[Congressional Record Volume 144, Number 146 (Wednesday, October 14, 1998)]
[House]
[Pages H10901-H10903]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     DEMOCRATIC MANAGED CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 15 minutes as the designee of the minority leader.
  Mr. PALLONE. Madam Speaker, let me also if I can just take a minute 
to also express really the friendship that I have had over the last few 
years with Tom Manton. He is also on the Commerce Committee with me and 
the gentleman from New York (Mr. Engel) and the gentleman from New York 
(Mr. Towns) as well. I have always admired him for the reasons my 
colleagues have all set forth but just to mention a couple of things. 
My father was a policeman. I know what it was like to have a policeman, 
to serve on the police force, and I know that he is the kind of 
policeman or the person in the police law enforcement background that 
is really kind of the perfect image, if you will, of a law enforcement 
individual.
  In addition to that, I have seen him as I think the gentleman from 
New York (Mr. Towns) said really be a consensus builder on the 
committee. The committee can often be very contentious, not only 
Republican-Democrat but even within the Democrats. Tom was always the 
person that was out there trying to bring us together on so many very 
important issues. I also saw him operate with the Hellenic Caucus. I do 
not know if that was mentioned tonight, but he worked very hard with 
the Greek community and he was a leader dealing with those issues as 
well. I really admired him for a long time. We worked on the Merchant 
Marine Committee together. He was always a person that was trying to 
help other Members of Congress, to help his colleagues at all times and 
do what was best for the country and for his State and for his 
district. Thanks again, also. I am going to miss you as well.
  Madam Speaker, I just wanted to take some time this evening, if I 
could, to essentially refute, if you will, some of the statements that 
were made earlier this evening in the special order that my colleagues 
on the Republican side of the aisle made on the issue of HMO reform. I 
have taken to the floor many times over the last few months to point 
out that I believe, and I think the evidence shows, that the Republican 
leadership of this House was very much determined not to bring a true 
HMO or managed care reform to the floor and essentially was very much 
under the influence of the insurance industry which still today does 
not want to see any real HMO reform. And so I was sort of, not shocked 
I would say but I was sort of displeased to see that in the waning 
hours of this Congress that the Republicans who put together the HMO 
bill that passed this House were actually trying, I think effectively, 
to defend their actions, because they know that the American public is 
clamoring for HMO reform.
  And so I will say two things tonight: One is the fact that the HMO 
reform bill was not even taken up in the other body, in the Senate, is 
a strong indication of the fact that from the beginning, the Republican 
leadership in both houses of Congress had no intention of really 
dealing with the issue of HMO reform. In addition to that, the 
Republican leadership over here bypassed all the committees, never 
allowed hearings, never allowed a markup of the HMO reform bill and at 
the 11th hour when it appeared that there was overwhelming support for 
the Democrats' patients' bill of rights, which was really sort of a 
bipartisan bill because we had some Republicans, also, that supported 
us, but when the patients' bill of rights, the real HMO reform bill, 
was gathering incredible strength and the Republican leadership felt it 
was necessary to address the issue in some form, they quickly brought 
up their HMO bill, brought it to the House floor, without hearings, 
without committee markup, and passed it very narrowly, I think by about 
five votes, and

[[Page H10902]]

sent it over to the Senate where it was never heard from again.

  Let me just point out some of the reasons why this Republican bill 
was not real HMO reform. I really am using as a source some of the 
criticisms that were made by one of the Republicans that I most admire, 
the gentleman from Iowa (Mr. Ganske), a Republican Member who was 
initially part of the Republican health care task force but became very 
much opposed to the Republican bill because he felt that the patients' 
bill of rights, the true HMO reform bill, was far superior and that 
what the Republicans were bringing to the floor in terms of HMO reform 
was not real and actually set us back. I just want to give some of the 
examples, some of the criticisms, if you will, that the gentleman from 
Iowa (Mr. Ganske) made.
  First, on the issue of medical necessity. The Democratic patients' 
bill of rights guarantees a review on the merits by outside experts as 
to whether a service or treatment is medically necessary. Under the 
Republican bill that was talked about tonight, the outside review is 
limited to determining whether the plan followed its own definition of 
medical necessity. The biggest problem that we face today with HMOs is 
that people are denied care, an operation, length of stay in a 
hospital, whatever it happens to be, because the insurance company 
determines that that procedure or extra day in the hospital is not 
medically necessary. Well, under the Republican bill, the insurance 
company gets to define what is medically necessary. All the review that 
my colleagues on the other side were talking about tonight, external, 
internal review, extends exclusively to the issue of whether or not the 
plan correctly defined by its own terms what was medically necessary. 
So basically the insurance company can still say, this is not medically 
necessary, this procedure, this operation was not medically necessary, 
and there is no change in the current law.
  Emergency room coverage. The Republican bill has only a watered-down 
version of the prudent layperson rule which means that managed care 
companies still have ways to get out of paying for their patients' 
emergency room visits. What we say in the Democratic bill is if the 
average person would think that the pain that they have necessitates 
their going to the emergency room, then the insurance company has to 
cover it. That is not true in the Republican bill. If, for example, you 
have severe pain and the insurance company decides that severe pain 
does not qualify for emergency room care in a given circumstance, then 
the insurance company will not pay for your emergency room bill. Again, 
there is really no progress, if you will. Everything is pretty much the 
same. It is like the status quo.
  Protecting doctors and nurses from HMO bureaucrats. The GOP bill does 
not help doctors and nurses to serve as advocates for their patients 
because it gives medical professionals no protection from the health 
care plan when they speak up for their patients. In other words, under 
the Republican bill, they can be penalized because they speak up for 
their patients, the health care professionals.
  Access to specialists. The Republican bill does not provide for 
ongoing access to specialists for chronic conditions such as multiple 
sclerosis and arthritis. Under the GOP bill, patients with chronic 
conditions cannot get standing referrals to specialists or designate 
specialists as their primary care providers. This is very important. 
One of the major points of the Democrats' patients' bill of rights is 
that you have access to a specialist. Many senior citizens say to me 
that that is the main reason that they are concerned about their HMOs, 
because they cannot get referrals to their specialist. Well, there is 
no guarantee of that under the Republican bill.
  Financial incentives to withhold health care. The Democratic 
patients' bill of rights ensures that health plans not place 
inappropriate financial incentives on providers to withhold care. On 
the other hand, the Republican bill is silent on that point. So, in 
other words, a big problem now under the current system is that the HMO 
gives a bonus, if you will, to physicians who essentially limit care. 
Well, that is not changed under the Republican bill. That is still 
possible under the Republican bill in most circumstances. The 
Democratic bill basically prevents that and corrects it and says you 
cannot have those financial incentives to the physicians.
  Special legal protections for HMOs. This is most important. Because 
of a Federal law known as ERISA, patients injured because their HMO 
delayed or denied treatment have very limited remedies. The patients' 
bill of rights, the Democratic bill, would permit States to set their 
own rules for such actions. The Republican bill passed by the House 
tinkers with but does not really fix this problem.
  I just wanted to mention that because my colleagues on the other side 
spent a lot of time tonight explaining that you would not have the 
right to sue under the Republican bill but they are going to establish 
some very exotic and bureaucratic process whereby you would have some 
kind of review with some sort of penalty to the HMO. It took them 
almost 15, 20 minutes to describe it. Well, the bottom line is that if 
I am denied care and I am seriously injured because I cannot get that 
care, I have no access to that care, I should be able to sue the HMO. I 
can sue the doctor. Why can I not sue the HMO if they are the ones who 
are making the decision about denial of care? I know my colleagues on 
the other side are saying, well, we do not need any more lawsuits. That 
may be true in general, we do not need as many lawsuits as perhaps we 
have, but do not tell the person who has been denied the care and 
suffered severe damages that they cannot sue and recover for the 
damages. All the machinations that were made tonight about how we are 
going to deal with this without having you have the right to sue to me 
were just essentially a bunch of garbage. It had to be explained in 
such detail that it almost sounded like another legal case to explain 
the process as opposed to having the right to sue.
  My point is again, there was never any attempt by this Republican 
leadership to come up with true HMO reform. We knew that from the 
beginning, when they delayed and delayed and delayed and finally when 
they brought a bill to the floor, they brought a bill to the floor that 
actually makes the situation worse for patients in managed care, in 
HMOs. In addition to that, and I do not know if they mentioned it 
tonight on the other side, there were a number of poison pills placed 
in that Republican HMO bill. I say poison pills because they were so 
controversial and unrelated to the issue of HMOs that they made it 
impossible for that bill to ever move forward. They knew that this was 
a bill that was not going to move forward and ultimately it did not 
move forward in the Senate. Those are things that are not necessarily 
bad. Some people like them and some do not.
  The issue of medical malpractice was placed in the bill to reduce the 
cap on damages. We have controversy in the House back and forth over 
whether or not that is a good thing. But it is so controversial that it 
guarantees, or essentially it is a poison pill to make sure that the 
bill never sees the light of day.

                              {time}  1845

  Now many of us on the Democratic side went over to the Senate last 
week, and we tried to get HMO reform brought up in the other body, and 
we were essentially gaveled down. There was a vote, and the Republicans 
made it impossible to bring this up.
  So we know that this issue is dead this year because the Republicans 
have refused to let it proceed. All their efforts tonight to try to 
suggest that somehow they really meant it and they were really trying 
to achieve some kind of HMO reform to me is simply not true because, if 
there was a real effort to do that, then they would have allowed the 
process to proceed, and this bill would not have been killed in the 
other body.
  Let me also say that for the those who think that somehow there is 
not some cynical aspect to all this, and I mentioned before that the 
insurance companies basically wanted to kill HMO reform, we have a 
document in here that talks about the Business Round Table that is 
basically financed by the health insurance industry that is beginning 
now a $2 million ad campaign thanking the Republicans in key House 
districts for their opposition to

[[Page H10903]]

HMO reform. Now basically these are the companies that spend millions 
of dollars successfully lobbying to kill any major health insurance 
reform a few years ago when the President put forward his plan. Well, 
now they are spending another $2 million to make sure that people, that 
Republicans are returned to Congress who will continue to oppose HMO 
reform.
  There is just some information here about how they are going about 
it, but this is a coalition and its member organizations from the 
health benefits coalition, and they are the ones that are essentially 
out there to make sure that Members are elected who are friendly to the 
health insurance industry and who will not be supportive of HMO reform.
  But I want to say this:
  This issue may be dead for this Congress, but it is not dead for the 
American people. This is the number one issue that Americans care 
about. It is the number one issue that is brought to my attention by my 
constituents, and I know that next year, when the new Congress begins, 
this issue is not going to go away, it is going to be out there as a 
significant issue once again. The public will be clamoring for reform 
because the problem is not going away. There is going to be more and 
more pressure, if you will, built up to do something about HMOs and to 
have these kind of patient protections.
  So let us just rest assured we are going to be here again to deal 
with this, and even if Members of Congress are elected on some sort of 
platform because of what they owe to the insurance industry, that, you 
know, they cannot support this, I guarantee that the public is going to 
clamor for these patient protections and we are going to be back once 
again fighting for the patients bill of rights to make sure that it is 
passed in the next Congress.

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