[Congressional Record Volume 145, Number 77 (Wednesday, May 26, 1999)]
[House]
[Pages H3685-H3690]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        CALLING ON LEADERSHIP TO BRING UP HMO REFORM LEGISLATION

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Madam Speaker, it is very important that we keep up the 
pressure in this House to pass HMO reform.
  Despite the overwhelming support among the American people for HMO or 
managed care reform, the Republican leadership continues to let the 
issue languish. We still have no indication when or even if they will 
allow the Patients' Bill of Rights to come to the House floor for a 
vote.

                              {time}  2045

  The reason for this activity is the same as it was last year. The 
Republican leadership cannot figure out how they can pass a good 
managed care bill without alienating the insurance agency.
  So instead of doing what is right and best for the American people, 
they are once again appeasing the insurance industry and hoping an 
answer to this problem will magically fall from out of the sky.
  Unfortunately, Madam Speaker, as the leadership sits and waits and 
does nothing, the shortcomings of the system continue to forever change 
the lives of countless Americans. We need only to turn on the TV or 
open the newspaper to see this.
  I would like to use one example here tonight, and that is the issue 
of emergency room care. Earlier this month, USA Today ran an editorial 
on this issue. It was called ``Early Last Year'' starts the editorial.
  It mentions that a Seattle woman began suffering chest pains and 
numbness while driving. The pain was so severe that she pulled into a 
fire station seeking help only to be whisked to the nearest hospital 
where she was promptly admitted.
  To most, that would seem a prudent course of action, but not to her 
health plan. It denied payment because she did not call the plan first 
to get preauthorized, according to an investigation by the Washington 
State Insurance Commissioner.
  I mentioned this editorial, Madam Speaker, as an example of the 
problems people have with their HMOs in terms of access and paying to 
for emergency room care.
  Let me just go on to talk about this editorial again. The editorial 
says that this incident is typical of the enumerable bureaucratic 
hassles patients confront as HMOs and other managed care companies 
attempt to control costs.
  But denial of payment for emergency care presents a particularly 
dangerous double-whammy. Patients facing emergencies might feel they 
have to choose between putting their health at risk and paying a huge 
bill they may not be able to afford.
  The editorial in USA Today goes on to suggest a solution to the 
problem, noting that a national prudent layperson standard law covering 
all health plans would help fill in the gaps left by the current 
patchwork of State and Federal laws.
  Democrats have been basically making this point about managed care 
for a long time. We know that people have had problems with their HMOs 
if they need to use an emergency room either because they are told to 
go to a hospital emergency room a lot further away from where they live 
or where the accident occurred, or, as in this case that I just 
mentioned, the actual payment afterwards is denied because they did not 
seek preauthorization, which seems nonsensical certainly in the context 
of emergency room care.
  One only goes to an emergency room if it is an emergency. If one has 
to get preauthorization for it, it really is not an emergency. That is 
the dilemma that more and more Americans face, that their HMO plan does 
not cover emergency room care.
  The Democrats, in response to this, have introduced a bill called the 
Patients' Bill of Rights. Basically what we do in the Patients' Bill of 
Rights is say that the prudent layperson's standard applies.
  In other words, if the average person, the average, prudent person, 
if you will, decided that they had chest pains or they had a problem 
that necessitated going to the local emergency room, then they can go 
to the emergency room that is closest by, and the HMO has to pay, has 
to compensate for that care, has to pay for that emergency room care.
  In the last Congress, we, the Democrats, tried to bring up the 
Patients' Bill of Rights. The Patients' Bill of Rights provides a 
number of patient protections, not just the emergency room care, but 
access to specialists.
  It basically applies the principle that says, if particular care is 
necessary, medically necessary, and in the opinion of one's doctor is 
medically necessary, then it is covered; and the HMO has to cover that 
particular type of care.
  In the last Congress, the Republican leadership did not hold a single 
hearing on the Patients' Bill of Rights or even on an alternative 
managed care bill that they had proposed.
  So what we had to do, basically, was to seek what we call a discharge 
petition. We had to have a number of our colleagues come down to the 
well here and sign a discharge petition that said that the Patients' 
Bill of Rights should be allowed to come to the floor.
  As we reached the magical number that was necessary in order to bring 
the Patients' Bill of Rights to the floor, the Republican leadership 
finally decided that they would bring their own managed care reform 
bill to the floor. In the context of that, we were allowed to bring up 
the Patients' Bill of Rights.
  I think we are going to have to be forced to do that again. Basically 
in this session of Congress, even though the Patients' Bill of Rights 
have been reintroduced and even though there are some Republican 
managed care reform proposals, so far, the Republican leadership has 
refused to bring up HMO reform, either their bill, which is not as 
good, or the Patients' Bill of Rights, the Democratic bill.
  So what we have had to do again, and starting tomorrow, is to file a 
rule allowing for a discharge petition to be brought up and have as 
many Members of Congress come down to the well again in a couple of 
weeks and sign this discharge petition in order to force the Republican 
leadership to bring the Patients' Bill of Rights to the floor.
  It should not be that way. It should not be necessary that, in order 
to achieve HMO reform, that we have to sign a petition as Members of 
Congress to bring it up. It simply should be brought up in committee. 
There should be hearings. It should be voted on in committee to come to 
the floor. But so far, we have nothing but stalling tactics from the 
Republican leadership.
  I mentioned the example of emergency room care. But there are a lot 
of other examples that we can mention about why we need patient 
protections, why we need the Patients' Bill of Rights.
  Let me just give my colleagues another example, though. We have a 
Democratic Task Force on Health Care, which basically put together the 
Patients' Bill of Rights. We had some hearings on the Patients' Bill of 
Rights in the context of our Democratic Health Care Task Force because 
we could not get hearings in the regular

[[Page H3686]]

committees of the House because of the opposition from the Republican 
leadership.
  I just wanted to mention another example because I think it is one of 
the most egregious that came before us when we had this hearing. We 
invited a Dr. Charlotte Yeh, who is a practicing emergency physician at 
the New England Medical Center in Boston, to the hearing that we had. 
She provided a number of examples of the effects that the managed care 
industries approach to emergency room care is having on patients, 
including one from Boston.
  She told our task force about a boy whose leg was seriously injured 
in an auto accident. At a nearby hospital in Boston, emergency room 
doctors told the parents he would need vascular surgery to save his leg 
and that a surgeon was ready at that hospital to perform the operation.

  Unfortunately for this young man, his insurer insisted he be 
transferred to an in-network hospital for the surgery. His parents were 
told, if they allowed the operation to be done anywhere else, they 
would be responsible to the bill. They agreed to the move. Surgery was 
performed 3 hours after the accident. By then, it was too late to save 
the boy's leg.
  Dr. Yeh went on to express her very strong support to making the 
prudent layperson's standard the national standard for emergency room 
care. As I said before, basically the prudent layperson's standard 
says, if one does go to the emergency room to seek treatment under 
conditions that would prompt any reasonable person to go there, one's 
HMO would pay for it.
  But in addition to the prudent layperson's standard, Dr. Yeh also 
emphasized the need to eliminate restrictive prior authorization 
requirements and the establishment of post-stabilization services 
between emergency physicians and managed care plans.
  The Patients' Bill of Rights includes all of these types of 
provisions. If I could for a minute, Madam Speaker, just run through 
some of the protections that are included in the Patients' Bill of 
Rights, it guarantees access to needed health care specialists, very 
important. It provides, as I said, access to emergency room services 
when and where the need arise. It provides continuity of care 
protections to assure patient care if a patient's health care provider 
is dropped.
  It gives access to a timely internal and independent external appeals 
process. Let me mention that for a minute. If one is denied care right 
now because one's HMOs decides that they will not pay for it, one of 
the things that my constituents complain to me about is that they have 
no way to appeal that decision other than internally within the HMO.
  So if the HMO decides, for example, that a particular type of 
treatment is not medically necessary or that one does not have to stay 
in the hospital a couple more days, even though one's doctor thinks 
that one should be staying there, or a number of other things that they 
consider not medically necessary, well, most of the times, under 
current law, there is no appeal other than to the HMO itself; and they 
of course routinely deny the appeal because, for them, it is largely a 
cost issue.
  What we are saying in the Patients' Bill of Rights is that that 
person should be able to go to an external appeal, someone outside the 
HMO, or a panel outside the HMO that would review the case and decide 
whether or not that care should be provided and paid for by the HMO.
  In addition, what we say is that, if one has been damaged for some 
reason, God forbid, that one needed some kind of procedure or one 
needed to stay in the hospital a few more days and the HMO refused to 
allow that and, as a result, one suffered injury and damage, then one 
should be able to bring suit in a court of law and recover for those 
damages.
  Most people do not realize that option does not exist today for a lot 
of people who are in HMO plans because the Federal Government has said 
that, in the case of people covered by a Federal plan or where the 
Federal Government has usurped or preempted the State law for those who 
are mostly self-insured by their employer, that there is no recourse to 
seek damages in a court of law.
  That is not right. It is not right. Someone should be able to sue for 
damages and sue the HMO if they have been denied care and if they have 
been hurt or damaged as a result of that.
  Just to mention a couple more things, we also have in the Patients' 
Bill of Rights, we assure that doctors and patients can openly discuss 
treatment options, because, oftentimes, HMOs tell the doctors they 
cannot tell about treatment options that are not covered, the so-called 
gag rule.
  We assure that women have direct access to an OB/GYN. As I said, we 
provide an enforcement mechanism that ensures recourse for patients who 
have been maimed or die as a result of health plan actions.
  There are a lot more things that we can go into, and we will tonight; 
but I yield to the gentlewoman from Texas (Ms. Jackson-Lee), who has 
been outspoken on this issue and has oftentimes talked about how in her 
own State of Texas a lot of these protections exist. They exist in 
Texas. They should exist nationally.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the gentleman from New 
Jersey (Mr. Pallone) for his persistent leadership on the issue.
  He is very right. Some two sessions ago, the legislative team or the 
legislative body and houses of the State of Texas passed a bipartisan 
Patients' Bill of Rights and one that has been effective in assisting 
the individuals of my State in better health care. We can always do 
better, however.
  I think to follow up on the gentleman's line of reasoning about the 
discharge petition, I think it is important to note just what that 
means. The discharge petition is something that most Members would 
rather not have to procedurally utilize. It is really a cry of anguish 
and frustration as well as an emphasis on the national, if you will, 
priority that the issue deserves.
  We have done it with campaign finance reform, which the American 
people over and over again have indicated that it is high time to get 
special interests out of politics. We are now doing it and have done it 
in the past with the Patients' Bill of Rights because we have seen the 
response by the American people.
  In fact, I just recently saw, about 2 weeks ago, a poll done that 
indicated the high level of frustration with HMOs by the American 
people, just an enormous amount of frustration, not with the physicians 
who have already said get the business or the insurance companies out 
of my hypocritic oath, if I have it correct in their phraseology, let 
me be a physician, a nurturer.
  But the American people have now spoken. So this discharge petition 
is a response to the fact that we have a crisis. We have a road of no 
return. We have no light at the end of the tunnel.
  The American people are over and over speaking about the need to be 
able to make personal decisions about their health care with their 
physicians. We already understand the value of efficiency. We already 
under the value of making sure that we do not wastefully spend monies 
that are not necessary, unnecessary procedures, or unnecessary 
equipment, if you will. I can think of a box of tissues that showed up 
on a bill more than 10 times or so. We have already gone through that.
  I think the American people, the Congress has addressed the question 
of waste. So waste is not the issue. The issue is what kind of care are 
we giving our patients and those who work every day and deserve health 
care.
  I think that there is something so pivotal to the relationship and 
the confidence that people would have in their HMOs and their health 
care; and that is to be able to go somewhere and say, ``Doctor, I have 
a pain'', to the emergency room, ``I have a severe pain'', and being 
considered legitimate in one's expression.

                              {time}  2100

  The Democratic Patients' Bill of Rights allows for severe pain to be 
established as a legitimate reason to be able to go to the emergency 
room.
  Why is this so very important? My colleague already evidenced where 
there was a situation where there was an accident and a tragedy 
occurred where a young man's leg could have been saved if they only had 
not shipped him from one place to the other 3 hours later.
  What about a situation where it is not visible that there is 
something

[[Page H3687]]

very tragic happening? My example that I offer to my colleagues is not 
the same. But a very outstanding member of our committee, someone who 
did not think that they were sick and went with their spouse to the 
emergency room, drove themselves and walked up to the emergency room, 
which was not a familiar emergency room, not one maybe in their 
neighborhood, experiencing pain, and they had to sit down.
  Now, this is not directly. But it shows what happens when we have 
delayed circumstances with hospitals because they are checking on their 
HMO rather than the ability to go to the nearest emergency room because 
of an expressed pain. And of course, they had to take time checking 
whether they were at the right place.
  Lo and behold, that individual had a massive cardiac arrest and did 
not survive. The tragedy of the family having to be delayed with 
paperwork, ``where is your identification? do you belong here?'' 
realizing that they had some coverage but they had to detail whether 
they were at the right location.
  The Patients' Bill of Rights that we, as Democrats, are offering 
deals with these kinds of delays because it provides them the 
opportunity to be at almost any emergency room if they have a severe 
pain and they can be covered.
  I listened as there were discussions on the floor of the House 
earlier about the values between the Democrats and the Republicans, 
more particularly the Republican Party. I want to remind the gentleman 
from New Jersey (Mr. Pallone) that we are always to be counted upon, I 
believe, when there are crises around survival.
  I am reminded of Franklin Delano Roosevelt and Social Security. 
Social Security now is the infrastructure, is the backbone of survival 
for our senior citizens. I am very proud that a Democratic president 
saw that it was crucial to deal with this issue. And it has survived.
  Lyndon Baines Johnson saw the great need in providing senior citizens 
with a basic kind of coverage so that they would have the ability to 
have good health care, Medicare. And although we are in the midst of 
trying to fix and extend Social Security and Medicare, those two 
entities have withstood the test of time.
  Unfortunately, the Republican bill dealing with the Patients' Bill of 
Rights does not allow people with chronic conditions to obtain standing 
referrals. Our Patients' Bill of Rights does. The Republican bill 
purports to prohibit gag clauses but in reality does not do such 
things, and that is that they cannot have the ability of doctors 
talking with doctors about their health care and, therefore, keeping 
information away from both the patients and another doctor about what 
is transpiring with their condition.
  The Republican bill does not require plans to collect data on 
quality. Our Patients' Bill of Rights does. And the Republican bill 
does not establish an ombudsman program to help consumers navigate 
their way through the confusing array of health options available to 
them.
  The other thing that is so very important to many women who I have 
met in my district is that it does not, whereas ours does, the 
Republican bill does not allow women to choose their OB-GYN as their 
primary care provider. That is key in the private relationship between 
physician and patients.
  Let me say, as well, in closing to my friend from New Jersey, I would 
like to again thank him for consistent and persistent leadership 
dealing with getting this bill to the floor. It is important to let the 
American people know that we do not bypass procedures.
  I remember 2 or 3 or 4 years ago having hearings out on the lawn 
about Medicare. We were so serious about the issue that we decided, if 
we could not get hearings here in the Congress, that we as Democrats 
would be out on the front lawn. We may be relegated to this.
  I know there have been a number of hearings dealing with this 
particular issue. But we have been bogged down by the allegations that 
we have lifted up this right to sue and medical necessity and that 
these are issues that are maybe holding us back. And I think people 
should understand that this is not an issue of attack, this right to 
sue. This is not to encourage frivolous litigation.
  But even the physicians who two-to-one have supported and are 
supporting the Democratic Patients' Bill of Rights have said, ``We are 
sued. Sometimes we are blocked from giving good health care or 
providing a specialist because someone far away with a computer is 
saying `you cannot do it'.''
  Why should they be vulnerable and the actual decision was made by an 
HMO, an insurance company, or someone looking at the bottom line and 
not looking at good health care?
  I think America deserves better. And I would just simply say that all 
the people who have been injured, all the people who have suffered, the 
loved ones, because of countless deaths, my fear of an injury being in 
the United States Congress, why should I be in fear? Because it still 
happens to any one of us that would be confronted with the choices of 
an emergency room that would say they are not eligible to come in here. 
This is a fear that happens more to our constituents that have no other 
options.
  I think it is high time that we take the time out as we are moving to 
discuss passing gun safety laws that should be passed this week. I 
voted against adjourning because we have so many things to be doing. It 
is important that we get the Patients' Bill of Rights here to the floor 
of the House with a vigorous debate.
  I am convinced that we will draw many of our colleagues on the other 
side of the aisle when they see the reasoning of our debate on this 
issue that a Patients' Bill of Rights is only fair for all Americans. 
Because we deserve and they deserve and frankly this Nation deserves 
the best health care we can possibly give.
  We have got all the talent, but we do not have the procedures to 
allow them to have it. I hope our colleagues will sign the discharge 
petition. It is not something we do lightly. But we have a problem 
here. American people are losing faith, and I think now is the time for 
us to respond to that.
  Mr. PALLONE. Madam Speaker, I want to thank the gentlewoman and 
particularly emphasize again what she said about the extraordinary 
nature of this procedure of the discharge petition. And it is 
unfortunate.
  As my colleague mentioned, there are major differences between the 
Democrats' Patients' Bill of Rights and the Republican leadership bill, 
which we know is really defective in terms of providing patients' 
protections compared to what the Democrats have put forward.
  The bottom line is that the Republican leadership refuses to bring 
any bill up. So it is not even a question, as my colleague pointed out, 
whether this is a good bill or bad bill. They just refused to bring the 
issue up and let us have a debate on the floor of the House of 
Representatives.
  We had the same problem last year. We had to use this discharge 
petition. As my colleague knows, back a month ago, I guess in April 
around the time of Easter and Passover, we actually had the President 
going to Philadelphia with a number of us and start this whole national 
petition drive on the Internet to show how many people supported 
bringing up the Patients' Bill of Rights.
  Since that time, a number of us on the Committee on Commerce, and I 
see my colleague the gentleman from Texas (Mr. Green) is here, also on 
the Committee on Commerce, have pleaded and sent letters to the 
Republican leadership and our committee asking that they have hearings 
and mark up this legislation or any legislation related to HMOs, 
managed care reform.
  So far, we have been told we will have hearings sometime this summer. 
Well, that is a long time. That brings us into the fall. And if there 
is no action on this because we are having hearings all summer, that is 
not going to solve the problem. So we have no recourse, essentially, 
other than to go to this petition route. That is why we are doing it. 
And it is extraordinary.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, if the gentleman would yield, 
I am glad he reminds me. While he was in Philadelphia, as he well 
knows, we agreed, if you will, to not go just upon our position or our 
opinion and a lot of us were in our districts.
  So I do want to share with my colleague that I was at the Purview A&M 
School of Nursing; and two-to-one, the nursing staff professional 
staff, students, joined in in signing on-line for

[[Page H3688]]

the Patients' Bill of Rights. I understand that all over the country 
people joined voluntarily to say that we needed to pass this.
  I think that was a very important point that my colleague made. So we 
are not just here speaking on our personal behalf or we are not trying 
to get a discharge petition because we are over anxious for personal 
legislation to pass.
  But I tell my colleagues, everywhere I go in my district, and I have 
talked to my colleagues, people are talking about getting some fair 
treatment with HMOs and needing our assistance, and I think that is 
important to bring to the floor's attention.
  Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from North 
Carolina (Mrs. Clayton), who is one of the co-chairs of our Health Care 
Task Force.
  Mrs. CLAYTON. Mr. Speaker, I thank the gentleman for yielding.
  I want to thank him also for the leadership. And I like the word that 
the gentlewoman from Texas (Ms. Jackson-Lee) used, his ``persistent'' 
leadership, his dogged persistent leadership, his patient leadership. 
It takes all of that to get an issue of this magnitude in the 
consciousness of us. So I want to thank him for that.
  Madam Speaker, when a child suffers with a disease that can be cured, 
should that decision on whether to provide the needed treatment be made 
by a doctor or the child's parents or by a bureaucrat who is counting 
dollars and dimes?
  When a wife and mother undergo surgery for a mastectomy and the 
anesthesia has yet to wear off, should she be forced to leave the 
hospital that very day because of a rigid routine that puts saving 
money and sparing pain and suffering?
  When a husband and father forced to go to the emergency room is 
unable to get approval from his insurance provider, the very provider 
he pays for insurance, should he be required to pay the medical bill 
himself?
  When a grandfather is stricken with a life-threatening stroke, should 
those transporting him to the hospital emergency care be forced to pass 
one hospital to go to one farther away because narrow thinking people 
are more interested in crunching numbers and saving lives?
  These are not rhetorical questions. They are not even hypothetical 
situations. These are real-life examples of what can happen to anyone, 
in fact what is happening all too often across this country under the 
current Federal law.
  So that is the reason we need the Patients' Bill of Rights. The 
Patients' Bill of Rights effectively provides basic and fundamental 
rights to patients. The Patients' Bill of Rights provides real choice 
because patients are entitled to choose their health care provider and 
treatment decisions are made by the patient's doctor and not the 
insurance company bureaucrat.
  The Patients' Bill of Rights that we are talking about provides real 
access. Managed care plans are required to ensure timely and necessary 
care. Patients would also have the right to go to the emergency room 
when they need to without prior authorization.
  The Patients' Bill of Rights actually provides open communication 
between their doctor and the patient. Physicians are free to discuss 
any and all aspects of their care with the patient. That is what we are 
trying to guarantee in the Patients' Bill of Rights. That is why we 
need health care now and we need health care protected by the Patients' 
Bill of Rights.
  This is not an isolated issue. This is a national challenge. However, 
our national challenge does not stop here. We have an even deeper-
rooted problem. Approximately 45 million Americans are uninsured. The 
numbers of Americans without health insurance has grown by nearly 10 
million over the past decade.
  A smaller share of Americans have health insurance today through 
their jobs than 10 years ago. And even more would be uninsured if it 
were not for the extension of eligibility under the Medicaid program.
  In 1997, almost one-third of non-elderly adults were uninsured at 
times in a two-year period. Of these, over 40 percent were uninsured 
over 2 years.
  Why are these persons without insurance? Because, simply, it is too 
expensive or their employers do not provide it. And even though the 
Medicaid expansion in the 1980s and the 1990s lowered the number of 
uninsured children, why does it remain almost one out of ten Americans 
are uninsured? Because job-based insurance coverage is decreasing while 
the cost of working families is increasing. And, therefore, we have a 
real serious problem.
  We heard reference to the April event when we were announcing our 
intentions about the Patients' Bill of Rights. I sponsored an April 
event in the First Congressional District at my community college where 
I engaged nurses. In fact, I had a town hall meeting through the 
information highway where we were in four locations.

                              {time}  2115

  In addition to that, we went out into the community and got people to 
sign up. All too often what I found, many of these individuals were not 
indeed insured by anyone. Therefore, the Patients' Bill of Rights 
petition that they signed, they wanted for themselves, they were not 
eligible. Too many of my constituents do not even have the opportunity 
of being insured. However, if they were insured, indeed they would need 
the protection that the Democratic Patients' Bill of Rights would 
provide for them.
  Therefore, Madam Speaker, we must focus on two issues in health care 
reform. First, to reform the Patients' Bill of Rights, and, second, we 
must protect the right of uninsured persons to get health insurance. 
Again, I want to say that when we are asked to find opportunities for 
the Patients' Bill of Rights to ensure those of us who are fortunate 
enough to have insurance, we cannot forget the millions of individuals 
and families who are not insured at all.
  I thank the gentleman for providing the leadership on the Patients' 
Bill of Rights and just say that we are approaching tomorrow one phase 
of our national crisis but not the total phase of it. I am pleased that 
we will indeed do that. I agree with my colleague who said that the 
discharge procedure indeed is a radical method that we have to 
undertake simply because we are denied an opportunity to discuss it in 
the formal legislative processes that are available to us. We are using 
this process because that is the only way we can get it as a full 
debate. I think on tomorrow the American people will understand the 
difference between our commitment to health care and certainly our 
commitment to have a Patients' Bill of Rights that protects those who 
are not insured.
  But I want to say, I am further committed, our goal is even greater 
than just protecting those who have insurance. Our goal must be to 
provide health coverage for all those who need health coverage.
  Mr. PALLONE. I want to thank the gentlewoman. I think it is very 
important as she did to point out that as much as we support the 
Patients' Bill of Rights and we want to bring it up, that we also need 
to address the problems of the uninsured and the fact that the numbers 
are growing. Of course part of our Democratic platform that has been 
pushed, also, by President Clinton is to address some of the problems 
of the uninsured.
  Of course, a few years ago, our health care task force worked on the 
Kennedy-Kassebaum bill which allows people to take their insurance with 
them if they lose their job or they go from one job to another, and 
then we moved on the kids health care initiative which is now insuring 
a lot of the children who were uninsured, and, of course, the President 
and the Democrats had the proposal for the near elderly where people 
who are between 55 and 65, depending on the circumstances, can buy into 
Medicare.
  But the gentlewoman is right. We are trying to address those issues 
but the larger issue of the uninsured also needs attention.
  Mrs. CLAYTON. I would just say that the gentleman is absolutely 
correct. We tried to address this large, pressing issue, I guess, about 
6 years ago. At that time we had 40 million who were uninsured, where 
it is reported now we may have 45 to 46 million who are uninsured. As 
we try to address this issue, the pool is getting larger and a larger 
number of individuals are falling through the cracks.
  Now, I am very pleased the effort we indeed did make and were 
successful as

[[Page H3689]]

it related to children. I am also very pleased that we were able to 
have portability and remove the barrier of preexisting conditions as a 
means of eligibility for coverage. All of those enabled us to expand 
the coverage in a meaningful way. But I would be remiss if I ignore the 
suffering, and we are talking about the working poor, who are just not 
able to buy into insurance and they need it desperately.
  I just want to commend the gentleman for what he is doing on the 
Patients' Bill of Rights. I think it will be a great first step 
tomorrow and we will push to make sure that this is successful, but we 
also have a higher goal, to make sure that those who are unfortunate 
enough to have no insurance whatsoever, indeed we are speaking for the 
poorest of the poor as well as for those who are fortunate enough to 
have insurance.
  Mr. PALLONE. I agree and I appreciate the gentlewoman bringing it up. 
We can also continue to address and find ways of providing coverage as 
part of our health care task force which the gentlewoman cochairs.
  I yield to the gentleman from Texas (Mr. Green). He is the second 
Texan we have had tonight. I think part of the reason is because he has 
had a very successful type of patients' bill of rights passed in Texas 
that applies statewide.
  One of the things we have been pointing out tonight is that even 
States like Texas that have gone very far in providing these kind of 
patient protections that we would like to see done nationally, because 
of the Federal preemption that exists for those where the employer is 
self-insured, the Texas law in many cases does not apply. That is why 
we need Federal legislation.
  Mr. GREEN of Texas. I would like to thank my colleague again for this 
special order like my other friends, and neighbors even, because to 
talk about managed care reform is so important, and also in light of 
the filing of the rule for a discharge petition, which is a major step 
in the legislative process.
  I am proud to serve on the Committee on Commerce. It took me a couple 
of terms to get there. I would like for the Committee on Commerce, both 
Democrats and Republicans, to be able to deal with this bill. The last 
session we were not. The bill was actually drafted by a health care 
task force of the Republican majority and written in the Speaker's 
office. It was placed here on the floor that we could not amend except 
we had one shot at it. We came close, lost by six votes, it went to 
Senate and died which it should have because it actually was a step 
backward in reform.
  I am glad you mentioned Texas, New Jersey and other States have 
passed managed care reform that affect the policies that are issued 
under State regulation. But in Texas, I think the percentage is about 
60 percent of the insurance policies are interstate and national in 
scope, so they come under ERISA.
  A little history. ERISA, I understand, was never intended to cover 
health insurance, it was really a pension protection effort. But be 
that as it may, that is why we have to deal with it in Congress to 
learn from what our States have done and to say, ``Okay, let's see what 
we can do to help the States in doing it.'' The State of Texas now has 
had the law for 2 years. I know there is some concern about the 
additional cost, for example, that these protections would provide, 
emergency, without having to drive by an emergency room, to go to the 
closest emergency room, outside appeals process, accountability and 
eliminate the gag rules. In Texas it is very cheap. In fact there was 
only one lawsuit filed, and that was actually by an insurance company 
challenging the law that was passed. Now, maybe there have been other 
ones recently, but it is not this avalanche of lawsuits, suing, whether 
it be employers or insurance companies or anything else. And so it has 
worked in a State the size of Texas, a large State, very diverse 
population, both ethnically and racially but also with a lot of rural 
areas and also some very urban areas.

  In fact, my district in Houston, Houston and Harris County, is the 
fourth largest city in the country. So you can tell that it is a very 
urban area and it is providing some relief, but again only for about 40 
percent of our folks. So we need to pass real managed care reform. And 
we need to deal with it in the committee process, not like we did last 
session. And the discharge petition that I hope would be available by 
the middle of June, and both Democrats and Republicans hopefully will 
sign that petition to have us a hearing on it and to have the bill here 
so we can debate, so we can benefit those folks.
  The reason I was late tonight, I take advantage of the hour 
difference in Texas and try to return phone calls. A young lady called 
my office and was having trouble with her HMO. She was asking us to 
intervene. We have done that. We have sent letters to lots of 
individual HMOs. Frankly they are responsive to the Members of Congress 
oftentimes, but we each represent approximately 600,000 people, and how 
many of those folks call their Member of Congress to have that 
intervention? We need to structuralize it where people can do it. The 
outside appeals process, timely appeals, not something that will 
stretch out, because again health care delayed is health care denied.
  If, for example, you have cancer, then you want the quickest decision 
by the health care provider that you can. That is why it is important. 
I am looking forward to being able to work on the bill, whether it be 
through our committee or on the floor of the House and send to the 
Senate real managed care reform. We cannot eliminate managed care, and 
I do not think I want to. What I want to do is give the managed care 
companies some guidelines to live by, just like all of us have in our 
businesses, or in our offices and individual lives. We just need to 
give them some parameters and say, ``This is the street you have to 
drive on. You can't deviate. You can't deny someone access to some of 
the cutting-edge technology that's being developed around the country 
for health care.'' We just want to give them that guideline and go 
their merry way and make their money but also provide the health care.
  Let me tell the gentleman a story. My wife and I are fortunate, our 
daughter just completed her first year of medical school. Last August, 
she had just started, and I had the opportunity to speak to the Harris 
County Medical Society and talk about a number of issues. During the 
question and answer session, the President of the Harris County Medical 
Society, the first question is, when I explained that I am a lawyer, 
and normally legislators and Democrats do not speak to medical 
societies in Texas. He congratulated me on my daughter who had been in 
medical school all of 2 weeks.
  And so I joked. I said, ``She's not ready for brain surgery yet.'' 
The President of the medical society said, ``You know, your daughter 
after 2 weeks of medical school has more knowledge than who I call to 
get permission to treat my patients.'' That is atrocious in this great 
country. That is, that it is affecting your and my constituents and all 
the people in our country. Sure, we want the most reasonable cost 
health care and I think we can get it. We are doing it in Texas, at 
least for the policies that come under State law. But we also want to 
make sure we have some criteria there so our constituents will be able 
to know the rights they have.
  Let me just touch lastly on accountability. At that same discussion, 
the physician said, they are accountable for what they do. That if they 
make a mistake, they can go to the courthouse. And in Texas we have 
lots of different ways. You do not necessarily go to the courthouse. 
You can go to other alternative means, instead of filing lawsuits, to 
have some type of resolution of the dispute. But accountability is so 
important, because if that physician calls someone who has less than a 
2-week training in medical school, that decision that that person 
makes, that doctor has to live with.
  That doctor has to say, ``Well, I can't do that.'' Or hopefully they 
would say that. But that accountability needs to go with the decision-
making process. If that physician cannot say, ``This is what I 
recommend for my patient who I see here, I've seen the tests, and I'm 
just calling you and you're saying no, we can't do that.''
  We have lots of cases in our office, and I think all Members of 
Congress do, where, for example, someone under managed care may have a 
prescription benefit but their doctor prescribed a certain 
prescription, but the HMO says, ``No, we won't do that, we'll give you 
something else.'' I supported as a State

[[Page H3690]]

legislator generic drugs if they are the same component, but oftentimes 
we are seeing the managed care reform not agree to the latest 
prescription medication that has the most success rate that a lot of 
our National Institutes of Health dollars go into research, and they 
are prescribing something or saying, no, we will only pay for something 
that maybe is 5 or 10-year-old technology. Again, that is not what 
people pay for. They want the latest because again the most success 
rate. And it ought to be in the long run cheaper for insurance 
companies to be able to pay up front instead of having someone go into 
the hospital and have huge hospital bills because maybe they did not 
provide the most successful prescription medication.
  There are a lot of things in managed care reform, antigag rules, and 
I know some managed care companies are changing their process and they 
are changing it because of the market system. That is great. I 
encourage them to do it. But city councils, State legislators and 
Members of Congress, we do not pass the laws for the people who do 
right, we do not pass the laws for the companies who treat their 
customers right. We have to pass the laws for the people who treat 
their customers wrong. That is why we have to pass this and put it in 
statute and say even though XYZ company may allow doctors to freely 
discuss with their patients potential medical services, or they may 
have an outside appeals process, a timely outside appeals process, but 
we still need to address those people who are not receiving that care.
  I can tell you just from the calls and the letters we get in our own 
office, without doing any scientific surveys, we get a lot of calls 
from people, partly because I talk about it a lot not only here but in 
the district. But people need some type of reform.

                              {time}  2130

  Mr. Speaker, I hope this Congress will do it timely. When the 
gentleman mentioned a while ago that he heard our committee may conduct 
hearings all summer, that is great. I mean I would like to have 
hearings in our committee, but we got to go to mark up what we learn 
from our committee. We have to make the legislative process work, the 
committee process work. We will put our amendments up and see if they 
work, and maybe they are not good, and we can sit down with the Members 
of the other side.
  But that is what this democracy and this legislative process is 
about, and last session it was terminated, it was wrong, and we saw 
what happened. We delayed, and there was no bill passed. It did not 
even receive a hearing in the Senate because it actually was a step 
backward in changing State laws like in Texas.
  So I would hope this session, maybe with the discharge rule being 
filed tomorrow, we will see that we are going down that road, but maybe 
we can actually see maybe hearings in June when we come back after 
celebrating Memorial Day, and with a short time we can, a lot of us 
have worked on this issue. So, sure, I would like to have some 
hearings, but maybe we could have a markup before the end of July or 
June or mid July, something like that, so we could set it on a time 
frame where we would vote maybe before the August recess on this floor 
of the House for a real managed care reform, and when we vote on the 
House floor, let us not just come out with a bill and say, ``Take it or 
leave it.'' As my colleagues know, let us have the legislative process 
work within reason and so we can come up with different ideas on how it 
works and the success.
  So again I thank the gentleman for taking the time tonight and my 
colleagues here, and particularly glad we had the first hour.
  Mr. PALLONE. I want to thank the gentleman from Texas (Mr. Green). He 
brought up a number of really good points, if I could just, as my 
colleague knows, comment on them a little bit.
  I mean first of all I think it is important to stress that with this 
discharge petition, we are not doing it out of spite or disrespect or 
anything like that. We just want this issue brought to the floor, and 
as my colleague said, as my colleagues know, having hearings all summer 
does not do the trick. So far we have not gotten any indication from 
the Republican leadership or the committee leadership that there is any 
date certain to mark up this bill in committee and to bring it to the 
floor, and that is why we need to go the discharge petition way.
  The other thing the gentleman said I think is so important is he 
talked about how the Texas law, which does apply to a significant 
number of people in Texas, even not everyone, that both the cost issue 
and the issue of the fear, I guess, of frivolous lawsuits has so far 
proven not to be the case. In other words, the, as my colleagues know, 
one of the criticisms of HMO reform or Patients' Bill of Rights that 
the insurance companies raise unfairly is the fact that it is going to 
cost more, and in fact in Texas it has been found that the cost, there 
is practically no increased costs whatsoever. I think it was a couple 
of pennies or something that I read about.
  And in terms of this fear that there are going to be so many lawsuits 
and everybody is going to be suing, actually there have been very few 
suits filed, and the reason I think is because when we put in the law 
that people can sue the HMO, prevention starts to take place. They 
become a lot more careful about what they do, they take preventive 
measures, and the lawsuits do not become necessary because you do not 
have the damages that people sue for. So I think that is a very 
important point.
  The other point the gentleman made that I think is really crucial is 
the suggestion that somehow because of the debate and because of the 
pressure that is coming from, as my colleagues know, the talk that is 
out there, that somehow many; some HMOs I should say; are starting to 
provide some of these patient protections, and the gentleman's point is 
well taken, that even though some of them may be doing it, and there 
are not really that many that are, but even though some of them are 
doing it, that does not mean that we do not need the protections passed 
as a matter of law for those, as my colleagues know, bad actors, if you 
will, who are not implementing these Patients' Bill of Rights.
  So there needs to be a floor. These are nothing more than commonsense 
proposals that are sort of a floor of protections. They are not really 
that outrageous, they are just, as my colleagues know, the commonsense 
kind of protections that we need.
  So I think that our time is up, but I just wanted to thank my 
colleague from Texas. We are going to continue to push. Tomorrow the 
gentleman from Michigan (Mr. Dingell) is going to file the rule for 
this discharge petition, and we are going to get people to sign it so 
we can bring up the Patient Bill of Rights.

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