand what's going on here. They know full 
well that higher premiums mean no coverage. Why? Because affordable 
access to healthcare is an even higher priority than quality. If it 
isn't affordable, it doesn't exist! By issuing one-size-fits-all 
mandates and setting the stage for endless litigation, the President's 
bill could dramatically raise the price of premiums--barring people 
from purchasing insurance. The President would be well advised to call 
his legislation the ``Patient's Bill,'' because a costly bill is 
exactly what Americans would receive. That's the bottom line for 
American families--the cost. We all want quality. There isn't a member 
in Congress who doesn't want quality. But if Americans are expected to 
pay up to 23 percent higher premiums to get it, they'll most often have 
to go without insurance. It's that simple.
  I remember the reaction Wyoming residents had to the 1993 ``Clinton 
Care'' plan. I was a State Senator living in Gillette, Wyoming at the 
time. I recall how the President and First Lady rode a bus across 
America--promoting nationalized healthcare. I also remember the detour 
they took when they arrived at the Wyoming border. Instead of entering 
my home state, they chose a more populated route through Colorado. That 
was an unfortunate choice. They missed an important healthcare point. 
Had they driven all 400 miles across southern Wyoming, they would have 
seen for themselves why one-size-fits-all legislation doesn't work in 
rural, under-served states.
  Affordable and accessible care is THE life-line for Wyoming 
residents. I live in a city of 22,000 people. It's 145 miles to another 
town of equal or greater size. Many of my constituents have to drive up 
to 125 miles one-way just to receive basic care. More importantly, 
though, is the difficulty we face enticing doctors and practitioners to 
live and practice medicine in Wyoming. I'm very proud of Wyoming's 
health care professionals. They practice with their hearts, not their 
wallets.
  In a rural, under-served state like Wyoming, only three managed care 
plans are available and that covers just six counties. Once again, this 
is partly due to my state's small population. Managed care plans 
generally profit from high enrollment, and as a result, the majority of 
plans in Wyoming are traditional indemnity plans--commonly known as 
fee-for-service. Some folks might wonder why I am so concerned about 
the President's healthcare package, especially since it's geared toward 
managed care. I'm concerned because a number of Wyoming insurers offer 
managed care plans elsewhere. Any premium hike spurred by mandates in 
the Presidents' bill could be distributed across the board--causing 
increases in the fee-for-service premiums in Wyoming. Simply put, my 
constituents could easily end up paying for services they'll never get! 
40 percent of my constituents are self-insured--meaning they pay for 
their own health insurance out of their own pockets. Expecting my 
constituents to pay more poses a clear and potential threat to exclude 
them from health insurance coverage. The urban areas get the care--we 
get the cost. Added cost--that's it--that's all.
  The Republican plan is the right choice for America. It would 
safeguard 48 million people out of the 124 million now covered by the 
1974 Employee Retirement Income Security Act or ERISA by requiring that 
group healthcare plans provide enrollees with: access to emergency 
medical care; point-of-service coverage; access to ob-gyn care; access 
to pediatric care; continuity of care; and, a ban on patient/doctor 
``gag'' rules. ERISA plans, whether fully-insured or self-insured, 
would also be required to provide enrollees with information about 
plans and providers such as options, restrictions and descriptions.
  The Republican Patients' Bill of Rights would also allow a patient to 
hold their health plan accountable. The President's bill, however, 
would allow a patient to sue their own health plan and tie up state 
courts with litigation for months or years. The only people that 
benefit from this would be trial lawyers. The patient, however, would 
be lucky to get a decision about their plan before their ailment 
advanced or even took their life. A big settlement doesn't do much good 
if you got it, because you died while the trial lawyers fiddled with 
the facts. Folks aren't interested in suing their health plan. They 
watch enough court-TV shows to know how expensive that process is and 
how long it takes to get a decision made. This isn't L.A. Law--it's 
reality. The Republican Patients' Bill of Rights avoids all this by 
incorporating an internal appeals process that doesn't exceed 72 hours. 
If not satisfied, an enrollee would be able to access an external 
review by independent medical experts. Getting quick decisions saves 
lives.
  The President has repeatedly said that the Republican Patients' Bill 
of Rights should apply to all health insurance plans. Such claims are 
no different than those made by the President back in 1993. He wants 
nationalized healthcare--plain and simple. There is a reason the 
Republican bill only amends ERISA. It's because the 124 million ERISA 
enrollees are not regulated by the states. The states, by the way, have 
been in the business of regulating the health insurance industry far 
longer than Congress or any President was beating up on managed care.
  The President wants all regulatory decisions about a person's health 
insurance plan to be made from Washington--nationalized care. The 
reason this won't work is that it fails to take into account the unique 
type of healthcare provided in states like Wyoming. While serving in 
the Wyoming Legislature for 10 years, I gained tremendous respect for 
our state insurance commissioner's ability to administer quality 
guidelines and insurance regulations that cater to our state. State 
regulation and understanding is absolutely, unequivocally essential. I 
firmly believe that decisions which impact my constituents' health 
insurance should continue

[[Page S12351]]

to be made in Cheyenne--not Washington.
  Congress has an obligation to ensure such quality services to the 124 
million ERISA enrollees whose plans are currently absent these 
protections. In doing so, however, the Republican bill stays within its 
jurisdictional boundaries and doesn't trample over states' rights. As a 
result, Americans can gain protections whether they are insured under a 
state, ERISA, or Medicare regulated plan. I believe that this approach 
is rational and fair.
  The Republican Patients' Bill of Rights would provide individual 
rights with respect to a person's own, personal health information. 
Access to personal medical records is a delicate matter. Provisions, 
however, are included to address inspection and copying of a person's 
medical information. Safeguards and enforcement language has also been 
added to guarantee confidentiality. In relation to this language, group 
health plans and health insurance issuers in both the group and 
individual market would be prohibited from collecting or using 
predictive genetic information about a patient with the intention of 
denying health insurance coverage or setting premium rates.
  The Republican plan would establish the Agency for Healthcare Quality 
Research. This is not a new federal agency, but rather a new name for 
the current Agency for Health Care Policy and Research within the 
Department of Health and Human Services. This agency would be 
modernized to improve healthcare quality throughout America. The agency 
would not mandate a national definition of quality, but it would 
provide information to patients regarding the quality of care people 
receive, allow physicians to compare their quality outcomes with their 
peers, and enable employers and individuals to make prudent purchases 
based on quality.
  The Senate Labor Committee held a number of hearings in relation to 
women's health research and prevention. As a result, the Republican 
Patients' Bill of Rights includes a number of important provisions that 
represent women's health. These provisions will clearly benefit the 
promotion of basic and clinical research for osteoporosis, breast and 
ovarian cancer, the effects of aging and other women's health issues.
  Finally, the Republican Patients' Bill of Rights broadens access to 
coverage by removing the 750,000 cap on medical savings accounts 
(MSA's). MSA's are a success and should be made available to anyone who 
wishes to control their own healthcare costs. Moreover, persons who pay 
for their own health insurance could deduct 100 percent of the costs if 
the Republican plan is enacted. This would have a dramatic impact on 
folks from Wyoming. These provisions would, without a doubt, pave the 
way for quality healthcare to millions of Americans without dismantling 
access and affordability.
  While the President's bill has been pitched as being essential to 
enhancing the quality of care Americans receive, I hope that my 
colleagues will carefully evaluate the impact that any nationalized, 
bureaucratized, budget-busting, one-size-fits-all bill would have on 
our nation's healthcare system. As I have encouraged my constituents to 
read the fine print, I ask my colleagues to consider how the 
President's legislation impacts you and your home state. Rural states 
deserve a voice, too. Only the Republican Patients' Bill of Rights Act 
would give them that voice.

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