[Congressional Record Volume 144, Number 146 (Wednesday, October 14, 1998)]
[House]
[Pages H10889-H10894]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     REPUBLICAN MANAGED CARE REFORM

  The SPEAKER pro tempore (Mr. Hansen). Under the Speaker's announced 
policy of January 7, 1997, the gentleman from Missouri (Mr. Talent) is 
recognized for the balance of the hour as the designee of the majority 
leader.
  Mr. TALENT. Mr. Speaker, I thank the gentleman from Illinois for 
yielding to me and for all his really excellent work on this bill. It 
is a great pleasure to get up and talk about the Patient Protection Act 
which passed the House this year. We made enormous progress in the 
direction of ensuring that people get the care that they need and that 
their physician has prescribed when they need it and that we could do 
that without big government. It was a great bill. It passed the House. 
Unfortunately it got caught up in politics and some partisanship both 
in the other body and on the other end of Pennsylvania Avenue and that 
is unfortunate. We have all heard some specimens of that this 
afternoon. But that should not keep us from talking about this bill and 
what it would do for people, because, as I said before, we have made an 
enormous amount of progress. We need to make progress in this area.
  When I go around my district and talk with people about health care, 
they are concerned. It is less about the reach of the coverage that 
they are promised in their insurance. There is some concern about that. 
The concern is that if they get sick, they will not get the care they 
have been promised. They will not get the care that their physician has 
prescribed. They have some reason for that concern, Mr. Speaker. We 
have all heard about these horror stories around the country. They are 
not just horror stories, they are horrible stories. People losing their 
children because an HMO turned down the care that their physician had 
recommended, pregnant women not being allowed to go into the hospital 
when they have high-risk pregnancies, seniors being denied chemotherapy 
on the grounds that it was supposedly experimental. These are horrible 
stories. We should not have that. We do not have to have that. We can 
have a system that refocuses the health care system and the power in 
the system on the patient and on their physician. That is what the 
Patient Protection Act does. The gentleman from Illinois has talked 
about some of the good things in it. I am going to be yielding to 
people in a few minutes to go into greater depth on that.
  Let me just say the bill does two things that are very important and 
it is the only bill that was before the House this year that did these 
two things: The first thing, it expanded the coverage that was 
available, good private sector coverage available to people around the 
United States. At any given time about 42 million people do not have 
health insurance coverage, working people. But they work for employers, 
typically small employers who typically cannot afford to provide the 
coverage to them. Our bill had a feature in it that no other bill had 
that we have needed to do for decades here that makes perfect common 
sense and would make good, solid, private sector health care available 
to millions of those people who currently do not have it. The gentleman 
from Illinois (Mr. Fawell) is going to discuss it later, but briefly, 
Mr. Speaker, it is the concept of association health plans. All that 
means is that these small businesses who cannot afford them, they may 
only have 5, 6 or 10 employees and cannot afford to go through all the 
administrative costs and the hassle of offering health insurance, can 
pool together as associations. Then the association is a sponsor of a 
health plan and the small business can send its employees to that 
health plan, can put up some money for the employees, they put up some 
money on their own and they are able to buy health insurance from a 
plan that can offer them all the choices that currently employees of 
big companies have. Why should an employee just because he or she 
happens to work for a restaurant have no health insurance offered to 
him or her or have fewer choices offered to him or her than somebody 
would if they worked for IBM or they worked for Emerson Electric or 
they worked for Boeing or any other of the big employers in the 
country? This provision in the bill when we pass it out of here, and I 
think we will get it early next year because it is an idea whose time 
has come, will make health care available to millions who currently do 
not have it. It is the only bill that does that.
  I will say, Mr. Speaker, we were enlightened on that issue when at a 
press conference a reporter asked a very important member of the other 
body what the administration bill does for the uninsured. He thought 
about it and said, with his typical candor, ``Not much.'' That is true. 
It did not do anything for the uninsured. This bill would make health 
care available to millions of people who currently do not have it. It 
is part of the whole idea behind this bill, to provide health care to 
people when they need it, when their physician prescribes it, without 
big government.
  But the feature I am up here to talk about and I am going to be 
yielding to other Members of Congress to talk about other features in 
the bill, the feature I want to talk about, Mr. Speaker, is the 
accountability features in the bill. The gentleman from Illinois (Mr. 
Hastert) referred to this generally, but what we did, we worked on this 
for months and months and came up with the tightest, best 
accountability procedure anywhere in this country to ensure that 
patients get the care their physician recommends at the time their 
physician recommends it, notwithstanding some bean-counter at the HMO. 
It is low-cost to the patient, it is easily accessible, it is quick, 
and it is certain. I think it is going to be a model that will be used 
in States, and I certainly hope in Federal legislation when we pass it 
next year.
  Basically what it does is this: The problem now is that if you belong 
to a plan, an HMO, let us suppose your physician recommends care for 
you or your family. I will just take an example. Let us suppose, 
because I have three children, Mr. Speaker, 8, 6 and 2. None of them 
have a problem with their ears. Some kids have a constant problem with 
ear infections. With my kids it is sinus infections. With some people 
it is ear infections. Let us suppose that after two or three times the 
pediatrician says, for a 4 or 5-year-old, ``Look, we got to put in the 
ear tubes.'' That is a very common procedure. So you call up the HMO 
and they say, ``No, we don't think that's medically necessary. So we're 
not going to pay for the ear tubes.'' What would you do today? What 
would you do without this bill? You would either pay for the ear tubes 
yourself or you would file some amorphous appeal with the HMO that 
would take months and months and months and then they could turn it 
down and never tell you why and if you wanted to then you can go to 
court and sue them for the cost of putting in the ear tubes and who is 
going to do that? It is just not a feasible procedure for the average 
person who belongs to an HMO.

[[Page H10890]]

 Under this bill what you could do is this: You could immediately file 
an appeal, what we call it is an internal review. The first stage is an 
internal review before a physician in the plan. It would have to be a 
physician. No more would the plan be able to turn down the care your 
physician has recommended on the authority of an accountant, or even a 
nurse or some other allied health care professional. So immediately you 
would get a review before a physician in the plan. That review would be 
either within 3 days if your physician said it was an emergency 
situation, 10 days if your physician said it was urgent care or 30 days 
if your physician said it was routine care. This would probably be 
considered, absent some kind of really bad side effect of the 
infection, a more or less routine situation. But that would be up to 
your physician, the treating physician, to say whether it was 
emergency, urgent or routine care. If the plan did not return a result 
from the appeal within the time limit specified in the statute, the 
appeal would be taken as granted and the care would be paid for, so 
they could not spin you out and deny the care just by indecision.

  So you go before the plan physician. Let us say the plan physician 
backs up the plan, says, ``No, I don't think it's medically necessary, 
either.'' Then you would get an appeal to an external panel of 
independent specialists. Our bill was the only one that provided for 
easy, low-cost access to a panel of independent specialists in this 
field. In this case it would be pediatricians, and so the plan would 
have had to contract, let us say, with the Mayo Clinic or the local 
research hospital, they would make their pediatricians available, it 
would be a double-blind kind of situation. The plan would not know who 
the pediatricians were who were reviewing that case, the pediatricians 
would not know the name of the patient, just the information before 
them. Then these specialists would make a decision about whether it was 
medically necessary. If they said it was medically necessary and the 
plan still refused to pay for the care, you could go immediately to 
court. When you went to court, you could sue not only for attorney's 
fees, not only for the cost of the treatment, not only for the court 
costs but for a penalty of up to $1,000 a day up to $250,000 if they 
refused to pay the cost of providing those ear tubes. What are the 
plans going to do, Mr. Speaker? Under those situations they are going 
to say, ``We better pay because if we don't pay up front now, we're 
going to end up paying up front, we're going to end up paying in a few 
weeks anyway. And in addition we're going to have to pay all these 
attorney's fees and we're going to get whacked with this huge 
penalty.''
  The key to this plan, and we have outlined it here, from the time the 
initial claim is denied, within a matter of weeks you get an internal 
appeal before a physician. It is the only bill that provides for that. 
You get an external review with no threshold. It does not have to be a 
$1,000 claim or a $5,000 claim or a $10,000 claim, and it should not 
be. If it is a $200 claim but it is required under the insurance 
contract, you should get it.
  I yield to the gentleman from Georgia.
  Mr. NORWOOD. There was another bill before us in Congress, those from 
the left had a managed care reform bill, too. Did they have a threshold 
in their bill?
  Mr. TALENT. Yes, they did.
  Mr. NORWOOD. Do you know what that threshold was?
  Mr. TALENT. I will reclaim my time. I am sorry for stepping on the 
gentlemen's comment there, but they said it had to be a significant 
claim. Then it left that up to the Department of Labor to define. We 
said any claim that you feel you are not getting coverage on that you 
have been promised coverage, you can go to external review.
  Mr. NORWOOD. Does that not mean, then, many cases of patients who 
were in HMOs who had a claim that was being denied, many of those 
people would not have an external appeals process through their plan, 
do I have that right?
  Mr. TALENT. That is absolutely correct. I thank the gentleman for 
raising the point. We all know on that task force it was the gentleman 
through his efforts who made sure that this bill did not have a 
threshold. Then again, after external review if the plan still does not 
pay, you go to court immediately. You do not have to wait until your 
child has lost his hearing. You do not have to wait until somebody has 
got really sick and died and then maybe 4 or 5 years later after you 
have run the gauntlet in the State court system you can try to sue for 
recovery later on, you can sue right away for penalties up to $250,000 
in addition to attorney's fees, court costs and the cost of the 
treatment. There are others who want to speak on this bill, Mr. 
Speaker. I am eager to have them do it.
  Mr. NORWOOD. If the gentleman will yield further, I wanted to ask him 
a question, if I could, about the court remedy. One of the things I 
keep hearing is that under our bill, patients could not sue an HMO and 
under the Democratic bill they said you could sue an HMO. I believe 
that is incorrect information. Under our bill, you can sue HMOs, but, 
in fact, without our bill, you can sue HMOs.
  Mr. TALENT. There is a major difference. Under our bill, you do not 
have to die first. You can sue to get the treatment that you need. 
Because the emphasis here, and I appreciate the gentleman's comments, I 
say, in all good faith, the emphasis here is on giving people the care 
they need when they need it. We want people in the treatment room, not 
in the courtroom. I would anticipate that very few people would have to 
go to court. Because we have changed the incentives in this bill for 
these HMOs. For the very same reason that they have been denying care 
in the past, they are going to be granting care now because they are 
going to know, it is going to end up costing them more money if they 
deny the care up front. So I would anticipate that few people would 
have to go to court. But that hammer is there. If they spin people 
along, if they do not pay when they are supposed to pay, you go to 
court right away. In fact, as the gentleman knows, you can go to court 
up front in an emergency situation to get an injunction, an emergency 
injunction to order them to pay. Florence Cochran, the very unfortunate 
lady who had a high-risk pregnancy and her doctor wanted her to go into 
the hospital and the HMO said, ``No, we don't think it's all that high 
risk a situation,'' she could have gone to court under our bill, got an 
injunction to allow her to go into the hospital right away and then 
because it was an emergency gone through this internal and external 
review procedure within about a week to establish the right that she 
had the right to have that hospital care paid for.
  Mr. NORWOOD. If the gentleman will yield further, would Mrs. Cochran 
have been able to go into court immediately?
  Mr. TALENT. Yes.
  Mr. NORWOOD. Once the benefits of the plan were denied, she would 
have been able to get to court immediately. Because her case was not 
just routine care, it bordered at least on urgent and perhaps 
emergency. So she could have gotten into court immediately.
  Mr. TALENT. And it would have been up to her physician to decide 
whether it was emergency or urgent care which then triggers the time 
limits in the bill. Moreover, if the plan had denied coverage after the 
external review panel had said it was covered, as the gentleman knows, 
the $250,000 penalty is a per diem penalty, a per day penalty. Every 
day they do not pay, they would be liable for up to $1,000. Why? 
Because we are not trying to promote litigation in this. We want the 
treatment covered when the physician has recommended it. And so what we 
are saying to the HMOs, ``Pay and don't delay because the longer you 
delay the more you're going to have to pay after a few weeks or 
months.''

  Mr. NORWOOD. If the gentleman will yield further, I am not an 
attorney and I know that the gentleman is, but explain to us as an 
attorney how attorneys would be able to take cases today where benefits 
are denied and patients can sue their HMOs today for benefits, but what 
if the benefit was only $1,000? Can an attorney afford to take a case 
like that, that is $1,000, not knowing whether they will ever be paid 
for their services that may run up $20,000, their fees.
  Now, the change in our bill, how does that help that?
  Mr. TALENT. It would be borderline because under the law today you 
are

[[Page H10891]]

allowed attorney's fees. So it would be a borderline type of situation. 
In many cases the lawyer would just say and the patient would say, 
``It's not worth it.'' Why do I want to go years and years and years in 
court with the plan having every incentive to spin out the case as long 
as possible? So ours is an improvement in a number of different 
respects. First of all, the $250,000 penalty, which is triggered by 
delay, we are saying to the plans, ``Every day you delay it costs you 
more. We want you to pay when this panel has said you should pay.'' In 
addition, you can go to court right up front to get an emergency 
injunction in those cases where a life is really at stake. Any judge is 
going to say, ``The treating physician has recommended this care, it's 
an emergency situation, there's some kind of a contract dispute, I'm 
going to put this person in the hospital while you take the necessary 
week or 10 days or whatever it is to resolve this matter.''
  So we have expedited the process, it is low cost to the patient as 
the gentleman knows, it is swift, it is sure, it is certain, it is a 
way of getting people the care that they need. I will just say to the 
gentleman, then I will close and yield to the gentlewoman from New York 
to discuss a different aspect of the bill.
  I was asked during this debate on the bill by somebody who said to 
me: Look, suppose they have this situation. A person has an infected 
leg, and his plan physician recommends institutional care in a 
hospital. The plan turns it down, the infection gets worse, the persons 
loses the leg, what can they recover? Under your bill, what could they 
recover from the plan?

                              {time}  1700

  And I said, ``Well, they can get attorney fees, they can get costs, 
they can get $250,000 in penalty, they can get the cost of the 
treatment, and they get their leg because that leg is not lost.''
  And that is the whole point. Nothing I think differentiates the 
different approaches that were before this House in that example.
  We have written this as air tight as you can write it, and where that 
care is medically necessary, where the treating physician recommends 
it, the person is going to get the care that they need.
  That is what America wants, and they want it without litigation, they 
want it without big government, they want people in treatment rooms, 
not in courtrooms, and, as in most cases, the American people got a lot 
of good common sense in this. That is what this bill would have given 
to them. I am very glad it passed the House. I think it is the starting 
point for legislation next year.
  And I am very happy to yield to the gentlewoman from New York (Mrs. 
Kelly) for any comments she may wish to make.
  Mrs. KELLY. Mr. Speaker, I rise today to join my colleagues from the 
House Working Group on Health Care Quality to reflect on the critical 
legislation passed by the House in July, the Patient Protection Act.
  Mr. Speaker, unfortunately politics has taken precedence over policy 
with regard to reasonable health care reform. I want to share with 
Americans some key provision of the Patient Protection Act that will 
not come to fruition because some Members of this Congress would rather 
resort to demagoguery on the issue rather than actually do something to 
improve America's health care.
  As my colleague has pointed out, we are interested in making sure all 
Americans have health care when they need it, not have to go to court 
to fight for it.
  I have approached the health care debate from two different 
perspectives, the first from that of a professional patient advocate 
and the second from that of a former small business owner. As a 
professional patient advocate, I have dedicated my life to ensuring the 
sanctity of the doctor/patient relationship. It is that relationship, 
the relationship between a patient and their doctor that results in 
high quality care. To that end, the Patient Protection Act includes 
several provisions that recognize the distinctive health care needs of 
patients, especially women and children.
  For example, the Patient Protection Act provides women with direct 
access to their OB/GYNs without authorization or referral by a primary 
care physician. It also gives parents a very important right, access to 
a pediatrician as their child's primary care provider.
  Other patient protections in the bill include providing new avenues 
to health care coverage where quality and choice are available by 
requiring health plans to offer a point of service option. The measure 
also includes a prohibition on gag rules that are often placed on 
medical providers as well as ensures access to emergency care by 
eliminating preauthorization requirements for emergency services, 
allowing a patient to access emergency services from any emergency 
service provider and demanding that coverage is based on patient 
symptoms rather than a final diagnosis.
  However, while it is of utmost importance for Congress to protect 
patients in today's managed health care market, it is also our 
responsibility to be mindful of producing a bill that does not have 
dire consequences such as making health insurance too expensive for 
American families and businesses.
  The Patient Protection Act does not turn its back on the financial 
impact health care reform might have on families and businesses. The 
President's health care proposal does nothing to address the 42 million 
uninsured Americans, many of whom work for small businesses or are 
self-employed. In fact, the Congressional Budget Office reports that 
his proposal could result in a premium increase of 4 percent which 
would result in many Americans losing health care coverage. The Patient 
Protection Act, on the other hand, is the only health care reform 
proposal that creates new health care choices so that more, not less, 
Americans can have access to affordable health care.
  Mr. Speaker, the Patient Protection Act recognizes that reform means 
nothing to those Americans who cannot access health care. The Patient 
Protection Act is an excellent starting point on the road to quality 
affordable health care for all Americans. It is my hope that next year 
Congress will rise above political rhetoric and demagoguery and protect 
America's patients and families as well as America's uninsured.
  Mr. TALENT. Mr. Speaker, it is my pleasure now to yield to the 
gentleman from Florida (Mr. Bilirakis) for such comments as he would 
wish to make, and I will just add in yielding to him that Mr. Bilirakis 
has been a leader in this field both of health care reform and patient 
protection and access to health care for a number of years and did 
outstanding work in this task force, and it is a pleasure to yield to 
him.
  Mr. BILIRAKIS. Mr. Speaker, I thank the gentleman for yielding to me 
and for those kind remarks.
  Mr. Speaker, Congress had a tremendous opportunity this year to 
expand health care access to the uninsured as well as to the insured 
and, at the same time, provide better protections for the patients of 
managed care providers.
  Earlier this year the House completed its job and passed health care, 
health reform legislation. Unfortunately, the Senate was not able to 
debate and approve a similar bill. I am deeply disappointed by the fact 
that the Congress was unable to work in a bipartisan fashion and reach 
agreement in this very important issue, and I honestly feel let down 
because many days and hours, early and late, would have gone for naught 
because many needed patient protection reforms would not be available 
for patients.
  This situation, Mr. Speaker, we are in today is similar to what we 
went through in 1994. At that time we had the Rowland-Bilirakis health 
bill sidetracked by the then Democratic majority leadership because the 
large number of cosponsors from both parties meant sure passage, sure 
passage if the bill had been allowed to come to the floor. A couple of 
years later, many of the same provisions, I would say most of the same 
provisions, were contained in the Kassebaum-Kennedy bill which was 
enacted into law, but the American people would have had those reforms 
available to them 2 years earlier under the aforementioned Rowland-
Bilirakis bill.
  As our task force worked on the Patient Protection Act, I believed it 
was necessary to include provisions on health access to the uninsured 
as well as those who are insured. After all, we

[[Page H10892]]

have to ask ourselves what good is insurance if one does not have 
access to basic medical care? Both expanded care for the uninsured and 
increased patient protections were accomplished, as others have already 
said I think, in the Patient Protection Act without, without imposing 
burdensome government mandates.
  One principle way our bill expanded health access was by broadening 
the role of community health centers. Currently there are 42 million 
uninsured individuals in the United States. Our bill made it easier for 
community health centers to offer health care to those in medically 
underserved areas. H.R. 4250 would have saved money because patients 
would have used more efficient forms of care.
  The bill also created community health organizations which are 
managed care plans controlled by community health centers. H.R. 4250 
eliminated state requirements preventing community health organizations 
from participating in the health market.
  H.R. 4250 also encouraged more competition in order to lower prices 
for health consumers. Community health centers would have had more 
money because they would have had more private paying patients using 
their facilities, and, as a result, these health centers would have 
provided care to even more uninsured people.
  In addition, the Patient Protection Act also created important new 
safeguards which have been mentioned previously and gave patients 
greater access to high quality health care. The bill included a 
provision that enabled employers to pull together in health marts, a 
voluntary choice market where small employers could have obtained low 
cost and high quality coverage through the fully insured market. Of 
course the Patient Protection Act also included, as we have already 
said so many times, important new patient protections.

  For months people across the country told Congress that they wanted 
to choose their own doctors. Well, we listened to our constituents. In 
fact, through our bill patients were guaranteed their choice of medical 
providers.
  We also made it easier for patients to determine what their health 
plans covered. People would have actually understood their health care 
policies because descriptions would have been written in plain English.
  Mr. Speaker, again Congress had a great opportunity to follow through 
with its commitment to reform health care in our country, and I 
challenge those that support patient rights to put people ahead of 
politics and agree to work with us instead of against us. Next year we 
must continue our fight for the uninsured. They deserve access to 
health insurance, and we will not stop until we achieve this goal, and 
in addition we must help those who want to choose their own doctors 
instead of allowing their insurance companies to choose their doctors 
for them. People want their personal health evaluated by someone who 
they can trust, and I feel it is our responsibility as Members of 
Congress to move forward in order to make this goal a reality for all 
Americans.
  And finally, Mr. Speaker, I want to personally thank both you and 
Congressman Denny Hastert and of course all of the members of the task 
force with whom it was such a pleasure to work for their leadership in 
this issue. Both of you, both the Speaker and Mr. Hastert, have done a 
tremendous job in bringing health reform before the House of 
Representatives this year. I will continue to be supportive of your 
efforts during the 106th Congress.
  Mr. TALENT. Mr. Speaker, I appreciate the gentleman's comments, as 
always, about this bill which would have expanded the reach of private 
health insurance to millions of people who currently do not have it and 
then help to guarantee that those who do have health insurance get the 
care they need when they need it, when their physician recommends it 
and done that without big government. It was a good bill. It is a shame 
we could have closed ranks behind it.
  Mr. Speaker, nobody did more to fight for this bill and to fight for 
the interests of people who currently do not have health insurance than 
the gentleman I am pleased to yield to next, the gentleman from 
Illinois (Mr. Fawell), and I just want to say about him that he has 
fought tirelessly year after year after year to make association health 
plans a reality, he has talked to small business people, he talked to 
employees of small business people and he knows that patient 
protections are not worth anything if you do not have health insurance, 
as the gentleman says. And so it is a pleasure to yield to him for such 
comments as he might wish to make.
  Mr. FAWELL. Mr. Speaker, I thank the gentleman very much, and I do 
want to commence my remarks by lauding Chairman Hastert who brought a 
tremendous group of, yes, Republican Members of the House together, all 
of whom had varying degrees of experience in health care, and they 
worked, they have worked so hard, and they came up with a bill that I 
think the Patient Protection Act was a very fine piece of legislation. 
Unfortunately so much has happened. The President's problems and other 
matters have come along, and we have not had the light shine upon this 
legislation to bring forward its many, many good parts to which 
reference, a lot of references have already been made.
  I think that the expansion that we were talking about here of the 
ERISA statute, for instance, so that small businesses can have the very 
same advantages that unions and large businesses have had for many, 
many years to be able to give to small businesses the ability to be 
able to band together into multiple-employer health care plans and so 
that they can have the economies of scale so they can do what the large 
businesses and unions can do. And what the large businesses and unions 
can do is they can, because they have the economies of scale, they can 
self-insure, and when they can self-insure, Mr. Speaker, that means 
that they have the ability to use clout and be able to bargain with 
health care providers or be able to bargain, for instance, with 
indemnity insurance companies and HMOs to bring the price down and to 
demand that there be the highest possible quality that can be given to 
their employees.

                              {time}  1715

  This ERISA statute is often misunderstood, but it enables employers 
who are, by the way, not pro-health care provider nor pro-insurance 
company. They are pro-consumer. They are pro and for the employees of 
their company. And the large corporations all across America utilize 
this ERISA statute to have some very innovative and creative 
legislation.
  In fact, it covers about 132 million people who get their health care 
from employer provided ERISA health care plans. And this legislation 
was simply suggesting that because the 43 million people in America who 
do not have health care are largely people who live in homes where the 
breadwinner is employed by small businesses or is self-employed, where 
obviously they do not have the economies of scale of large businesses 
or large unions, that this legislation suggested the very elementary 
idea that, why not allow small businesses to also band together 
multiple employer health care plans under association health care 
plans, which would be churches, associations, the Boys Club of America, 
for instance, farm groups, the National Chamber of Commerce, any number 
of business associations which are solid people, they are interested in 
their members. And why not let them therefore sponsor these 
associations, and therefore they too would have the ability because 
they have the numbers to be able to self-insure and to be able to have 
the ability to talk to health care providers and to bring the price of 
health care down, and that is what managed care is all about, and be 
able to also deal with indemnity insurance companies, the regular 
indemnity insurance companies, and be able to experience rates, for 
instance, on the basis of their particular smaller employers and 
employees.
  That is what large corporations do. I think that is why most people 
who are employed by large corporations do have good solid health care 
coverage, and with a lot of choices too. That is awfully important. 
That means they have fee-for-service choices and things of that sort, 
which we would like to see occur.
  As it is right now, the 43 million people, of course, have to go out 
into the individual market and, one by one, they do not have the 
economies of

[[Page H10893]]

scale, they do not have the clout and the ability to do what larger 
corporations can do.
  So this legislation, for instance, that is just one part of this 
legislation. It is an idea whose time is long past due. I will not see 
it come to fruition, but people like the gentleman from Missouri (Mr. 
Talent), the gentleman from Georgia (Mr. Norwood), and so many of the 
other fine people, the gentleman from Pennsylvania (Mr. Goodling), the 
gentleman from Virginia (Mr. Bliley), the gentleman from California 
(Mr. Thomas), the gentleman from Florida (Mr. Bilirakis), the gentleman 
from Ohio (Mr. Hobson), the gentleman from Florida (Mr. Goss), the 
gentlewoman from Texas (Ms. Granger) and the gentlewoman from New York 
(Mrs. Kelly), I hope I have not missed anybody, but these are all-
stars. These are people who really worked on this, and I feel the only 
sad part of it is they did not get this legislation to be really 
allowed to blossom.
  Mr. TALENT. The gentleman's comments are very kind. I just have to 
say it is the gentleman's efforts year after year that have brought 
this to the floor and I hope bring it to fruition next year.
  It comes down to this: If you are an employee of, let us say the 
Boeing Company, and Boeing has a very important division in my district 
with a former McDonnell Douglas company, with tens and tens of 
thousands of people working for them, it is a great company, so that 
company is big enough and has this huge group of people and the group 
is an efficient group and they can put out money and sell funds, so in 
effect they do not have an insurance company except maybe to administer 
different aspects of the plan. As a result, they can stay in control, 
they can provide the kind of coverage that their employees want, and 
they have these kinds of economies of scale.
  Is not the whole issue why should not small employers be able to band 
together as groups to offer the same thing to their employees? They 
want to do it, their employees want it. There are tens of millions of 
people who do not have private health insurance. Why should they not be 
able to do that? Can you think of a reason?
  Mr. FAWELL. No, I certainly cannot, except I suppose one might say 
that those who may be out there now serving this small business 
community do not want the competition, and I can understand that.
  Mr. TALENT. That is the other question. Who was it that opposed this 
provision? Let us be up front about it. Was it not the insurance 
company who opposed this provision?
  Mr. FAWELL. They did not agree with our view of the legislation. Yes, 
that is quite true. But the time has come where I have tried to point 
out the 43 million people who have to go out into the regular indemnity 
insurance market, for instance, which is, by the way, under state 
jurisdiction, are really anti-selected. Forty-three million cannot get 
health care.
  We have to do something about it. If we do not do something about it, 
I would suggest that the private market is going to get a real black 
mark and somebody is going to talk about let us go back to the Clinton 
plan or something like that, when we do have the ability to be able to 
do something about it.
  I wish you folks well in the next session of Congress. I shall be 
rooting for the team. I hope you get the same team together. And the 
gentleman from Illinois (Chairman Hastert), I cannot say enough for 
him, because he sat there meeting after meeting after meeting. You know 
how many hours we worked, how many days we worked on this. And we had a 
great work product.
  Unfortunately, the day that I think that that was passed, another 
event of terrible magnitude here occurred, a shooting and murder of two 
fine policemen, and then, after that, the President had his troubles, 
and I think the news media never even looked at this legislation very 
much as a result of this.
  But it will pass eventually. It has to pass, because it is good 
legislation. I thank the gentlemen for their time.
  Mr. TALENT. I thank the gentleman for his comments.
  Mr. Speaker, it is curious that this bill was opposed in this House 
and the other body by people on the grounds that it was too nice to 
insurance companies and they opposed the provisions in it that the 
insurance companies were fighting, and that can only happen in 
Washington. Unfortunately, it happened here.
  I am happy to yield to the gentleman from Georgia, whose efforts it 
is I think quite correct to say are the reason why this bill, a bill on 
this issue, was before the House. He has labored long and hard and 
against opposition sometimes from a lot of different quarters, and he 
has it here, and there is nobody I respect more and nobody who worked 
harder on behalf of patients. I yield to the gentleman from Georgia 
(Mr. Norwood).

  Mr. NORWOOD. Mr. Speaker, I thank the gentleman for his comments. I, 
too, enjoyed the 300 hours we spent on our task force trying to hammer 
out a patient protections bill. I thought in the few minutes I have to 
talk, I would like to talk about the history and how we got to really 
where we are at the end of the 105th Congress.
  Much of this started many years ago, 1973 when Congress passed an HMO 
act, 1974, when Congress passed an ERISA act. And then we come up to 
1995, and it was Republicans that dropped the health care bill. It was 
the Republicans who dropped a bill to bring to the attention of the 
104th and 105th Congress that there were problems in managed care. 
People were being denied treatment, people were being rationed 
treatment, people were not being able to choose their own doctors. And, 
over the last three years, it has been Republicans who have said we 
have to deal with some of these issues.
  Now I would like to just focus in on maybe two things. It is the two 
things I think about health care reform right now that are most 
important, and it has to do with principles like freedom, freedom to 
choose your own doctor. It has to do with principles, such as being 
responsible for the decisions you make.
  When I go home in my district, I see a lot of political ads out there 
about HMOs that simply are not correct. They are being played, in my 
view, by people who do not quite understand what is going on.
  But one of those issues and the one that probably has been the most 
contentious is about liability. I think everybody in America should 
know today, even though the Federal law, ERISA, preempts any state law, 
in other words, public policy at the state level no longer takes 
effect, and even though Federal law through ERISA is very solid on 
public policy regarding health care, it does at least say this: A 
patient has the right today, without us passing any legislation, to sue 
their insurance company or their HMO if their benefits are denied. You 
can do that today.
  Now, the beauty of what this bill does, this task force bill, is it 
improves that so that it works. This is all under contract law. It 
allows people to actually be able to sue for their benefits, because if 
you win that benefit after going through an external review, then you 
cannot only win the cost of the benefit, but you can win the cost of 
going to Federal Court. That is extremely important, because that has 
denied people their due process because of the $25,000 or $30,000 it 
took to go to court to win the value of a $2,000 benefit. Basically 
nobody could go. We corrected that in the House task force bill.
  In addition to that, if you have been denied care in a very untimely 
manner, then you have the possibility of winning up to $250,000 
appointed by the judge. Now, this is very, very important, because all 
of these court cases are before bodily harm or death occurs. That is 
when you need the health care.
  A mother wants their child treated. A mother does not want to go to 
court necessarily and win $1 million in punitive damages because their 
child died. Now, that is the beauty of the health task force bill.
  I had a bill known as Patient Access to Responsible Care, PARC, and 
in that bill we were trying to give the patients the right to sue their 
HMO at the state level through tort law, through malpractice. I still 
believe that is a very good way to go, because what it does for these 
health care accountants, it makes them think twice before they turn to 
the mother and say, ``I know your pediatrician wants to have your child 
hospitalized, but I am the accountant and I say no.'' Then should 
bodily harm or death occur, that accountant should be held responsible 
for that decision in a state court of law.

[[Page H10894]]

  Now, unfortunately, I could not win that debate. In January of this 
year, as I was pushing my bill, I was the only one willing to say that. 
I pleaded with the White House to add that kind of language in their 
Patients' Bill of Rights. I pleaded with the White House to add that to 
the State of the Union. I actually found out that the Democrat 
leadership was against that. The original Kennedy-Dingell bill didn't 
have that in it. In fact, one of my good friends in Congress on the 
other side of the aisle would not cosponsor my bill because it had it 
in it.
  I find it very curious that today, that is the very thing that the 
Democrats decided to fall on their sword about and keep those in the 
Senate from putting out a good piece of legislation.
  The other part of our bill, the task force bill, and my bill, PARC, 
that is extremely important, in my opinion, is to allow people to 
choose their own doctor. This is America, is it not? Why should we not 
have as much freedom as they do in England?
  Now, our bill, for the first time, had what is known as a point of 
service provision in it that opened the door to allow the American 
people to choose their own doctor. But maybe even more importantly in 
this task force bill, that was not in mine, I wish it had been, was 
improving on medical savings accounts.
  That is the greatest freedom there is in health care. I am very proud 
to be part of a task force that made possible medical savings accounts 
for those all over the country.
  In conclusion, let me just say that what we hear today in the 
political ads is exactly what has killed health care reform in the 
105th Congress. It is people who were more willing and more wishful of 
having votes than they were of protecting patients. That is exactly 
what the Democratic Senate did. They wanted to win votes on this issue, 
rather than opening the door and for the first time having some 
national public policy regarding health care.
  I am going to join with my friend the gentleman from Missouri (Mr. 
Talent) and the gentleman from Illinois (Mr. Fawell), who will not be 
here, but the gentleman from Florida (Mr. Bilirakis) and others, and we 
are going to start again and keep on, and we are going to keep on and 
keep on until we give the patients of this country what they deserve, 
and that is the right to choose their own doctor and ask people who 
make decisions about your health care and tell people that you have to 
be responsible.
  Mr. TALENT. I thank the gentleman for his comments.
  I know I am close to being out of time, Mr. Speaker. I will just 
repeat again, we had a good bill. It would have provided the people the 
care they need, when they need it, when their physician recommends it, 
without big government and a lot of lawyers' fees.
  As the gentleman from Georgia said, we will be back with it. I am 
confident we will have success. It is what the American people want. It 
is the best thing we could have done in the 30 years since the Congress 
passed Medicare.

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