[Congressional Record Volume 145, Number 67 (Tuesday, May 11, 1999)]
[House]
[Pages H2971-H2974]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          MANAGED CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentlewoman from California (Ms. Woolsey) is 
recognized for 60 minutes as the designee of the minority leader.
  Ms. WOOLSEY. Mr. Speaker, we are going to speak today in our special 
order about managed care reform. To get started, I yield to my 
colleague, the gentlewoman from North Carolina (Mrs. Clayton).
  Mrs. CLAYTON. Mr. Speaker, I thank the gentlewoman from California 
(Ms. Woolsey) for yielding me this time; and I thank her for arranging 
this special order on the Patients' Bill of Rights. I also thank her 
for her leadership in this area.
  Mr. Speaker, there is a young woman in my district who attends East 
Carolina University. She is a student in the Allied Health Department. 
This young woman is no different than any other student at ECU. She has 
hopes, dreams, goals and ambitions. However, her hopes and dreams, her 
goals and ambitions are inhibited.
  She is a quadriplegic. The story of this young person, disadvantaged 
due to a disability, is not a new story, but this is a story that is 
distinct from others. This story is distinct because it could have been 
different. It could have been very different because if she had 
received the treatment she required she may have been able to avoid the 
complete paralysis that she must live with for the rest of her life. If 
she had received the treatment required, she may not have been a 
quadriplegic, which she is now.
  Why then, one may ask, did she not receive the proper treatment? The 
reason is that her neurologist, under pressure from her insurance 
provider, did not render the treatment.
  Mr. Speaker, let me share the words of this student. She states, 
``Eventually, I had the surgery, and they told me that if I had the MRI 
that my radiologist recommended, I would not be in the condition I am 
today.''
  She goes on to say, ``I feel that managed care, along with my 
neurologist, made a decision that changed my whole life.''
  Life-changing decisions are being made every day by those who count 
numbers and do not count individuals.
  Life-changing decisions are being made every day by those who put 
profit before people and the bottom line before the end result.
  Witness, for example, the father of another student in my district. 
This father, a veteran, faced terminal illness. While hospitalized, his 
family was informed that his HMO had instructed that he be removed to a 
nursing home within 24 hours. The family was out of town, and while 
grappling with the pain of a father's illness, they had to endure the 
pressure from the HMO.
  This father had defended the country when he had good health but now 
that he was down he could not defend himself. Worse, under current 
conditions, the country could not or would not defend him.
  Mr. Speaker, there are countless horrible stories like these. Perhaps 
that is why 22,000 citizens nationwide now have signed a petition 
demanding a change. Almost 2,000 of those persons came from the State 
of North Carolina. These persons recognize that it is fundamental that 
every citizen have access to doctors of their own choice.
  It is fundamental that every citizen have access to needed 
prescription drugs. It is fundamental that every citizen can appeal 
poor medical decisions, can hold health care providers accountable when 
they are wrongfully denied care and can get emergency care when 
necessary. The Patients' Bill of Rights Act, H.R. 358, provides these 
fundamental rights.
  A bill reported from the Senate, which is S. 326, does not provide 
these fundamental rights. Health care should be about curing diseases, 
not counting dollars and dimes. Medical treatment should be about 
finding remedies, not a rigid routine that puts saving money over 
sparing pain and suffering of human beings.
  Patients deserve service from trained, caring individuals; not 
narrow-thinking persons more interested in crunching numbers than 
saving lives.
  The Patients' Bill of Rights Act effectively provides a panoply of 
basic and fundamental rights to patients.
  The other managed care reform bill, passed by the Senate, does not.
  The Patients' Bill of Rights Act provides real choice. The other bill 
does not.
  The Patients' Bill of Rights provides access. The other bill does not 
provide comparable access.
  The Patients' Bill of Rights Act provides open communication. The 
Senate committee-passed bill does not.

                              {time}  1945

  Mr. Speaker, these are not radical rights, these rights are very 
basic and fundamental. Legislation of this type is needed and necessary 
because 60 percent of the American people living in this country do not 
have protection that will give them patient protection regulations.
  The Patients' Bill of Rights Act simply provides minimum standards 
for the protection of patients in managed care. I am proud to be a 
cosponsor of the Patients' Bill of Rights Act. I am proud to join my 
colleague today in this special order, and I urge and encourage all the 
citizens to continue to sign onto the Internet, but more importantly, I 
urge my colleagues to make sure they support the Patients' Bill of 
Rights Act. We must change the way we provide health care, and we must 
respect the Patients' Bill of Rights Act.
  Again, I thank my colleague for providing me the opportunity and 
arranging this special order.
  Ms. WOOLSEY. I thank the gentlewoman for being here. I would like to 
point something out that the gentlewoman will find sad and yet 
interesting.
  As far back as 1997, the Henry J. Kaiser Foundation and Harvard 
University School of Public Health had a study. One of their questions 
asked was, in the past few years, did they or someone they know have an 
HMO or managed care plan deny treatment or payment for something a 
doctor recommended.
  Like the young woman the gentlewoman referred to earlier, the answer 
from 48 percent of the participants was, yes, denied care that was 
necessary from an HMO or a managed care plan. That 48 percent 
represents 96 million people who have had problems with health care, or 
know of someone who has. That is why we are here tonight. I thank the 
gentlewoman very much for coming and being part of this.
  Mr. Speaker, 5 years ago the Republicans defeated President Clinton's 
health care reform bill. They claimed it would allow the Federal 
Government to interfere with doctor-patient relationships. Yet, when 
that same relationship between a doctor and a patient was threatened by 
a corporate bureaucracy, the managed health care industry, Republicans 
last year offered legislation that did absolutely nothing to protect 
the sanctity of choices made by doctors and their patients.
  It is the same story in the 106th Congress. Democrats have been 
waiting for 2 years to pass the Patients' Bill of Rights Act, the bill 
that is outlined here on this board. Right now we are ready to work to 
improve Americans' access to quality health care. There must be 
enforceable rights to make consumer protections real and meaningful for 
all Americans.
  Many States have passed legislation making a patchwork of 
protections. This patchwork does not provide a good fix for over 175 
million Americans who need the Patients' Bill of Rights Act to be 
passed. We must remember, when we are talking about the Patients' Bill 
of Rights Act and managed care, that three of four people are in the 
managed care system.

[[Page H2972]]

  While there are many top notch managed care organizations, 
particularly in my own district, I represent Marin and Sonoma Counties, 
just north of the Golden Gate Bridge in California, there are good 
managed care systems in that part of this country, but we hear too many 
horror stories across the rest of this country.
  Doctors tell us the real life horror stories. They tell us about how 
they are gagged by insurance companies that dictate what they can tell 
their patients about their treatment options. They tell us that a 
patient's treatment decisions are often overruled by an insurance 
clerk, and that often patients are denied a specialist's care, or 
patients are shuttled out of a hospital before they are fully or 
adequately recovered and ready to go home.
  Americans are demanding that the Republican leadership take real 
action and take it now, but instead, today, the Republican leadership 
has legislation that does not provide better patient access to quality 
care, nor does the Republican bill provide an independent external 
appeals process to review complaints when a patient's life or health is 
jeopardized.
  Further, the Republican legislation does not ensure that patients 
have the right to see a specialist, nor does it prevent insurance 
companies from continuing to send women home after a mastectomy early, 
against the advice of their doctors and their health care providers. As 
important as all the rest, lastly, under the Republican bill, patients 
do not have the right to sue for damages.
  In the final analysis, the Republican bill will do little to prevent 
medical decisions from being made by insurance companies instead of by 
doctors. What our country needs is the Patients' Bill of Rights Act. 
This legislation will make certain that doctors and patients are free 
to make decisions about health.
  The Patients' Bill of Rights Act will ensure that patients have the 
right to openly discuss all of their treatment options with their 
doctors. The Patients' Bill of Rights Act provides patients access to 
important health care specialists, and allows specialists to be primary 
care providers.
  Under the Patients' Bill of Rights Act, patients have the right to 
receive uniform information about their health plan, go to the 
emergency room when the need arises, provide continued care to patients 
when a doctor leaves a plan, and seek remedy from the courts when 
claims have been unfairly denied.
  It is time to put doctors and patients back in charge of our health 
care system, and it is time for Congress to get out of the pocket of 
the managed care industry. The Republicans have the managed care 
industry on their side. They know it. But the Democrats have the 
support of the American people, and that is what counts.
  I urge the Speaker, I urge all of my colleagues, to listen to what 
the people in this Nation are saying. They want a Patients' Bill of 
Rights Act, and they want it now.
  Mr. Speaker, I yield to my colleague, the gentleman from Connecticut 
(Mr. Maloney).
  Mr. MALONEY of Connecticut. Mr. Speaker, I thank the gentlewoman from 
California (Ms. Woolsey) for yielding to me.
  Mr. Speaker, I rise today to express my strong support for H.R. 358, 
the Patients' Bill of Rights Act of 1999. Last year we came within 5 
votes of adopting this strong, meaningful patients' protection 
legislation, legislation that would have assured access to medically 
necessary care for patients, that would have prevented inappropriate 
interference in the doctor-patient relationship, and guaranteed timely, 
independent external appeals when plans inappropriately deny care.
  Unfortunately, our efforts to reestablish patient health as the 
primary focus of health plans were blocked by the partisan leadership 
opposed to reform. Their alternative bill, which was denounced by the 
American Medical Association as a sham, barely squeaked through this 
House, and was not even brought up for debate in the other body.
  The partisan obstructionists had hoped that this issue would go away, 
but the real problems besetting patient care by HMOs still exist, and 
momentum for real change continues to build.

  Although many States, including my home State of Connecticut, have 
enacted reforms to provide basic protections to patients, the Federal 
ERISA law exempts a significant segment of the insured population from 
the reach of those State laws.
  About 40 percent of the total American population is left 
unprotected. Consequently, millions of Americans are covered by managed 
care plans who do not have to meet any quality standards whatsoever. 
Indeed, 122 million Americans are not guaranteed any enforceable 
patient protections.
  In Connecticut alone, more than 1.7 million people are relegated to 
second-class medical care citizenship by the ERISA law and the failure 
of the Congress to enact meaningful reform. Each day that reform 
efforts are delayed, more patients will unjustly suffer from adverse 
decisions about their coverage.
  It is time to enact a comprehensive set of strong, enforceable 
patient protections that will guarantee quality health care for all 
Americans. The Patients' Bill of Rights Act of 1999 would do just that. 
I am proud to be a cosponsor of this critical managed care reform 
legislation.
  Let me stress five key provisions.
  First, among other things, the bill would guarantee that if a patient 
has an emergency, hospital services would be covered by their plan. The 
bill says that individuals must have access to emergency care without 
prior authorization in any situation that a prudent layperson would 
regard as an emergency.
  Second, patients with special conditions must have access to 
specialists who have the requisite expertise to treat their problem. 
The Patients' Bill of Rights Act allows for referrals for patients to 
go outside of their plan's network for specialty care at no extra cost 
to the patient if there is no appropriate provider inside the plan.
  Third, the Patients' Bill of Rights Act provides important 
protections specific to women in managed care: Direct access to OB-GYN 
care and the ability to designate an OB-GYN physician as a primary care 
provider. The proposal also provides protection regarding mastectomy 
length of stay.
  Fourth, prescription medications must be reasonably available. For 
plans that use a formulary, a standard list of prescription drugs, our 
legislation says beneficiaries must be able to access medications that 
are not on the formulary when the prescribing physician dictates those 
medicines for sound medical reasons.
  Fifth and finally, individuals must have access to an external 
independent body with the capability and authority to resolve disputes 
for cases involving a denial of service which the patient's doctor 
determines is medically necessary, or for other cases where a patient's 
life or health is put in jeopardy.
  In the Patients' Bill of Rights Act, States and the Department of 
Labor must establish an independent external appeals process for the 
plans under their respective jurisdictions. The plan pays the cost of 
the process, and any decision is binding on the plan.
  Americans need and deserve these protections, protections which have 
been endorsed by the American Medical Association and the American 
Nurses Association, and 168 other major health and business 
organizations.
  I urge my colleagues to support and pass the Patients' Bill of Rights 
Act of 1999, the real Patients' Bill of Rights Act.
  Ms. WOOLSEY. Mr. Speaker, I thank the gentleman for coming. I was 
wondering if the gentleman would like to consider with me the 
importance of this bill, H.R. 358, based on some data that we have.
  We all know that the way that most Americans obtain and paid for 
health care has drastically altered in the last few years, because a 
decade ago fewer than three out of ten health insurance companies were 
in managed care, three out of ten. Today more than three out of four 
people are in managed care plans.
  So while managed care has been successful, it has slowed down the 
increase of health costs temporarily, at least, this change has been 
quite unsettling, and therefore, that is why consumers are clamoring 
for a Patients' Bill of Rights Act that will control managed care 
providers.
  Mr. MALONEY of Connecticut. They are indeed clamoring for action by 
the Congress. I regularly hold what we call

[[Page H2973]]

neighborhood office hours on Saturdays outside of a shopping center, 
and not a Saturday goes by when I hold those office hours but one or 
more people in a short period of time, an hour or an hour and a half, 
will come up and tell me one more horror story about problems that they 
have had.
  It is clear that managed care has had some benefits in controlling 
costs. The problem is that there are no rules for managed care. There 
are rules for how lawyers practice law, there are rules for how 
security agents practice security transactions, there are rules for 
real estate agents, there are rules for our local plumber, but there 
are no rules for managed care, and in fairness to the American public, 
there need to be a set of minimum guarantees, rules, for managed care.
  Ms. WOOLSEY. And without those rules, the good managed care providers 
are having to slip and slide to the bottom of the rung of the ladder 
with the poorer providers, because they cannot compete in the 
marketplace. That is why we are here, and that is why we so support the 
Democrats' Patients' Bill of Rights Act, H.R. 358.

                              {time}  2000

  One of the other reasons we support it so strongly is that, as of 
last summer, 1998, not one State had passed a comprehensive set of 
protection consumer laws. So leaving it up to each State will not make 
the grade. It will not help consumers.
  As a matter of fact, Vermont has enacted the greatest number of 
protections, 11; and South Dakota, the fewest, none. Sixteen States 
have enacted between five and 16 protections. The State I live in, 
California, makes the mark on six patient protections and misses the 
mark on seven of the key protection areas. Thirty-three States have 
enacted between one and four of these protections.
  About 30 percent of Americans with employer-provided plans, which is 
about 51 million people, are in self-insured plans. Self-insured plans 
are preempted from patient protections established by State laws. So 
what does that tell us? We are not protecting people under the managed 
care plans.
  Americans who have health insurance provided by their employers, of 
those Americans, 83 percent or 124 million Americans cannot seek 
remedies for wrongful denials of health care.
  So I want to make it clear that all of these individuals who are not 
able to seek remedy would benefit from meaningful Federal remedies and 
a good health care safety plan and one that would protect American 
citizens. By the way, when the gentleman from Connecticut (Mr. Maloney) 
was talking about what was going on, it is clear to me that if we do 
not do something very soon, the public, even those of how many millions 
that are covered, 124 million Americans who are covered by their 
company's health care plan, they, too, are worried about what health 
care means to them and where is it going to go when they pay more and 
get less.
  I think we are getting ever so much closer to a national health care 
system because we are being ever so irresponsible in providing good 
health care to the people of this Nation. A good health care reform 
plan like the Patients' Bill of Rights can protect them and may make 
that difference.
  Mr. CUMMINGS. Mr. Speaker, I rise today in support of placing the 
reigns of health and well-being back where they belong--in the hands of 
the patient.
  Sadly, over 50% of Americans believe that with the advent of managed 
care, the quality of health care has declined. The root of this 
dissatisfaction is the fear that they are powerless and unprotected in 
the face of possible violations of their rights.
  The solution: A bill of rights.
  When drafting our nation's Constitution, our forefathers were 
concerned about protecting individual rights. As such, they had the 
insight to enact a Bill of Rights, guaranteeing freedom of religion and 
speech, protection against unreasonable search and seizure, and 
subsequently outlawing slavery and providing people of color and women 
the right to vote. These built-in Constitutional checks and balances 
were included to keep the government from becoming too powerful and 
unresponsive to the will of the people.
  Well, we are currently witnessing a period in which managed care has 
become unresponsive to the will of the people. To date, over 22,000 
persons have signed a petition calling for patients' rights. And as 
lawmakers, we have a duty to provide checks and balances to guarantee 
our nation's patients the right to quality health care.
  A Patients' Bill of Rights should include: Access to specialists, 
emergency care, and reproductive services; the right to appeal or seek 
legal redress on HMO decisions; guaranteed transitional care; 
physicians and patients determining what care is medically necessary; 
and expanded access to prescription drugs and clinical trials.
  Enactment of these provisions is a critical and essential step 
towards fulfilling our duty to our citizens and creating the health 
care safety net that they deserve.
  Let's adopt the insight of our forefathers who believed that all 
citizens had the right to life, liberty and the pursuit of happiness.
  Let's enhance these rights by renewing our citizens' sense of 
empowerment in their own health and welfare.
  Pass H.R. 358, the Patient's Bill of Rights.
  Mr. VENTO. Mr. Speaker, I rise today in support of H.R. 358, the 
Patients' Bill of Rights. I'm pleased to have joined as a cosponsor of 
this measure. This important legislation reaffirms Congress' commitment 
to address the fundamental health insurance concerns of America's 
workers. More importantly, it recognizes that quality, access and 
protection should be the basic cornerstones of our health care system.
  As possibilities of higher costs or burgeoning numbers of uninsured 
workers arise, there is too often a reluctance to enact important 
changes in our national health care policy. However, without managed 
care reform, we will see a continued decline in the scope and 
effectiveness of health care coverage for millions of Americans.
  Since a growing number of Americans get their health insurance 
through managed care plans, and since managed care is premised on the 
ability to contain costs, an important impetus for the Patient's Bill 
of Rights has been the prevalence of underinsurance. Americans are 
underinsured when they are denied medically necessary treatment, and 
have no form of recourse. Americans are also underinsured if they are 
unable to see necessary providers or have insufficient coverage 
options.
  The patient's health care bill of rights establishes a framework of 
appeals to encourage fairness and expeditious review, while 
acknowledging that women, children and patients with special needs 
should have common sense access to specialty care. Furthermore, it 
seeks to prevent the interference of managed care in medical decisions, 
which adversely impacts the quality of care and helps destabilize the 
doctor-patient relationship.
  Mr. Speaker, managed care has been an important innovation attempting 
to stretch the health care funding to cover more needs, but managed 
care policy needs balance, a voice for the patient and medical 
personnel. Furthermore, states cannot affect many interstate insurance 
programs under the authority of ERISA. Only national policy can address 
the deficiencies of such multi-state insurance programs.
  It is unfortunate that we continue to subordinate significant reform 
to uncertain financial consequences. It is unfortunate that we continue 
to allow a slow erosion of health care coverage at the expense of some 
of our most vulnerable workers and their families. As the world's 
wealthiest nation, equity and quality should be the unquestioned 
foundation of our health care system. I urge my colleagues to support a 
sound Patients' Bill of Rights this session.
  Mr. VISCLOSKY. Mr. Speaker, as my colleagues have pointed out, access 
to emergency care is one of the most important issues in the managed 
care debate. Protection during medical catastrophes--the confidence 
lent by knowing that we have a doctor, and have access to quality 
medical care--is one of the primary reasons we buy health insurance. We 
want to make sure that if someething happens to us or our family, we 
will be covered. It is an unjust shock to insurance-holders when their 
time of need comes, and they rush themselves or their loved ones to an 
emergency room, only to have their insurance company tell them that 
because they did not have the medical knowledge to foretell the true 
extent of the emergency, their medical care will not be covered.
  It is clear why insurance companies have these policies; emergency 
care is the most expensive type of medical attention available. It 
requires 24-hour staffing and resources that must be instantaneously 
available for any incident. But the fact is that people buy health 
insurance because they know they could not afford to pay for medical 
care out of pocket if they needed extensive treatment. Emergency care 
is one of those treatments that is just too expensive to pay for up 
front. However, if multi-million dollar corporations cannot afford this 
care, surely private individuals who are also paying their monthly 
health insurance premiums cannot either.
  Managed care companies' continuing denials of emergency care are 
changing the face

[[Page H2974]]

of health care in a very broad way. What happens when insurance 
companies refuse to pay for treatment is that, often, it just doesn't 
get paid. The debate over instituting a prudent layperson standard for 
emergency care does not just involve patients and insurance companies, 
it inolves hospitals, as well. Hospitals are already required to treat 
uninsured patients out of their emergency rooms, and lost millions of 
dollars doing so. When we let insurance companies impose arbitrary 
limits on the type of emergency care they will cover, we essentially 
increase the population of uninsured that hospitals are required to 
serve. The number of uninsured individuals in this country is already a 
problem; we surely do not need to allow insurance companies to create 
another population of ``pseudo-insured,'' whose insurance premiums are 
never passed on to the health care providers.
  In addition to this overarching change in the relationship between 
patients, hosptials and insurance companies, denials of emergency 
claims are also changing health care in a more personal way. Emergency 
rooms, aware of the unfunded liability posed by the pseudo-insured, are 
treting patients differently.
  For example, I was contacted by one woman in Northwest Indiana, whom 
I shall refer to as Louise. She is not a member of a health maintenance 
organization (HMO). However, when she rushed her seven-year-old som to 
the emergency room with a broken arm, she was not able to stop home 
first and pick up her insurance card. The hospital, again aware that if 
it did not follow protocol it could be left with the bill, protected 
itself by acting on the assumption that she was in an HMO. The 
Emergency Room doctor tried to get prior authorization to run several 
diagnostic tests on the boy, who had fallen from a slide and was having 
abdominal pain in addition to the pain in his arm. He could not. But 
the denial did not come about becasue it was immediately obvious that 
there was a confusion about the insurance. Louise's participation in 
the HMO was not questioned. Rather authorization was denied and Louise 
was instead told to drive her son to a clinic thirty miles away. When 
the doctor attending to the boy at the emergency room objected, he was 
told that, because the bone was not sticking out of the skin, Louise 
was expected to sign a form assuming all responsibility for the boy's 
condition and drive him to the clinic. Instead, Louise agreed to pay 
for the tests out of pocket, thinking that the insurance company would 
surely pay for treatment if the tests proved it was necessary. She was 
wrong. By the time the emergency room physician reviewed the x-rays and 
tests and found that the boy's arm was broken at a greater than 45-
degree angle, the clinic to which he had been referred had closed. When 
the emergency room physician again asked for permission to set the arm, 
Louise was told to go home and bring the boy to an orthopedic 
physician's office at the clinic in the morning, fourteen and one-half 
hours later. She was encouraged to carefully monitor her son's finger 
circulation and sensation, because if there was further loss of 
circulation or it the bone broke through the skin she would have to 
take him back to the emergency room. Louise could not believe the 
treatment her son was receiving. At this point, when her son had been 
lying on his back with a broked arm for five hours, the confusion over 
Louise's, insurance was cleared up, and her son's arm was finally 
treated.
   Managed care organizations' unfairly limiting patients' access to 
emergency care is having a ripple effect on our health care system, and 
it has to stop. Reasonableness must be introduced into the health 
insurance system. It is reasonable for an insurance-holder to go to the 
emergency room, the emergy care must be covered. If the treatment 
prescribed by a licensed medical practitioner is reasonable, that must 
be covered as well. Letting profit-seeking obscure the basis 
understanding in health insurance--that you buy health insurance to pay 
for your health care--is wrong. The Patients' Bill of Rights, which 
would institute a ``prudent layperson'' standard for emergency care, 
will go a long way toward making it right.
  Mr. FILNER. Mr. Speaker, here we go again! Once again, we hear that 
the Republican party wants real managed care reform, but what we see 
coming to us in legislation from your party is just a shell offering 
few real patient protections.
  The bill Republicans tout as their solution to the pleas we hear from 
our constituents--many of whom have been the victims of harmful 
decisions meted out by managed care administrators--makes its mark by 
its failings.
  Rather than protect patients, the Republican bill should be more 
correctly titled the ``Insurance Industry Protection Act.'' The bill 
leaves medical decisions in the hands of insurance company accountants 
and clerks, instead of doctors; fails to provide access to care from 
specialists; fails to provide continuity in the doctor-patient 
relationship; fails to provide an effective mechanism to hold plans 
accountable when a plan's actions or lack of action injures or kills 
someone; fails to respect doctors' decisions to prescribe the drugs 
they believe would provide the best treatment; fails to prevent plans 
from giving doctors financial incentives to deny care; and allows 
health maintenance organizations to continue to penalize patients for 
seeking emergency care when they belief they are in danger.
  Most importantly, the Republicans' bill will not even provide its 
``shell'' protection to more than 100 million of the American people--
it fails to cover two-thirds of all privately insured people in the 
United States.
  As you can see, the Republicans' bill has many failings! On the other 
hand, Senate Bill 6 and H.R. 358, part of the 1999 Families First 
(Democratic) Agenda, will deliver real protections to millions of 
American families. These bills, which have the backing of dozens of 
consumer groups, include these vital protections--and more. They 
provide a vital mechanism for a timely internal and independent 
external appeals process--an essential tool when someone's life is in 
the balance! But the Republicans' bill is deliberately deceiving--it 
was introduced in the Senate after the Democratic-sponsored bill that 
contains real safeguards (and is also co-sponsored by Senate 
Republicans,) yet those promoting this ``protection-in-name-only'' bill 
gave it the same name, ``The Patients' Bill of Rights.''
  The Republicans and the high-powered health insurance industry are 
trying to scare everyday working Americans, telling them if Congress 
mandated the protections that the Republicans left out--and which are 
contained in the Democrats' bill--then health care premiums would 
increase. The non-partisan Congressional Budget Office, however, 
estimates that each person would only pay $2 a month more for the 
protections in the Democrats' bill.
  The reality is that the cost of the Republican bill is too high.
  It would continue the present system of administrators making health 
care decisions, exposing countless more people to inadequate care that 
could injure or kill them; it would force Americans to pay their own 
emergency room bills unless a doctor or nurse first told them to go 
there; and it would fail to allow doctors to freely practice medicine 
without the constraints of gag rules or limitations on prescription 
drugs.
  Two dollars a month for these important patient protections is a 
reasonable cost for access to quality care!
  Let us stop this destructive game of trying to convince people that 
they are better off with a reform bill that is ``reform'' in name 
only--that lacks the substance and real protections! To offer so-called 
``protections'' with few safeguards to back them up is a deadly game we 
should not be playing!

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