[Congressional Record Volume 145, Number 54 (Tuesday, April 20, 1999)]
[Senate]
[Pages S3919-S3920]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SPECTER (for himself, Mr. Graham, Mr. Cochran, and Mr. 
        Robb):
  S. 836. A bill to amend the Public Health Service Act, the Employee 
Retirement Income Security Act of 1974, and the Internal Revenue Code 
of 1986 to require that group health plans and health insurance issuers 
provide women with adequate access to providers of obstetric and 
gynecological services; to the Committee on Health, Education, Labor, 
and Pensions.


               access to women's health care act of 1999

  Mr. SPECTER. Mr. President, I have sought recognition to discuss an 
issue of great importance, and an issue on which I believe we can all 
agree. Regardless of health insurance type, payer, or scope, it is 
critical that women have direct access to caregivers who are trained to 
address their unique health needs. To help us ensure that all women 
have direct access to providers of obstetric and gynecological care 
within their health plans, I am joined by Senator Bob Graham in 
introducing the ``Access to Women's Health Care Act of 1999.'' This 
legislation will allow women direct access to providers of obstetric 
and gynecological care, without requiring them to secure a time-
consuming and cumbersome referral from a separate primary care 
physician. Senator Graham and I are also pleased to have Senators 
Cochran and Robb as original cosponsors of this vital legislation. I 
would like to extend thanks to the American College of Obstetricians 
and Gynecologists, whose members have worked diligently with Senator 
Graham and myself in crafting this bill.
  While many managed care plans provide some form of direct access to 
women's health specialists, some plans limit this access. Other plans 
deny direct access altogether, and require a referral from a primary 
care physician. Under the ``Access to Women's Health Care Act of 
1999,'' women would be permitted to see a provider of obstetric and 
gynecological care without prior authorization. This approach is 
prudent and effective because it ensures that women have access to the 
benefits they pay for, without mandating a structural change in the 
plan's particular ``gatekeeper'' system.

[[Page S3920]]

  It is important to note that 37 states have enacted laws promoting 
women's access to providers of obstetric and gynecological care. 
However, women in other states or in ERISA-regulated health plans are 
not protected from access restrictions or limitations. For many women, 
direct access to providers of obstetric and gynecological care is 
crucial because they are often the only providers that women see 
regularly during their reproductive years. These providers are often a 
woman's only point of entry into the health care system, and are 
caregivers who maintain a woman's medical record for much of her 
lifetime.
  I believe it is clear that access to women's health care cuts across 
the intricacies of the complicated and often divisive managed care 
debate. During the past few years, Congress has debated many proposals 
which attempt to address growing problems in managed health care 
insurance. These proposals have been diverse, not only in their 
approach to the problems, but in the scope of the problems they seek to 
address. Most recently, during the 105th Congress, the House of 
Representatives passed a managed care reform proposal which, among many 
other reforms, included provisions requiring health plans to allow 
women direct access to obstetrician/gynecologists which participate in 
the plan. I would also note that this direct access provision has been 
included, in varying forms, in all of the major managed care reform 
proposals introduced in the Senate this year, including the bipartisan 
managed care reform bill, the ``Promoting Responsible Managed Care Act 
of 1999'' (S. 374), which I cosponsored. It is for these reasons that I 
offer this legislation today.
  Only through bipartisanship and consensus-building can we come to an 
agreement on the difficult issue of addressing managed care reform. I 
believe that cutting through the cumbersome gatekeeper system to ensure 
women have access to the care they need is a good place to start, and I 
urge swift adoption of this legislation.
  Mr. GRAHAM. Mr. President, I rise today, along with Senators Specter, 
Cochran and Robb, to introduce the Access to Women's Health Care Act of 
1999. This important legislation would provide women with direct access 
to providers of obstetric and gynecological services. It is critical 
that women have direct access to health care providers who are trained 
to address their unique health care needs.
  Women's health has historically received little attention and it is 
time that we correct that. An obstetrician/gynecologist provides health 
care that encompasses the woman as a whole patient, while focusing on 
their reproductive systems. Access to obstetrician/gynecologists would 
improve the health of women by providing routine and preventive health 
care throughout the woman's lifetime. In fact, 60 percent of all visits 
to obstetrician/gynecologists are for preventive care.
  According to a survey by the Commonwealth Fund, preventive care is 
better when women have access to obstetrician/gynecologists. The 
specialty of obstetrics/gynecology is devoted to the health care of 
women. Primary and preventive care are integral services provided by 
obstetrician/gynecologists. Complete physical exams, family planning, 
hypertension and cardiovascular surveillance, osteoporosis and smoking 
cessation counseling, are all among the services provided by 
obstetrician/gynecologists. For many women, an obstetrician/
gynecologist is often the only physician they see regularly during 
their reproductive years.
  Congress, so far, has been more reluctant to ensure direct access to 
women's health care providers than states. Thirty-seven states have 
stepped up to the plate and required at least some direct access for 
women's health care. We should commend these states for their efforts 
and work together so that women across the nation are afforded this 
important right.
  I hope that with the help of my colleagues in Congress we will be 
able to improve women's health, by increasing their access to providers 
of obstetric/gynecological care. This provision has been included in 
varying forms in many of the managed care reform proposals this 
Congress.
                                 ______