[Congressional Record Volume 145, Number 81 (Wednesday, June 9, 1999)]
[House]
[Pages H4004-H4010]
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 gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, the managed care issue was left unfinished 
in the last Congress. On the House side, the Patients' Bill of Rights 
was defeated by just five votes when it came to the floor and it was 
considered on the floor as a substitute to the Republican leadership's 
managed care bill which did pass and in my opinion was a thinly veiled 
attempt to protect the insurance industry from managed care reform.
  I want to say, Mr. Speaker, that support among Democrats for passing 
the Patients' Bill of Rights is as strong as ever and it certainly 
needs to be. The Republican leadership in the House has reintroduced a 
bill that is virtually identical to what it moved last year, and on the 
Senate side earlier this year a Senate committee approved what I 
considered a sham managed care bill that does not allow patients to sue 
insurance companies but does allow insurance companies, not doctors and 
patients, to define medical necessity.

                              {time}  2100

  Mr. Speaker, what the Democrats are trying to do in the next week or 
so is to bring the Patients' Bill of Rights to the floor, and because 
of the fact that we have been unable, as in the last session of 
Congress to get any hearings or committee action on the bill in the 
House, we have already put in place a procedure known as a discharge 
petition which will probably ripen next week and which will allow 
Members to come down to the floor and sign the petition to essentially 
force the Republican leadership to bring up a vote on the Patients' 
Bill of Rights.
  In many ways it is unfortunate that we are reduced to that. The 
bottom line is that the Republicans are in the majority in this House, 
not the Democrats, and if the Democrats cannot get a bill brought up in 
committee because they are not in the majority, they do not chair the 
committees, then the only recourse they have is to resort essentially 
to the discharge petition process and hope that we can get a majority, 
all the Democrats and some Republicans, to force a vote on the 
Patients' Bill of Rights.
  I wanted to say, Mr. Speaker, that another disturbing development has 
apparently taken place in the House over the last week, and that is 
that a few months ago we had heard that there were rumors that instead 
of moving a comprehensive managed care reform bill, the Republicans 
might try to bring up bits and pieces of patient protection. In other 
words, instead of bringing the comprehensive Patients' Bill of Rights 
to the floor, they would bring up bills that only deal with emergency 
room care or external appeals or whatever.
  I just wanted to say that this approach should concern anyone who 
really cares about managed care reform. I think it is being considered 
as a means by which the Republicans hope to avoid the debate, a real 
debate on the whole comprehensive issue of managed care reform, 
particularly the right to sue and the issue of medical necessity.
  What I think the Republicans may try to do is to bring up these 
individual bills in this piecemeal approach and then give the 
impression that somehow they are doing something on the issue of 
managed care reform or patient protection, when in fact they are not.
  If this piecemeal approach is adopted, I think the concerns of the 
American people are certain to be ignored, the issues they care about 
the most will be left off the table in order to appease the insurance 
industry, and those pieces of patient protection that do get to the 
floor will be riddled with loopholes and all kinds of escape clauses.
  Healthcare problems and the deaths and the serious injuries and 
serious problems that we have seen that have occurred because of the 
inability of patients to get a particular procedure, an operation, to 
be able to stay in the hospital, these things will continue to happen 
unless we have comprehensive managed care reform like the Patients' 
Bill of Rights.
  I have a number of my colleagues here with me tonight to join in this 
special order, and I should say that every one of them has been 
involved in a major way, either as a member of our Democratic Health 
Care Task Force or members of the Committee on Commerce, or one of my 
colleagues from New Jersey's case, the ranking member on the 
Subcommittee on Education and Labor that deals with managed care 
reform, and I am pleased they are with me.
  Mr. Speaker, I yield to my colleague from Arkansas, who has been one 
of the leaders on the issue of managed care reform. He is a cochair of 
our Health Care Task Force. It was he who last year brought up the 
Patients' Bill of Rights as a substitute on a motion to recommit and 
allowed us to consider the bill on the floor of the House.
  Mr. BERRY. Mr. Speaker, I thank my distinguished colleague from New 
Jersey for yielding.
  Mr. Speaker, once again we are here asking the Republican leadership 
to bring patients rights legislation to the floor for a vote, once 
again. We need this reform so we can make managed care work. We need 
managed care.
  We are only asking the leadership to do the job the American people 
want them to do, to bring up a bill to guarantee all Americans with 
private health insurance, and particularly those in HMOs or other 
managed care plans, certain fundamental rights regarding their 
healthcare coverage.
  Today approximately 161 million Americans receive medical coverage 
through some type of managed care organization. Unfortunately, many in 
managed care plans experience increasing restrictions on their choice 
of doctors, growing limitations on their access to necessary treatment, 
difficulty in obtaining the drugs they need and should have and must 
have to stay alive, and an overriding emphasis on cost cutting at the 
expense of quality.
  Patients rights legislation would guarantee basic patient protections 
to

[[Page H4005]]

all consumers of private insurance. It would ensure that patients 
receive the treatment they have been promised and paid for. It would 
prevent HMOs and other health plans from arbitrarily interfering with 
doctors' decisions regarding the treatment of their patients and the 
necessary healthcare that they require.
  Patients rights legislation would restore the patient's ability to 
trust that their healthcare practitioner's advice is driven solely by 
health concerns and not cost concerns.
  HMOs and other healthcare plans would be prohibited from restricting 
which treatment options doctors may discuss with their patients. One of 
the most critical patient protections that would be provided is 
guaranteed access to emergency care. We would ensure that patients 
could go to any emergency room during a medical emergency without 
calling their health plan for permission first. Emergency room doctors 
could stabilize the patient and focus on providing them the care that 
they need without worrying about payment until after the emergency had 
subsided.
  HMO reform legislation would also ensure that health plans provide 
their customers with access to specialists when they are needed because 
of the complexity and seriousness of the patient's sickness.
  Let us bring patient protection legislation to the floor. Let us give 
the Americans the patient protection they are asking us for.
  Mr. PALLONE. Mr. Speaker, I thank the gentleman, and just again 
reiterate that the only way we were able, as you know, to get the 
Patients' Bill of Rights to the floor in the last Congress was because 
of the discharge petition that we filed. I think we ended up with 
almost 200 signatures on it. Even with that the Republicans brought 
their essentially sham managed care reform bill to the floor, and it 
was only through the efforts of the gentleman from Arkansas that we 
were able to do a motion to recommit and have full consideration of the 
Patients' Bill of Rights.
  We need to do that again, unfortunately, because again the Republican 
leadership in the House has refused to have hearings or any kind of a 
markup in committee of managed care reform, so once again we are forced 
to go the route of the discharge petition in order to have the bill 
considered.
  Mr. Speaker, I just want to stress again, if I could, how this is an 
extraordinary procedure. As elected members of the House of 
Representatives, we should not have to resort to signing a petition 
essentially to get a bill considered, but that is where we are.
  Mr. Speaker, I now yield to another colleague on our Health Care Task 
Force and a member of the Committee on Commerce and has been dealing 
with this issue for a long time as well.
  (Mr. GREEN of Texas asked and was given permission to revise and 
extend his remarks.)
  Mr. GREEN of Texas. Mr. Speaker, I would like to thank my colleague 
from New Jersey, who is our Chair of the Democratic Health Care Task 
Force and also serves on the Committee on Commerce and the Health 
Subcommittee. The reason I asked to move to the Committee on Commerce 
two years ago was, one, because of the complaints and concerns about 
managed care, along with Medicare and lots of other issues, 
prescription medication for seniors and everyone.
  It is frustrating, because we now, after the experience of the last 
two years, we have a bill that has a huge number of cosponsors on it, 
bipartisan cosponsors working on it, and now to have to go to the 
discharge petition route that will be ripe next week for us to begin 
working on that.
  Again, it is only because we are having to do that, it is literally 
taking the bill away from the committee, because this year, here we are 
almost in the middle of June and have not had hearings on managed care 
reform. So we obviously know what the priorities of our colleagues on 
the other side, who are very honorable and I enjoy working with them, 
but they do not have the same priorities as we do.
  Again, managed care reform is one of the top Democratic agendas this 
year, so that is why we have had to go through the discharge petition 
to try to get on this floor a fair hearing on real managed care reform.
  I say that, and I want to make sure we use the word ``real'' in 
quotes, because our experience last year was that the managed care 
reform bill that was written in the Republican task force, or in the 
Speaker's office actually, turned back the clock, actually was worse 
than passing no bill at all. That is why when it passed this House, it 
died over in the Senate.
  The reason I say that is because in Texas, and my colleague from 
Dallas and I know that Texas passed a law in 1997 that would do what we 
are asking to do on a national level. All we are trying to do is learn 
from our State's experience and say okay, the states have done their 
job on insurance policies issued in the states; now we need to do our 
job on policies, insurance policies, issued nationally, that come under 
ERISA.
  Last year's experience, the bill that passed on this floor would have 
reversed the success in the State of Texas. That is why I have some 
concern about my colleagues on the Republican side saying, well, we are 
going to pass legislation now on a piecemeal basis, whether it is 5 
issues or 9 issues or whatever they come up with, because I watched 
last year and they would have reversed the successes of our individual 
states, and that is why we need real managed care reform this year.
  Let me talk a little bit about the Texas plan. It has been in effect 
for 2 years now. We have seen no ground swell of lawsuits. In fact, 
there are very few. I knew the first one was filed by one of the 
insurance companies challenging it. There may have been one more filed. 
But we actually have a great experience in Texas on there not being any 
huge costs associated with these real reforms that have been used, a 
lot of times saying we don't want to build in costs. In Texas we have 
not had the costs.
  In fact, on the outside appeals process, it is one of the issues that 
actually 50 percent of the appeals have been found in favor of the 
patient, so that is a .500 batting average if you are a baseball fan. 
But let me tell you, if I was one of those 50 percent that had been 
denied some type of health insurance coverage for a procedure, I would 
be glad that I had that 50 percent percentage.
  Now, sure, 50 percent went against the patient and their request, but 
that shows how important it is to have the appeals process, which is 
just one of the issues.
  The no-gag clause is important again. That was part of the Texas 
bill. Medical necessity, the emergency room care, the accountability 
issue, there are so many things that have to be in a real managed care 
reform bill, and they have to be drafted correctly. They cannot be 
drafted to where, sure, we are going to give you the accountability or 
medical necessity, but they will leave a loophole that you can drive an 
18 wheeler truck through. That is what happened last year.
  So I have to admit coming to this floor I do not doubt the sincerity 
of my colleagues, but I saw what happened last year, and it does not 
take too much to show us from Texas that maybe your intent is not as 
good as what it should be on real managed care reform. Again, an 
outside appeals process is not going to break the bank. The experience 
in Texas is very small cost.
  No gag rules, let a doctor or provider talk with their patients. Even 
if the insurance policy does not cover certain procedures, that doctor 
ought to be able to tell that patient that. Just like Medicare does not 
cover everything, that doctor ought to be able to tell that patient 
``Medicare does not do this, I will do it, but you have to pay for 
it.''
  Accountability, if the doctor is held accountable for a certain 
procedure, then whoever tells that doctor they cannot do that procedure 
should also be accountable.
  Again, medical necessity is so important for those of us who realize 
that we really want healthcare, and managed care is going to be with 
us.
  We just want to make it work. I think my colleague from Arkansas 
said, let us reform it. It is here, we are going to have to do the it.
  In closing, let me touch on one issue that came up during the break. 
I had an opportunity to speak to the National Association of 
Manufacturers group in my district. I have to admit there are not a lot 
of times over my

[[Page H4006]]

legislative career that I spoke to the National Association of 
Manufacturers. But during the question and answer period, one of my 
business owners said he did not understand the managed care debate. He 
said he has insurance for his employees. He said, ``I am afraid. I 
don't want my employees to sue me.'' I said, ``Let me tell you, that is 
not my intent as a cosponsor of this bill and a signatory on the 
discharge petition. Our intent is not to have employees suing 
employers. Our intent is to just make sure that employees have that 
ability to go to that person who makes that decision.'' Maybe it is in 
Hartford or Des Moines or wherever it is, or Dallas, Texas, but they 
ought to be able to go against that person who is making that decision.
  Employers do not make that decision. I was a manager of a business 
and had the job of finding insurance coverage for our company. I spent 
a lot of my time as a manager listening to my employees complain about 
the insurance coverage, so I would contact the insurance company and 
say, ``This is not what you told me when we bought this 3-year 
policy.''

                              {time}  2115

  Some employers can afford a Cadillac plan. Maybe they have a union 
contract and they bargained for their benefits. Some employers can only 
afford a Chevrolet. That is not the issue. We do not mandate. Whatever 
the employer can afford, we want to make sure that employee receives 
that care and what the employer is paying for.
  So there is no intent on that. Hopefully the National Association of 
Manufacturers will realize that we do not want their members to be 
sued. We want their members to get their money's worth out of what they 
are paying for insurance coverage today and in administering their 
plan. Hopefully they will realize that and we will see some support, 
because employers want to do the right thing by their employees.
  Hopefully their trade association here in Washington will do the same 
thing, and let them know that that is not our intent as Democratic 
members to have that happen.
  Again, I thank the gentleman. I am glad to see our other colleagues 
from other committees, the Committee on Education and the Workforce, 
where I served for 2 terms, because we have joint jurisdiction on this 
bill.
  Hopefully we will see some hearings, real hearings and a markup 
before we get our 218. But if not, we will work hard to get our 218 
signatures to have that discharge petition.
  Mr. PALLONE. I want to thank the gentleman in particular for bringing 
up what has happened in the gentleman's own State's legislature in 
Texas. As we know, some of the criticism which is really coming from 
the insurance company about the Patients' Bill of Rights or any kind of 
managed care reform is that somehow it is going to cause all those 
lawsuits. The Texas experience shows that is not the case. What we want 
to do is preventative. If these are in place, people do not have to 
file lawsuits because the protections are there.
  In addition, the gentleman pointed out there has been very little 
cost increase. We always get the criticism that this is going to cost a 
lot of money. It has been a matter of pennies, from what I understand.
  Mr. GREEN of Texas. If the gentleman will continue to yield, again, 
it is such a small cost, and the people are more than willing to pay it 
to get adequate health care.
  Mr. PALLONE. The other thing, too, is the insurance industry keeps 
saying, why do we have to do this if the States are doing it? Why do we 
have to do it on the Federal level?
  Of course, as the gentleman points out, most plans do not come under 
the State law because a lot of plans are preempted by ERISA. So if the 
company basically has its own insurance, which a lot of big companies 
do, they are not covered by the State law. So we do need the Federal 
legislation.
  I want to thank the gentleman again for his input.
  I yield to the gentleman from New Jersey (Mr. Andrews), the ranking 
member on the Subcommittee on Employer-Employee Relations. I know the 
gentleman is going to give us some information about this piecemeal 
approach we think some of the Republicans are trying to pursue right 
now, which goes very much against the comprehensive approach of the 
Patients' Bill of Rights.
  I yield to the gentleman from New Jersey.
  Mr. ANDREWS. Mr. Speaker, I thank my friend from New Jersey for 
yielding to me.
  Mr. Speaker, I did want to speak tonight about the efforts of the 
members of the Committee on Education and the Workforce to bring to 
this floor a vote on our ideas of how managed care health insurance 
companies can be made more responsible and accountable to people.
  If we travel the country and listen to people of every neighborhood, 
every region, every economic group, every racial and religious 
background, there is one common refrain. That is that the managed care 
industry is out of control.
  The stories are legion. It is the story of the person who cannot get 
a referral to a specialist, a cardiologist or neurologist or an 
audiologist; stories about people whose children need another 6 weeks 
of speech therapy, but cannot get an extension under the contract 
because the managed care company will not interpret the contract that 
way.
  It is about people who travel out of town and find out that their out 
of town health benefits are meaningless because you basically have to 
travel back to wherever you came from for anything short of a dire 
emergency room problem. It is a matter of people going to emergency 
rooms and being treated for very serious problems, like collapses or 
chest pains, and then being told weeks or months later that it was not 
really an emergency, that they have to pay the bill themselves.
  It is about people being referred to specialists who may not be 
appropriate for the care that they need for mental health services or 
for other kinds of services.
  There are stories of women being discharged from hospitals 30 hours 
after giving birth by C-section, people being discharged from hospitals 
30 hours after having hip replacement operations. We are not making 
these stories up. I have heard them myself from people in my district 
in New Jersey.
  Now, how is this, that in this country an industry could become so 
autocratic and so unresponsive to consumers? I think the reason is that 
in our economy, there are three ways that institutional behavior is 
controlled. There is regulation, there is competition, and there is 
litigation.
  Regulation is obviously a set of rules that tells people and 
institutions and corporations what they can and cannot do. It applies 
to supermarkets, it applies to airlines, it applies to homebuilders, it 
applies to just about everything in American society.
  Under present law, regulations like those in my State, in our State 
of New Jersey, that say you have to give a woman at least 72 hours 
after she has given birth by C-section, do not apply to most Americans 
because they are covered by a Federal law called ERISA, the Employment 
Retirement Income Security Act of 1974, that wipes out the effect of 
those State laws. So most people are not protected by regulation in 
their health insurance plan.
  Then there is a matter of competition. If you do not like the Big 
Mack, you can buy a sandwich from Wendy's, Burger King, or one of the 
other chains. It does not work that way in health insurance. In most 
markets in metropolitan areas around the country, one or sometimes two 
major managed care plans control 75 percent or 80 percent of the people 
who live in an area.
  In the Philadelphia area in which I live, two plans cover about 85 
out of every 100 people. When there is that much domination of the 
market by that few people, there is no meaningful competition. If you 
do not like what one plan is doing, you really do not have a meaningful 
choice to go to someone else, which leads you to litigation. If you do 
not like what someone is doing, you sue them.
  I understand that some people feel that lawsuits have gotten out of 
control. Perhaps some of them have. But if you mow lawns for a living 
or build houses for a living or sell groceries for a living or paint 
houses for a living, if you do something wrong, you can be held 
accountable in a court of law.
  If you hire someone to paint your house and they do a lousy job and 
your

[[Page H4007]]

shutters fall off, you can sue them for all the damage they cause you 
as a result of their incompetence.
  But if an insurance company insures the health of your daughter and 
they deny her the right to see a specialist, and she gets very sick as 
a result of it, you cannot sue the insurance company because they are 
protected by this 1974 Federal law called ERISA that we are talking 
about.
  The only two businesses in America that are effectively immune from 
responsibility in a court of law are managed care plans and nuclear 
power plants. Everyone else is held accountable in a court of law, and 
we believe, I believe the majority of us in this Chamber believe, that 
that should stop in the case of managed care companies. They should be 
held accountable the same way everyone else in American society is for 
their decisions.
  That is the heart of the real Patients' Bill of Rights that was 
introduced by the gentleman from Michigan (Mr. Dingell), the senior 
member of the House of Representatives, and cosponsored by many of us 
at the beginning of this session.
  We are not so fixated in our beliefs that we believe that we are a 
thousand percent right and no one else can disagree with us. I think we 
are right. I think the Dingell bill should be enacted. President 
Clinton has said he would sign it. I think it would be good for the 
American people because it would for the first time hold the managed 
care companies accountable in the same way that everyone else is held 
accountable.
  But the majority here is not content to just say they disagree with 
us. The majority will not even let it come to a vote. So we can vote on 
naming Post Offices; we can vote on what should happen in Kosovo, as we 
should; we can vote on what we ought to do to regulate pharmaceutical 
products or to regulate the Y2K problem; we can vote on nuclear policy 
with the Peoples' Republic of China, all of which we should be talking 
about and doing.
  But for some reason, we cannot vote on this. We cannot bring this 
idea to the floor and let those of us who believe it is the right thing 
vote yes and those who disagree with us try to amend what we say or 
vote no. There has been no meaningful movement of this legislation to 
the floor.
  As a result of that, on Wednesday many of my Democratic colleagues, 
and I hope some Republican colleagues, will join us in signing a 
petition that forces this bill to the floor so we can have our day in 
court, we can have our debate, we can either win or lose.
  There is some other action on this which the gentleman from New 
Jersey (Mr. Pallone) made some reference to. There is an attempt by 
majority members of the committee on the Committee on Education and the 
Workforce to break up the Patients' Bill of Rights into little pieces 
and have us consider a little piece at a time.
  My subcommittee, which is the Subcommittee on Employer-Employee 
Relations of the Committee on Education and the Workforce will begin 
that process next week. I am glad we are starting the process, but I 
would say this, if we are going to start it, let us really do it right 
and let us finish it.
  Tomorrow at 10 o'clock members of our committee will be making an 
announcement. It is a strategy that we have to try to compel the 
Committee on Education and the Workforce to consider all of the issues 
on this; not just little pieces of it, not just the icing but the cake 
as well as the icing; to really talk about the central issues that are 
involved.
  So I would say to the gentleman from New Jersey (Mr. Pallone), I am 
looking forward to joining with the gentleman, the gentleman from 
Michigan (Mr. Dingell) and scores of our colleagues, I hope 218 of our 
colleagues, a majority, in marching to that podium next Wednesday to 
sign a petition that would force this issue to come to the floor.
  In the meantime, the members of our subcommittee, which I am 
privileged to lead from the Democratic side, will be doing whatever we 
can to use all the rules at our disposal to compel a vote, first in our 
committee and then on this floor, on this very, very important issue.
  I can certainly accept the fact that there will be those who disagree 
with us that the health insurance industry should be held to the same 
standard that everyone else in America is held to. That is not a 
universally-held view.
  But I would challenge, Mr. Speaker, those who disagree with our view 
to let us have our day in court. Let us bring our bill to the floor. If 
Members disagree with our bill, try to amend it. If Members believe it 
cannot be amended, then vote against it. But do not deny the will of 
the people of the country, and I believe the will of the majority of 
Members of this Chamber, when push comes to shove, to enact a law which 
is a real Patients' Bill of Rights which says to the health insurance 
industry that you are an important part of our economy, we value what 
you do, we encourage your continued development, but we do not hold you 
open to special treatment. We do not exempt you from responsibility for 
the decisions that you make and the wrongs that you sometimes cause as 
a result of your decisions.
  I assure the gentleman from New Jersey (Mr. Pallone) that the 
Democratic Members, and I hope we will be joined by Members of 
conscience from the other side of the Committee on Education and the 
Workforce, that we are going to knock on every door, pursue every road, 
and use every rule at our command so that the will of the majority can 
be done.
  Mr. PALLONE. I want to thank my colleague, the gentleman from New 
Jersey, and particularly for the references he made to this effort in 
the gentleman's subcommittee to do this piecemeal approach, if you 
will. I understand what the gentleman is saying, which is that finally 
at least there is going to be some discussion or perhaps some action on 
HMO or managed care reform in the subcommittee.
  But the gentleman rightly points out that this piecemeal approach is 
really not the right way to go. The problem is that it would allow the 
Republicans to essentially pick and choose what kind of patient 
protections they want us to consider.
  My fear is that they will ignore important parts of the Patients' 
Bill of Rights, such as the right to sue, or even, just as important, 
the really good definition of medical necessity.
  We have talked about medical necessity a little tonight, but I do not 
know that we have really described it that much. Basically, the core of 
the Patients' Bill of Rights is this idea that the doctor, or I should 
say the health care practitioner, because our next speaker is of a 
nursing background, and I want to make it clear, we are not just 
talking about physicians but also nurses. But the core of the medical 
necessity idea is that the decision about what kind of procedure, 
operation, or length of stay in the hospital, as the gentleman from New 
Jersey (Mr. Andrews) mentioned, is determined by the patient and their 
health care practitioner, their doctor or nurse, not by the insurance 
company.
  That is one of the things that I am convinced would never see the 
light of day if this piecemeal approach were adopted. So I am glad to 
see that the gentleman as the ranking member and the other members, the 
Democrats on this committee, are taking this position and going to have 
this press conference tomorrow. I thank the gentleman.
  I yield to the gentlewoman from Texas (Mrs. Eddie Bernice Johnson). 
She is a nurse by background, and I think that brings a lot to this 
whole debate, because once again we are looking at this from a 
practical point of view.
  One of the things that I notice when I go and talk to my constituents 
is that the reason there is overwhelming support for the Patients' Bill 
of Rights is because people understand that on a day-to-day basis that 
this is what is needed.

                              {time}  2130

  This is real. This is not pie in the sky. This is not ideological. 
This is what is happening day-to-day.
  Mr. Speaker, I yield to the gentlewoman from Texas (Ms. Eddie Bernice 
Johnson).
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, let me express my 
appreciation to the gentleman from New Jersey (Mr. Pallone) for taking 
the leadership and making sure that we get a chance to discuss such an 
important issue.
  Mr. Speaker, I am delighted to participate tonight in this special 
order.

[[Page H4008]]

 This is a very, very important issue. As I have sat and listened to 
the various presentations here, it occurs to me that, when a patient is 
admitted to a hospital, one of the first things that happens is that we 
take the history, and we want to know all of the individual signs and 
all of the individual differences of that patient.
  I wonder how the HMOs and the insurance companies can reconcile 
deciding that one size fits all after one goes to the extent of trying 
to determine what the individual differences are. Because it makes a 
difference in the way one begins to treat that patient.
  We have forgotten that in this industry. As a matter of fact, I am 
beginning to wonder if we have forgotten the patient altogether, 
because the insurance companies will place the physician out there with 
their instructions and almost dare them not to do anything else.
  The physicians are held accountable, not the insurance companies that 
dictate what they must do. That is not American. Nothing in the history 
of medicine in this country has allowed something like that to happen.
  In the past, when a physician graduated and met the standardized test 
and assured the Nation that they had that body of knowledge mastered, 
they had permission to practice medicine. They no longer have that 
under the HMOs. They have to take the dictation from that HMO. Yet, 
they can be held accountable by the patients and the patients' family, 
but not the HMO that dictates it.
  That is the most unfair thing that I have heard of. I cannot even 
imagine this being something that is happening as a routine way of 
doing business in health care delivery in this country, the super 
nation, the number one nation in the world, the 911 for the rest of the 
world, the Nation that every other nation expects to come to their 
rescue, and yet we cannot respect the patient as an individual. That is 
beyond my comprehension. This really has gone too far.
  The mere fact that we do not have the opportunity to bring back a 
course of doing business, this measure to the floor for honest debate 
is again un-American. It is unfortunate that we have to sign a 
discharge petition. I do not like the process of signing a discharge 
petition. We are placed in a position to do that.
  All 435 Members of this body will acknowledge that this is a problem 
in this Nation; and yet, we have to go to discharge petition signing to 
bring this measure to the floor. That is very difficult to believe. 
But, yet, I will proudly join the group next Wednesday and sign this 
discharge petition because this is a number one concern of the people 
of this Nation.
  No one wants to feel that, if they had an emergency and go to the 
emergency room, they might be rationed in what might be the approach if 
it is felt that it might cost the insurance company too much if they 
began a procedure that might be too expensive.
  We have had testimony that there have been times when physicians were 
actually complimented because a patient died in the emergency room 
which saved money for the insurance company. Does this sound like 
America? Does this sound like the Nation that has brought forth some of 
the most innovative measures and approaches to any disease, more so 
than anywhere else in the world; and, yet, the people of this Nation 
have no access to that success. Yet, all of us have participated in 
paying for it because all of us pay for medical research.
  We simply must address this issue for what it is. If all of us went 
into a department store to get a suit, we would not want a suit that 
would fit anybody, we would want a suit that would fit us. That is what 
we want when we get sick. We do not want a one size fits all. We do not 
want it to be just a diagnosis that must follow the script verbatim.
  We have to get back to looking at patients as individuals and making 
sure that they get the treatment they deserve. All that we can say 
about this when it comes right down to it, people pay for their care. 
They pay for their care, and they do not pay for it for the purpose of 
insurance companies having a lot of money to invest so they can take a 
lot of money home. They pay for it because it is a service, a service 
that members of that insurance company of that particular plan should 
have access to the needed care.
  We are not talking about abuse of care. There are many measures that 
can determine that. We are talking about essential basic care that an 
individual deserves to have when that individual becomes ill. We are 
talking about looking at that patient's history and making sure that 
that is considered when the doctors orders are written, not just to 
pull out a preprinted sheet and follow it simply because that is what 
the insurance company dictated. Yet, the biggest frightening scare is 
to be held accountable for what their dictating brings about.
  There is something simply not right. This is a basic fundamental 
right that every patient ought to have is access to care where they are 
considered as an individual. There is a difference between a 25 year 
old and a 75 year old; and, therefore, often the approach to that 
patient's diagnosis, although it might be the same, might be a little 
bit different.
  When we get away from that as a Nation, we have forgotten where we 
started, what this really is. This is really the health care industry. 
This is the industry that we are supposed to be able to have confidence 
to put our very lives in the hand of professional providers and feel 
certain that we can trust it, not just a simple sheet of paper that, if 
the doctor not follow it verbatim, then they are out a good stead with 
the insurance company. It is out of control, and we simply must do 
something about it.
  I thank the gentleman from New Jersey (Mr. Pallone) very much for 
having this special order. I do not think we can talk enough about this 
subject. This is basic and fundamental to every human being being seen 
as a human being in this country.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman from Texas 
and particularly when she points out that, from the practitioner's 
point of view, whether it is the physician or the nurse, that 
essentially they cannot practice medicine because of the straight 
jacket essentially that has been put on them many times by HMOs, 
managed care organizations. I think a lot of people do not understand 
that. It is important.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, the responsibility 
is still there, but they cannot make an independent decision.
  Mr. PALLONE. We cannot have it. We have to have an end to that. I 
agree with the gentlewoman.
  Mr. Speaker, I yield to the gentlewoman from Illinois (Ms. 
Schakowsky), who is a member of our Health Care Task Force and been 
working very hard to try to make sure that we are able to vote on this 
Patients' Bill of Rights and to articulate to our constituents what 
this is all about.

  Ms. SCHAKOWSKY. Mr. Speaker, I thank the gentleman from New Jersey 
very much for the opportunity to participate in this discussion and 
look forward to the successful efforts for all of us on this floor to 
be able to debate and vote on a comprehensive Patients' Bill of Rights.
  It is hard for me to imagine that there is anybody in this body who 
has not received lots of mail from their constituents about the abuses 
that are taking place every day. I have been hearing both from people 
who give care, nurses and physicians, and people who receive care, who 
are seeking the care, the patients.
  I want to give my colleagues one example of a heartbreaking letter 
that I received. It starts,

       Dear Representative Schakowsky, I am a 31-year-old nurse 
     with breast cancer. Because I am an HMO member, I have had 
     recurrent problems with receiving health care. As a patient, 
     I have not yet received compromised care, but I have been 
     denied services or have been told where to get care and who 
     could give me care. I recently also was made to change 
     primary doctors, giving up one that I had for 8 years because 
     of my HMO.
       I heard you speak on behalf of the Patients' Bill of 
     Rights, and I need you to know that, as a health care 
     provider and receiver and HMO member, I am certain that care 
     is being compromised and restricted and refused to us.
       I am knowledgeable about the health care system, and I am 
     still able to be my own advocate, but I am sure 1 day I will 
     not be able to make telephone calls endlessly pleading for 
     standard of care. Who will do it for me? Why do I need to beg 
     for treatments or for the right to remain in the care of my 
     own doctor?
       I am receiving follow-up care from my oncologists after 
     having a stem cell transplant for metastatic breast cancer, 
     and I am

[[Page H4009]]

     worried that continuity of care will be compromised. And I 
     will only be treated if the HMO sees fit rather than being 
     able to rely on the judgment of a physician who had known me 
     for 8 years and an oncologist who has seen me every month for 
     a year. I want managed care to stop making medical decisions. 
     I have a right to health care.
       As a nurse, I also know that quality health care is the 
     issue. Having cancer has changed my life. Having adequate 
     health insurance was a wise choice I made 10 years ago. Today 
     I am fearful that I have no rights as an HMO member. That is 
     one battle too many for me to take on.
  It frustrates me so much after having received this letter, and it is 
one of many that I have received, probably one of the most articulate 
descriptions of the problem, that we have to go through such a 
cumbersome process of marching down and gathering enough signatures for 
a petition simply to have the right to debate this issue fully in the 
House.
  One would think that all the Members would jump at the opportunity to 
do that on behalf of our constituents. The only thing I can think is 
that the concerns of the health care industry, of managed care 
companies, of insurance companies has superseded concerns for ordinary 
patients and consumers in our districts.
  I do not think it is sound health care policy to force a breast 
cancer patient to give up a physician of 8 years. It is not sound 
health policy to force a breast cancer patient like my constituent to 
beg for treatment. It is not sound health policy for insurance 
companies to make medical decisions. It is not sound health policy for 
the United States Congress to delay action on preventing these abuses.
  We have a number of excellent proposals, H.R. 358, the Patients' Bill 
of Rights, and as a prior colleague of mine said, there may be many who 
disagree with that, but we certainly should be able to discuss a bill 
that has provisions such as providing full and fair access to 
specialists and to emergency care, giving patients the right to timely 
appeals, including the right to appeal to an external and independent 
entity, holding managed care plans accountable for all their decisions, 
including the decision to deny care, and letting medical professionals 
and their patients make the medical decisions.
  So I am hopeful that next week when we do engage in gathering the 
signatures for this discharge petition that we are going to have a 
majority of Members of this body, both sides of the aisle, who say it 
is time now, it is more than time now to fully debate this issue.
  I am hoping that we will be able to provide the relief that our 
constituents are begging for and deserve.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman from 
Illinois. It is funny when we talk about this discharge petition 
process. It is extraordinary to think that here we are as the elected 
Representatives, normally petitioning is something that I think of as 
the citizens have grievances so they have to sign a petition and send 
it to us as their Representatives. I do not think most people ever 
imagine that their elected Representatives from Congress have to sign a 
petition to get a vote on a piece of legislation, because I think most 
of our constituents figure that is the normal procedure, that we get to 
vote on bills, not that we have to petition to vote on them.

                              {time}  2145

  I wanted to just compliment the gentlewoman also because I think that 
that letter that she brought forward really says a lot about why this 
Patients' Bill of Rights is so important.
  One of the things I think about the most is how difficult it is when 
a person is seriously ill or has cancer, as is the example that the 
gentlewoman gave, and how difficult it is for them at that time when 
they are not feeling well to have to go through all of the hoops that 
these managed care companies often make them go through. Like if they 
are not allowed to have a certain treatment, they are not strong, in a 
position to appeal that or to try to seek redress because they are not 
feeling well at the time. And it is really like the worst time for a 
person to have to worry about whether they are going to have access to 
treatment or how they can get access if it is denied. And I think that 
letter really points out why it is so important to have these 
protections that we are seeking. So I thank the gentlewoman again.
  Now I see that my colleague from the district next door to my west is 
here tonight, the gentleman from New Jersey (Mr. Holt), and one of the 
first things that that gentleman did when he was first elected and took 
office in January was to come to Monmouth County and have a town 
meeting on the Patients' Bill of Rights because, obviously, he thought 
it was so important. So I want to commend him for all he is trying to 
do in his district and here on this issue, and I yield to the 
gentleman.
  Mr. HOLT. Mr. Speaker, I wanted to join my colleagues, the 
gentlewoman from Illinois (Ms. Schakowsky), and thank my colleague from 
New Jersey for highlighting this issue and for pushing to get a 
comprehensive Patients' Bill of Rights to the floor, not bits and 
pieces but a whole thing, an integral piece, and that is what we want. 
That is what the public needs.
  Each of us would like to have a relationship with a Marcus Welby kind 
of physician, a kindly understanding doctor who really ministers to our 
whole being, and works with us on medical decisions that often include 
ethical decisions as well as scientific decisions. I have spent a lot 
of time, particularly since I have been in office now, talking with 
doctors, and it is interesting to think of it from their point of view. 
What doctors are about to lose or what they feel in many ways they have 
lost is the reason that they became doctors, the doctor-patient 
relationship; the ability to make medical decisions with the patients.
  And a lot of people say, well, the Patients' Bill of Rights, as it is 
set up, will just bring lawyers into the picture and we will end up 
having a medical system that is run by lawyers. Well, I do not think 
that is true at all. And the way it is now, who has the last word? It 
is not the doctor. If a patient can sue a hospital and can sue the 
doctor but cannot sue the insurance provider, the insurance company, 
who has the last word? Who can make the medical decisions? It is not a 
doctor-patient decision. And doctors feel that they have lost the 
reason that they went into that profession.
  There is a lot at stake here, and that is why I think it is important 
that we have a comprehensive Patients' Bill of Rights that provides 
emergency room access and makes it possible for doctors to talk about 
all of the treatments that are available, not just the cheapest ones, 
and that lets the medical decisions rest with the doctor and the 
patient. I hear that over and over again from doctors.
  An interesting, I guess political sidelight is that it was not very 
many years ago that doctors around the country by and large were very 
much afraid of what Congress might do. Now they are very much afraid of 
what Congress might not do. Doctors and their patients are looking to 
us to act to protect the patients rights.
  Mr. PALLONE. Well, I want to thank the gentleman. I think this is 
really all it is about.
  One of the things that I keep stressing, and that I think came up 
tonight with the various speakers, is the fact that this is just common 
sense. When we talk about these patient protections that are in the 
Patients' Bill of Rights, we are not really talking about anything 
abstract or difficult to understand or even difficult to implement. In 
fact, when I go through the list of the kinds of patient protections 
that are included in our bill, I think most people would be shocked to 
think that they are not already guaranteed.
  Mr. HOLT. If the gentleman would yield. In our State of New Jersey 
many of them are, in fact, provided. New Jersey has, in many ways, good 
doctor-patient regulations and laws. And much of what we are calling 
for in various parts of the country is provided. But what we need, I 
think, are good standards all across the country.
  Mr. PALLONE. And there is also the fact that the States do not have 
any power over the ERISA plans, and the majority of the people are 
actually under some kind of self-insured program or self-insured health 
care or managed care through where they work, and that is preempted by 
Federal law so that those State plans do not apply.
  Just to give an example, and I know we do not have a lot of time, we 
are almost out of time, but I just went

[[Page H4010]]

through some of the highlights of the Patients' Bill of Rights: 
Guarantees access to needed health care specialists. Most people 
probably think they have a right to see a specialist, but they do not 
necessarily right now.
  Provide access to emergency room services when and where the need 
arises. Most people are shocked to find out they cannot go to the local 
emergency room because their HMO says they have to go somewhere else.
  Provide continuity of care protections to assure patient care if a 
patient's health care provider is dropped. Give access to a timely 
internal, independent, external appeals process. Ensure that doctors 
and patients can openly discuss treatment options.
  That is a great one. The gag rule. When I explain to constituents 
that under many managed care plans now that a doctor cannot give them 
information about a course of treatment that is not covered by the 
insurance company, they cannot believe it. Most people view that as un-
American because they figure we all should have a right to free speech. 
And to imagine that a doctor cannot tell a patient about a treatment 
option because it is not covered by the insurance plan is un-American 
is unethical and just incredible.
  These are simple things. We are not really talking about anything 
that is terribly abstract. These are just common sense protections.
  If I could just conclude by saying that I just think it is very 
unfortunate that we just cannot bring this measure to the floor and 
have a vote up and down. And the worst part of it is that this is the 
second year. Last year we had to do the same thing; go through the same 
petition process, have 200 some odd Democrats and a few Republicans 
come down here and sign a petition to get this considered on the floor. 
And here we are about to do the same thing next week in order to bring 
this to the floor.
  It just should not be that way. That is not the way people expect 
this Congress to operate. But we are going to make sure it happens and 
we are going to make sure that we have an opportunity to bring the 
Patients' Bill of Rights to the floor of the House of Representatives 
because it is the right thing to do and it is what Americans want and 
expect from all of us.

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