[Congressional Record Volume 145, Number 90 (Wednesday, June 23, 1999)]
[Senate]
[Pages S7510-S7514]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  Mrs. MURRAY. Mr. President, I hope we can work out an agreement, but 
I rise today really to express my frustration and outrage with the 
inability of the Republican leadership to allow a fair and open debate 
on the real Patients' Bill of Rights.
  I do not like the idea of tying up must-do appropriations bills to 
try and force a fair and open debate on access to health care services. 
However, due to the inability to find a reasonable compromise on the 
number of amendments, we have been forced to bring this issue to every 
possible vehicle.
  I hope we can work out an arrangement with the majority party to do 
this and to have our opportunity to offer amendments that we think are 
very important.
  Sometimes we spend far too much time on issues of little significance 
to the American people. One of the majority's showcase pieces of 
legislation in 1999 was to change the name of National Airport to the 
Ronald Reagan Washington National Airport. We spent more time talking 
about the name change than we have on debating the Patients' Bill of 
Rights.
  When it comes to access to emergency room treatment, or access to 
experimental lifesaving treatments, we cannot seem to find 3 days for 
its consideration on the Senate floor. This is the kind of legislation 
that really does impact American working families. I would argue that 
it deserves a full and open debate on the Senate floor, allowing us to 
offer our amendments.
  The Republican reform legislation reported out of the HELP Committee 
is not--and let me repeat, is not--a patients' bill of rights. Oddly 
enough, it excludes most insured Americans and, in many cases, simply 
reiterates current insurance policy. It does not provide the kinds of 
protections and guarantees which will ensure that when you need your 
insurance, it is there for you and your family.
  Let's face it. Most people do not even think about their health 
insurance until they become sick. Certainly, insurance companies do not 
notify them every week or month, when collecting their premiums, that 
there are many services and benefits they do not have access to. It is 
amazing how accurate insurance companies can be in collecting premiums, 
but when it comes time to access benefits, it becomes a huge 
bureaucracy with little or no accountability.
  The Republican leadership bill is inadequate in many areas. Let me 
point out a couple of the major holes that I see in this legislation.
  During markup of this legislation in the HELP Committee, I offered 
two important amendments. The first one was a very short and simple 
amendment to prohibit so-called drive-through mastectomies.
  My amendment would have prohibited insurance companies from requiring 
doctors to perform major breast cancer surgery in an outpatient setting 
and discharging the woman within hours. We saw this happen before when 
insurance companies decided it was not medically necessary for a woman 
to stay more than 12 hours in a hospital following the birth of a 
child. They said there was no need for followup for the newborn infant 
beyond 12 hours. There was no understanding of the effects of 
childbirth on a woman and no role for the woman or physician to 
determine what is medically necessary for both the new mother and the 
new infant.
  I offered the drive-through mastectomy prohibition amendment only 
because an amendment offered earlier in that markup would continue the 
practice of allowing insurance personnel to determine what was 
medically necessary--not doctors, not patients, but insurance 
companies. I offered my amendment to ensure that no insurance company 
would be allowed to engage in drive-through mastectomies.
  My amendment did not require a mandatory hospital stay. It did not 
set the number of days or hours. It simply said that only the doctor 
and the patient would be able to determine if a hospital stay was 
medically necessary. The woman who had suffered the shock of the 
diagnosis of breast cancer, the woman who was told the mastectomy was 
the only choice, the woman who faced this life-altering surgery, 
decides, along with her doctor.
  Unfortunately, my colleagues on the other side did not feel 
comfortable giving the decision to the woman and her doctor. They did 
not like legislating by body part; and neither do I. But I could not 
sit by and be silent on this issue. Defeating the medically necessary 
amendment, offered prior to my amendment, forced me to legislate by 
body part. And I will do it again to ensure that women facing a 
mastectomy are not sent home prematurely to deal with both the physical 
and emotional aftershocks.
  For many years, I have listened to many of my colleagues talk about 
breast cancer and breast cancer research or breast cancer stamps. When 
it comes to really helping breast cancer survivors, some of my 
Republican colleagues voted no. I hope we are able to correct this and 
give all of my colleagues, not just those on the HELP Committee, the 
chance to vote yes.
  The other amendment I offered in committee addressed the issue of 
emergency room coverage. The Republican legislation falls short of 
ensuring that when you have a sick child with a very high fever, and 
you rush them to the emergency room in the middle of the night, the 
child will receive emergency care as well as poststabilization care. 
The Republican bill simply adopts a prudent layperson standard on 
emergency care, not care beyond the emergency.

  That means that a child with a fever of over 104 degrees may not 
receive the full scope of care necessary to determine what caused the 
fever to prevent the escalation of a fever once the child has been 
stabilized. As many parents know, simply controlling the fever is not 
enough; you have to control the virus or infection to prevent the fever 
from escalating again.
  I tried in committee to address the inequities in the Republican bill 
regarding emergency room coverage. Unfortunately, my amendment was 
defeated. Let me point out to my colleagues, if they think their 
language will protect individuals seeking emergency care, they are 
sadly mistaken.
  The insurance commissioner's office in my home State of Washington 
recently initiated a major investigation of insurance companies that 
had denied ER coverage based on a prudent layperson's standard. The 
commissioner's office discovered that despite a

[[Page S7511]]

State regulation requiring a prudent layperson standard, there were 
numerous examples of individuals being denied appropriate care in the 
emergency room.
  In Washington State, a 15-year-old girl with a broken leg was taken 
by her parents to a hospital emergency room. The claim was denied by 
the family's insurer, which ruled that the circumstances did not 
constitute an emergency.
  A 17-year-old victim of a beating suffered serious head injuries and 
was taken to an ER. A CAT scan ordered by the ER physician was rejected 
by the insurer because there was no prior authorization. This 17-year-
old child was stabilized, but the physician knew that only through a 
CAT scan would they know the full extent of the child's injuries. Yet 
the insurance company denied payment because they had not approved the 
procedure. They obviously did not think that a CAT scan was part of ER 
care.
  These are examples of gross misconduct by insurance companies in the 
State of Washington that are supposed to meet the same standard that is 
included in the Republican bill. As the insurance commissioner learned, 
a prudent layperson standard still allows for a loophole large enough 
to drive a truck through.
  I also want to remind many of my colleagues who support doubling 
research at NIH that we are facing a situation where we have all of 
this great research we are funding, and yet we allow insurance 
companies to deny access. Yesterday we heard testimony at the Labor-HHS 
Subcommittee hearing about juvenile diabetes. It was an inspiring 
hearing. We had more than 100 children and several celebrities testify. 
Yet as I sat there listening to the testimony from NIH about the need 
to increase funding for research and how close we are to finding a 
cure, I was struck by the fact that the Republican leadership bill 
would allow the continued practice of denying access to clinical 
trials, access to new experimental drugs and treatments, access to 
specialties, and access to specialty care provided at NCI cancer 
centers.

  It does little good to increase research or to find a cure for 
diabetes or Parkinson's disease if very few people in this country can 
afford the cure or are denied access to that cure. We need to continue 
our focus on research, but we cannot simply ignore the issue of access.
  I urge my colleagues to join me in supporting a real Patients' Bill 
of Rights that puts the decision of health care back into the hands of 
the consumer and their physician, that doesn't dismantle managed care 
but ensures that insurance companies manage care, not profits.
  I don't want to increase the cost of health care. I simply want to 
make sure people get what they pay for, that they have the same access 
to care that we, as Members of the Senate, enjoy as we participate in 
the Federal Employees Health Benefit Program. The President has made 
sure we have patient protections. Our constituents deserve no less.
  I thank the Chair.
  Mr. NICKLES addressed the Chair.
  The PRESIDING OFFICER. The Senator from Oklahoma.
  Mr. NICKLES. Mr. President, I have a couple comments. Again, we are 
trying to come up with an arrangement. I think all my colleagues are 
aware of the fact that we have been negotiating on this most of the 
day. Hopefully, we will come up with an arrangement that is mutually 
satisfactory to all participants in the debate.
  I will respond to a couple of the comments, because maybe they 
haven't been responded to adequately. There has been a lot of 
discussion about the Republican package doesn't do this or the Democrat 
package does so many wonderful things. The Democrat package before the 
Senate increases health care costs dramatically.
  I stated, maybe 2 years ago: When the Senate considers legislation, 
we should make sure we do no harm. By doing no harm, I stated two or 
three propositions. One, we should not increase health care costs; that 
makes health care unaffordable for a lot of Americans. Unfortunately, 
the package proposed by my colleagues on the Democrat side--the Kennedy 
bill--increases health care costs 4.8 percent, according to the CBO, 
over and above the inflation that is already estimated for this next 
year, estimated to be about 8 percent.
  If you add 5 percent on top of 8 percent, that is a 13-percent 
increase in health care costs. The result is, probably a million and a 
half Americans will lose their health care if we pass the Democrat 
package.
  I have heard a lot of my colleagues say: We need to pass the Kennedy 
bill; it is going to do all these wonderful things, because we are 
going to protect, we have a prudent layperson. It is just a great idea. 
We have emergency care. It is a wonderful idea. We are going to 
guarantee everybody all this assortment of benefits. We are going to 
mandate all kinds of little coverages that all sound very good.
  But they do have a cost. If we make insurance unaffordable and move a 
million and a half people from the insured category to the uninsured 
category, I think we are making a mistake; I think we are making a 
serious mistake.
  There are some costs involved, and there is a little difference in 
philosophy. Some of our colleagues said the Republican package doesn't 
cover this or doesn't do this, doesn't do that. What we don't try to do 
is rewrite health care insurance, which is basically a State-controlled 
initiative. We don't have the philosophy that Washington, DC, knows 
best. There is a difference in philosophy.
  The Kennedy bill says: States, we don't care what you are doing. We 
know what is best. We have a package, an emergency care package, that 
you have to have ER services under the following scenarios. We don't 
care what you are doing, States.
  I just looked at a note. Forty States have emergency care mandates. 
The Kennedy bill says: We don't care what you are doing, States. Here 
is what we say, because we know what is best.
  I wonder if the State of Massachusetts has it. The State of 
Washington has it. I heard my colleague from Washington, Senator 
Murray, talk about emergency care. The State of Washington has 
emergency care mandates in their health care packages for State-
regulated health care plans. I heard the Senator from Washington talk 
about ``prudent layperson.'' The State of Washington has a prudent 
layperson mandate. Maybe that is not adequate. Maybe somebody in the 
State legislature in the State of Washington said: We need to 
strengthen this; we need improvement.

  There is a difference of philosophy. We, on our side, are saying we 
shouldn't try to rewrite health care plans all across America. We don't 
believe in national health insurance, that the Government in 
Washington, DC, is the source of all wisdom, has all knowledge, can do 
all things exactly right, and we should supersede the governments of 
every State.
  We don't have that philosophy. There is a difference of philosophy. 
The Kennedy bill says: States, you have emergency room provisions. We 
do not think they are adequate. We know what is best.
  Then the health care plans say: Wait a minute, we have been regulated 
since our inception by the States, as far as insurance regulation. Now 
we have the Federal regulation. Whom should we follow? They are 
different.
  Who is right? Do we just take the more stringent proposal, or are we 
now going to have HCFA regulate not only Medicare and Medicaid, but are 
we now going to have HCFA regulating private insurance? I do not think 
we should.
  I will tell my colleagues, HCFA has done a crummy job in regulating 
Medicare. HCFA has not complied with the mandates we gave them in 1997 
for giving information to Medicare recipients on Medicare options. They 
haven't done that yet. They haven't notified most seniors of options 
that are available to them that this Congress passed and this President 
signed. They haven't notified people of their options. They have done a 
crummy job of complying with the regulations that they have now. They 
haven't even complied with--some of the States--the so-called Kennedy-
Kassebaum legislation that passed a few years ago. There are some 
States, including the State of Massachusetts, which don't even comply 
with the Kennedy-Kassebaum kid care formulations. HCFA is supposed to 
take that over. They haven't done it.
  My point is, people who have the philosophy, wait a minute, we need 
to

[[Page S7512]]

have this long list of mandates, we are going to say it, and we are 
going to regulate it and dictate it from Washington, DC, I just happen 
to disagree with.
  It may be a very laudable effort. Some of the horror stories that 
were mentioned--this person didn't get care, and it is terrible--are 
tough stories. But we have to ask ourselves, is the right solution a 
Federal mandate? Is the Federal mandate listing here of what every 
health care plan in America has to comply with, dictated by Washington, 
DC, dictated by my friend and colleague from Massachusetts, is that the 
right solution? I don't think so.
  Is there a cost associated with that? Yes, there is. I mention that 
to my colleagues and to others who are interested in the debate.
  We will have this debate. I think there will be an agreement reached 
that we will take this up on July 11, and we will have open 
availability for individuals to offer amendments with second-degree 
amendments, and hopefully a conclusion to this process.
  I did want to respond to say that this idea of somebody finding a 
horror story or finding an example of a problem and coming up with the 
solution, or the fix being ``Washington, DC, knows best,'' I don't 
necessarily agree with.
  I do think we can make some improvements. I do hope, ultimately, we 
will have bipartisan support for what I believe is a very good package. 
I am not saying it is perfect. It may be amended. It may be improved. I 
hope we will come up with a bipartisan package.
  We do have internal/external appeals which are very important and, I 
think, could make a positive contribution towards solving some of the 
problems many of the individuals have addressed earlier today.
  I yield the floor.
  Mr. EDWARDS addressed the Chair.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. EDWARDS. May I inquire how much time remains?
  The PRESIDING OFFICER. The minority has 5 minutes 10 seconds. The 
majority still has 15 minutes 50 seconds.
  Mr. EDWARDS. Mr. President, I come to the floor to address the 
important issue of the Patients' Bill of Rights. I will respond briefly 
to a couple of issues raised by my colleague, the distinguished Senator 
from Oklahoma, when the bulk of his argument and response to our 
Patients' Bill of Rights has to do with the issue of cost. I just want 
to point out that the most reliable studies done by the GAO indicate 
that the increased costs across America will be somewhere between $1 
and $2 per patient per month, which I think is less than a cup of 
Starbuck's coffee. My suspicion is that most Americans would be willing 
to bear that cost to have real and meaningful health care reform.

  There is a lot of rhetoric about national health insurance, and they 
are not for that. This bill has absolutely nothing to do with national 
health insurance. What it has to do with is creating rights for 
patients that provide them with protections against HMOs and health 
insurance companies that are taking advantage of them on a daily basis.
  There is another huge difference between these two bills. I prefer 
not to talk about them as the Democratic or Republican bill because, 
for me at least, this is not a partisan issue; it is a substantive 
issue. If we have a bill that is a real, meaningful Patients' Bill of 
Rights, whether it is Democratic or Republican, or a compromise between 
the two, I would support it. It makes no difference to me who authors 
the bill. I came here to talk about an issue that is critical to the 
people of North Carolina, to the people of America.
  The people of America are not interested in partisan bickering on the 
floor of the Senate. They are not interested in that; they don't care 
about it. What they do care about, and what I care about, is addressing 
the issue of health care and the issue of the Patients' Bill of Rights 
in a real substantive and meaningful way.
  I want to talk briefly, if I can, about a real case I was involved in 
personally--at least my law firm was involved in--before I came to the 
Senate this past January. The case involved a young man named Ethan 
Bedrick. Ethan was born with cerebral palsy. As a result of his 
cerebral palsy, he needed a multitude of medical treatments, including 
therapists--physical and speech--to help him with mouth movement and 
his limbs. The physical therapy was prescribed specifically for the 
purpose of being able to pull his limbs out and back and out and back, 
so he didn't develop what is called muscle contractures, so that he 
didn't get in a condition where he could not move his arms and legs any 
longer.
  Ethan is from Charlotte, NC. Ethan's doctors who were seeing him--a 
multitude of doctors, including physical therapists, a general practice 
physician, a pediatric neurologist who specialized in making 
determinations about what children in his condition needed--all of 
those physicians, every single one of them, everybody treating him came 
to the conclusion that Ethan needed physical therapy.
  When the family went to their health insurance company to try to get 
reimbursed for the physical therapy, the health insurance company 
denied paying for the physical therapy. Basically, they decided it 
based upon an extraordinarily limited and arbitrary reading of the term 
``medical necessity.'' They basically found the most limited definition 
and they looked around and found a doctor who was willing to support 
that position. So they denied the claims.
  I want the American people to understand that every doctor who was 
treating Ethan said he needed this care. It was absolutely standard 
care for a young child with cerebral palsy. But there was some doctor 
working for an insurance company somewhere in America who was willing 
to say: No, I don't think he needs it. Therefore, they denied coverage, 
regardless of what all his treating physicians said.

  We filed a lawsuit on behalf of Ethan against the insurance company. 
We had to jump through extraordinary hoops because it is so difficult 
to bring any kind of action against a health insurance company or an 
HMO. The case was decided, ultimately, by the U.S. Court of Appeals for 
the Fourth Circuit, which covers a number of States in the southeastern 
United States. That court, which is well known for its conservative 
nature, issued an opinion on Ethan's case. I will quote very briefly 
from that opinion. The court addressed in very stark terms what they 
saw as the problem. I am reading now from the opinion of the Fourth 
Circuit:

       . . . The precipitous decision to give up on Ethan was made 
     by Dr. Pollack, who could provide scant support for it. The 
     insurance company boldly states that she [Dr. Pollack] has a 
     ``wealth of experience in pediatrics and knowledge of 
     cerebral palsy in children.'' We see nothing [in the Record] 
     to support this. . . . In fact, she was asked whether, in her 
     twenty years of practice, she ever prescribed either speech 
     therapy, occupational therapy, or physical therapy for her 
     cerebral palsy patients. Her answer: ``No, because in the 
     area where I practiced, the routine was to send children with 
     cerebral palsy to the Kennedy Center and the Albert Einstein 
     College of Medicine. We took care only of routine physical 
     care.
       So much for Dr. Pollack's ``wealth of experience.''

  This was a physician who had absolutely no experience with 
prescribing physical therapy for children with cerebral palsy. Yet this 
physician was the sole basis for the insurance company denying this 
very needed care for this young boy with cerebral palsy.
  It gets worse. Dr. Pollack was then asked whether physical therapy 
could prevent contractures, which is what is caused when children with 
cerebral palsy don't get this. Their arms and legs become contracted 
and they can't be pulled out.
  This was her answer: No.
  She was asked: Why not?
  Answer: Because it is my belief that it is not an effective way of 
treating contractures.
  This is the insurance company doctor.
  She was asked: Where did this belief come from?
  She says: I cannot tell you exactly how I developed it because the 
truth is I haven't thought about it for a long time.
  The nadir of this testimony was reached soon thereafter because the 
baselessness for this insurance company doctor's decision became very 
apparent. The Fourth Circuit quotes from the questions and answers to 
Dr. Pollack:

       Question: . . . If Dr. Lesser and Dr. Swetenburg were of 
     the opinion that physical therapy at the rate and 
     occupational

[[Page S7513]]

     therapy at that rate were medically necessary for Ethan 
     Bedrick, would you have any reason to oppose their opinion?
       Answer: I am not sure I understand the question. Using what 
     definition of medical necessity?
       Question: Well, using the evaluation of medical necessity 
     as what is in the best interests of the child, the patient.
       Answer: I think we are talking about two different things.
       Question: All right. Expand, explain to me what two 
     different things we are talking about?
       Answer: I'm speaking about what is to be covered by our 
     contract.
       Question: Is what is covered by your contract something 
     that's different than the best interests of the child as far 
     as medical treatment is concerned?
       Answer: I find that's a little like ``have you stopped 
     beating your wife?''
       Question: That's why I ask it. If Doctor Swetenburg and Dr. 
     Lesser recommended physical therapy and occupational therapy 
     at the rates prescribed, do you have any medical basis for 
     why this is an inappropriate treatment that has been 
     prescribed [for this boy]?

  Remember, this is the insurance company doctor on the basis for which 
the insurance company had denied all coverage for this care.

       Answer: I have no idea. I have not examined the patient. I 
     have not determined whether it is appropriate or 
     inappropriate. But that isn't a decision I was asked to make.

  So what happened is, we have an insurance company doctor with no 
experience, never examined the child, who has decided this care is not 
medically necessary or medically appropriate, based on nothing and the 
insurance company denies coverage in the face of every single health 
care provider saying this child with cerebral palsy needs to be 
treated.
  This is a perfect example of what is wrong with the system. It is why 
we need real external review. It is why we need an independent body 
that can look at a decision made by an insurance company and decide--it 
would be obvious in this case--that the decision was wrong and that a 
child is suffering as a result.
  When I say an independent review, I mean a really independent review, 
not an independent review board made up of people chosen by the 
insurance company. That is an enormous difference between one of the 
bills being offered by our opponents and the bill being offered by us. 
We would set up a real and meaningful independent review board so that 
when something like this happens to Ethan Bedrick, a child with 
cerebral palsy, there would be a way to go to an independent board 
immediately and get a review, the result of which the decision would be 
reversed and in a matter of weeks, at the most, this child would get 
the therapy he so desperately needs.
  The long and the short of it is, even after we won this case in the 
court of appeals, it was over a year before Ethan Bedrick began to 
receive the care he deserved.
  This case illustrates perfectly why this is such an acute problem and 
why we need to address it. We need desperately to address it in a 
nonpartisan way. We need to do what is in the best interests of the 
American people; that is, to pass a real and meaningful Patients' Bill 
of Rights.
  Thank you, Mr. President.
  Mr. LOTT. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CRAIG. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CRAIG. Mr. President, are we still in morning business?
  The PRESIDING OFFICER. The Senate is in morning business. The 
Republican side has 8 minutes remaining.
  Mr. CRAIG. I ask unanimous consent we stay in morning business under 
the current restriction and continue until 4 o'clock.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CRAIG. Mr. President, for the last several days this Senate has 
been engaged in a fascinating exercise. I say that because last 
Thursday evening before I left the Senate I was approached by an 
individual in the media, a press person on Capitol Hill, who said: I 
understand the Democrats are about to slow the process down.
  I said: What do you mean?

       They think the Republican Senate is on a roll, you have 
     accomplished a good many things this week, and they are about 
     to slow you down.

  I said: What is the strategy here?
  That person said: We think they are going to offer the Patients' Bill 
of Rights to the agriculture appropriations bill.
  Of course, we now know that is exactly what happened. Their tactic is 
to slow the process down. I am not sure why. Obviously, they are going 
to get ample opportunity to make their statements and to have their 
votes on the issue of a Patients' Bill of Rights.
  Whether Democrat or a Republican, we can mutually agree that there is 
a very real problem in the health care community of our country 
specific to Americans and health care coverage. I am not sure we get 
there by punching American farmers in the face, or by acting as if they 
are of little to no importance and placing other national issues ahead 
of them.
  That is what has happened. I am amazed some of my colleagues on the 
other side of the aisle from dominant agricultural States and who have 
oftentimes led the agricultural debate on the floor would use these 
tactics to move their national agenda well beyond agriculture.
  What is important is that we deal with the ag appropriations bill, 
that we deal with it in a timely fashion to address those concerns of 
the American agricultural community within the policies of our 
government but also recognize we have a problem in the agriculture 
community today. We have turned to the Secretary of Agriculture and to 
the President to work with us to identify and shape that issue; we will 
come back with the necessary vehicle to address it beyond the current 
appropriations bill.

  We are waiting for their response.
  Agriculture issues have never been partisan. They shouldn't be 
partisan. I am amazed my colleagues on the other side of the aisle have 
used this dilatory tactic that all but ``partisanizes'' an agriculture 
appropriations bill, almost saying it doesn't count; our political 
agenda is more important than the policies of the government handled in 
an appropriate and timely fashion.
  Our leaders are negotiating at this moment to determine the shape of 
the debate over a Patients' Bill of Rights. I hope they are able to 
accomplish that. The clock ticks. American agriculture watches and 
says, there goes that Congress again, playing politics with a very 
important issue for our country.
  I will be blunt and say, there goes the Democrat side of this body 
playing politics with a very important appropriations bill that I hope 
we can get to.
  I see Senator Feingold on the floor. Our staffs have been working 
together on a very critical area of this bill, as I have been working 
with the Presiding Officer, to make sure that we shape the agriculture 
appropriations bill and deal with dairy policy in a responsible 
fashion.
  I come to the floor to associate patients' rights and health care 
with an agriculture policy. Is that possible to do? Well, it is. My 
colleagues on the other side of the aisle have attempted to do that. I 
hope my colleagues will listen as I shape this issue. There is a very 
important connection.
  It will not be debated on the agriculture appropriations bill, but we 
all know that American agriculture--farmers and those who work for 
farmers--is within the sector of about 43 percent of all workers in 
America who are not working for an industry that insures them. As a 
result, they must provide for themselves. They must self-insure and 
provide for their individual workers within their farms or ranches.
  The Patients' Bill of Rights that my colleagues on the other side of 
the aisle want to bring to the floor--and I trust their sincerity in 
wanting it to become law--will very much change the dynamics of the 
self-insured in this country. They do so in a very unique way. The 
average family premium in the individual self-insured market--I am 
talking about American farm families --is about $6,585 today. That is 
what it costs for them to insure themselves. Under the Democrat Kennedy 
bill, they are going to pay at least another $316.
  Figure this one out: As my colleagues on the other side of the aisle 
talk about the worst depression in farm country in its history, with 
depression-era prices for commodities, in

[[Page S7514]]

the same breath they stop the agriculture appropriations bill and say: 
Hey, farm family, on our Patients' Bill of Rights, because we are about 
to increase your medical costs by an average of $316 a year, that is 
money you don't have, but we will force you to do it anyway. Your 
premiums will go up by the nature of the bill we want to fashion.
  Some have stated this bill will cause over 2 million Americans to 
lose their health care insurance. This chart demonstrates a problem 
that all Members are sensitive to but a problem that we don't want to 
cause to be worse.
  A phrase that has been used on this floor in a variety of debates in 
the last couple of months is ``unintended consequences.'' If we pass 
the Kennedy health care Patients' Bill of Rights, there is a known 
consequence. You can't call it ``unintended.''
  By conservative estimates it would add one million uninsured 
Americans to the health rolls. That is the conservative estimate. I 
said 2 million a moment ago. That is the liberal estimate. It is 
somewhere in that arena. The other side knows that America's farmers 
and farm families will have to pay $300 to $400 more per year in health 
care premiums because they are self-insured.
  That is the nexus with the farm bill and the agriculture 
appropriations bill in its strange and relatively obscure way. But it 
is real. I hope our leaders can be successful in shaping the debate 
around the Patients' Bill of Rights that says we will have that debate, 
here is the time line, and here are the amendments that can be offered.
  It is going to be up or down. We will all have our chance to make our 
points, but let's not play the very dangerous game of tacking it onto 
any bill that comes along that stops us from moving the appropriation 
bills in a timely fashion. We will debate in a thorough nature why 
their legislation creates a potential pool of between 1 to 2 million 
Americans who will become uninsured because of an increase in premiums.
  On the other side of the equation is the Patients' Bill of Rights 
crafted by the Republican majority in the Senate. We go right to farm 
families. We say to farm families, we are going to give you a positive 
option in your self-insurance, and that is, of course, to create a 
medical savings account.
  In States made up of individual farms--Wisconsin, Indiana, Ohio, 
Illinois, and Iowa--already the meager efforts in creating medical 
savings accounts we have offered in past law have rapidly increased the 
coverage for health care at the farm level.
  So if we want to create a true nexus between an agriculture bill and 
a Patient's Bill of Rights, it is the Republican version that says 
let's expand medical savings accounts, let's give small businesspeople, 
farmers, ranchers, the option of being able to self-insure in a way 
that will cost them less money and have insurance to deal with, of 
course, the catastrophic concerns in health care that we would want to 
talk about.
  The reason I have always been a supporter of medical savings accounts 
is that it really fits the profile of my State. Farmers, ranchers, 
loggers, miners--small businesspeople make up a dominant proportion of 
the population of my State. Increasingly, many of them would become 
uninsured if the Democratic version, the Kennedy bill, were to pass 
this Congress and become law. The unintended, or maybe the intended, 
consequence would be to push these people out of private health care 
insurance and therefore have them come to their Government begging for 
some kind of health care insurance.
  Why should we set up an environment in which we force people to come 
to the Government for their health care instead of creating an 
environment, a positive environment, that says we will reward you for 
insuring yourself by creating for you the tools of self-insurance and 
therefore create also a tax environment we want, where today health 
care premiums for the self-employed are fully deductible, as they are 
for big businesses which offer health care plans to their employees.
  There is a strange, unique, and somewhat curious nexus between 
Democrats blocking an agriculture appropriations bill coming to the 
floor and the politics of the Kennedy bill on health care. It is that 
they would cause even greater problems in the farm community by raising 
the premiums, by forcing certain costs to go into health care coverage 
today. Our Patients' Bill of Rights would go in a totally opposite 
direction, creating an environment in which people could become more 
self-insured at less money, at a time in American agriculture when it 
is estimated the average income of the American farmer, having dropped 
15 percent last year, could drop as much as 25 to 30 percent this year, 
with commodity prices at near Depression-era levels.
  We need to pass the agriculture appropriations bill. We will then 
work with the Department of Agriculture and the Clinton administration 
to examine the needs, as harvest goes forward, to assure we do address 
the American farmers' plight, as we did effectively last year. But it 
should be done in the context of agriculture appropriations and a 
potential supplemental, if necessary, to deal with that. It does not 
fit, nor should it be associated with, a Patients' Bill of Rights.
  I hope the end result today is to clear the track, provide a 
designated period of time for us to debate the Kennedy bill and a true 
Patients' Bill of Rights, as has been offered by the Republican 
majority here in the Senate, and then to allow us to move later today, 
this evening, and on tomorrow, to finish the agriculture appropriations 
bill and get on with the debate on that critical issue.
  American agriculture is watching. I hope they write my colleagues on 
the other side of the aisle and say: Cut the politics. Get on with the 
business of good farm policy. Do not use us as your lever.
  I hope that message is getting through to my colleagues on the other 
side. Let us deal with agriculture in the appropriate fashion.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mr. CRAIG. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER (Mr. Sessions). Without objection, it is so 
ordered.

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