[Congressional Record Volume 145, Number 93 (Monday, June 28, 1999)]
[Senate]
[Pages S7696-S7705]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   AGRICULTURE, RURAL DEVELOPMENT, FOOD AND DRUG ADMINISTRATION, AND 
               RELATED AGENCIES APPROPRIATIONS ACT, 2000

  The PRESIDING OFFICER. The Senate will resume consideration of S. 
1233.
  The legislative clerk read as follows:

       A bill (S. 1233) making appropriations for Agriculture, 
     Rural Development, Food and Drug Administration, and Related 
     Agencies programs for the fiscal year ending September 30, 
     2000, and for other purposes.

  Pending:

       Feinstein Amendment No. 737, to prohibit arbitrary 
     limitation or conditions for the provision of services and to 
     ensure that medical decisions are not made without the best 
     available evidence or information.

  The PRESIDING OFFICER. The Feinstein amendment is the pending 
business.


                Amendment No. 1103 To Amendment No. 737

  Mr. LOTT. Madam President, I send a second-degree amendment to the 
desk to the pending Feinstein amendment.
  The PRESIDING OFFICER. The clerk will report the amendment.
  The legislative clerk read as follows:

       The Senator from Mississippi [Mr. Lott] proposes an 
     amendment numbered 1103 to amendment No. 737.

  Mr. LOTT. Madam President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Is there objection?
  Mr. FEINGOLD. I object.
  The PRESIDING OFFICER. Objection is heard. The clerk will read the 
amendment.
  Mr. LOTT. Madam President, I ask unanimous consent that reading of 
the amendment be dispensed with so that I may explain briefly what is 
in this amendment, and if the Senator from Wisconsin wishes, he can 
continue the objection. I will clarify it for those who are curious 
about exactly what that amendment is.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. LOTT. Madam President, I just offered the Kennedy health care 
bill, the identical text of amendment No. 703, which was offered by 
Senator Dorgan to the agriculture appropriations bill. I hope that our 
colleagues on the other side of the aisle will let this go forward so 
that we can take appropriate action.
  I wanted to explain that. If the Senator insists, the reading can 
continue.
  Mr. FEINGOLD. I thank the majority leader. I have no objection at 
this point.
  (The text of the amendment is printed in today's Record under 
``Amendments Submitted.'')
  Mr. LOTT. Madam President, again, I did offer the Kennedy health care 
bill to the agriculture appropriations bill. My thinking is that rather 
than doing this piecemeal, let's go ahead and deal with the overall 
Democrat bill dealing with the Patients' Bill of Rights. In order to 
make sure it is properly considered, I will advocate cloture and I 
will, in fact, vote for cloture. I think that way we can deal with this 
issue straight up, not playing around with it.
  I emphasize again that this is a farce. I am treating it accordingly. 
When both sides really want to get serious about sitting down and 
working out a way to consider this bill separately as a legislative 
vehicle, I will be glad to do that. But it should not continue to 
tangle up the appropriations bills. I believe Senator Daschle and I 
really want to get some work done this week for the benefit of the 
country. I am convinced that he has that intent. By taking this action, 
I think we can still pass some appropriations bills this week and clear 
our calendar of a lot of nominations.

[[Page S7697]]

                             CLOTURE MOTION

  Mr. LOTT. Madam President, I send a cloture motion to the Kennedy 
amendment to the desk.
  The PRESIDING OFFICER. The cloture motion having been presented under 
rule XXII, the Chair directs the clerk to read the motion.
  The legislative clerk read as follows:

                             Cloture Motion

  We, the undersigned Senators, in accordance with the provisions of 
rule XXII of the Standing Rules of the Senate, do hereby move to bring 
to a close debate on the pending amendment No. 1103 to the Agriculture 
Appropriations bill:
         Senators Trent Lott, Thad Cochran, Ben Nighthorse 
           Campbell, Susan M. Collins, Craig Thomas, Michael D. 
           Crapo, Kay Bailey Hutchison, Bob Bennett, Larry Craig, 
           Connie Mack, Chuck Grassley, Christopher H. Bond, 
           Richard Shelby, Tim Hutchinson, Ted Stevens, and 
           Michael B. Enzi.
  Mr. LOTT. Madam President, I know this is an important issue to the 
minority leader. He will be here shortly. If he wishes, I would be 
willing to go ahead and have this cloture vote occur as the last vote 
in the voting sequence that we have stacked this afternoon at 5:30, 
notwithstanding rule XXII. I am not asking for that right now, but I 
make that offer to our colleagues. We can vote on that cloture motion 
this afternoon if they wish, or we can do it tomorrow. But at some 
point, it will ripen, and we will then have a chance to vote on 
cloture. I suggest that we actually vote on it.
  At this time, I yield the floor.
  Mr. DURBIN addressed the Chair.
  The PRESIDING OFFICER. The Senator from Illinois is recognized.
  Mr. DURBIN. Madam President, I have just arrived from Illinois, and I 
have come at the right moment because we are considering something 
called cloture in the Senate. The reason you file a motion for 
cloture--as Senator Byrd knows because he knows the Senate rules better 
than anyone, and probably wrote most of them--is to bring to an end to 
debate and to force the Senate to go forward on a vote.
  The Republican strategy, as enunciated by Senators Lott and Nickles, 
is to bring an end to this debate. Which debate would they like to see 
end? The debate about reforming health insurance in America. They do 
not want us to move forward with amendments pending by Senators 
Feinstein of California, Kennedy of Massachusetts, and others, which 
address the issue of health insurance reform. They do not want to face 
votes on these amendments. They do not want us to bring the Democratic 
Patients' Bill of Rights to the floor and ask Members on both sides of 
the aisle to vote their conscience, up or down, yes or no, on how we 
can change health insurance in America.
  For several days last week, the argument was made that ``we don't 
have time to debate health insurance reform.'' But as one day flowed 
into a second day, and now into another week, we are spending a lot of 
time on the issue without voting on it. We are spending time finding 
ways to avoid voting on health insurance reform--a Democratic Patients' 
Bill of Rights.
  Now my Republican colleagues have their own version of the bill and, 
of course, they are very proud of their version, as we are of ours. We 
have suggested: Bring your bill to the floor and bring your amendments 
to the floor. We will bring ours, and then we will assume the role of 
Senators. We will debate and we will vote. Ultimately, we hope to put 
together a good bill. But whatever the outcome, we will then go home 
and explain to the people we represent why we voted one way or another. 
This is not a radical strategy or policy.

  Mr. NICKLES. Will the Senator yield?
  Mr. DURBIN. I will yield for a question in a moment, if the Senator 
will allow me to complete my thought.
  What we are suggesting here is reminiscent of what most people expect 
to occur on the floor of the Senate--that Senators of differing 
viewpoints come forward and present their points of view and vote on 
them. We have gone on day after weary day with the Republican 
leadership trying to find ways to stop us from debating and stop us 
from voting.
  Over this weekend, I made a tour of my State of Illinois, which is a 
big State. I ran into some people who told me an interesting story 
about their experience with health care. One group was in a machine 
shed on a farm near Farmington, IL. About 30 farmers gathered. I asked 
them about the farm crisis and I asked them about health insurance. 
They were equally animated on both subjects, concerned about their loss 
of income and also concerned about the jeopardy they and their families 
face because of health insurance.
  Last weekend, I was in Peoria and I met with Henry Rahn. He raises 
soybeans and corn. If you go to most Illinois farms, you will find that 
is the case. He was quoted a price of $17,000 a year for health 
insurance for himself and his wife. What really wrangled Mr. Rahn was 
that in spite of his paying top dollar, the insurance companies were 
always trying to get out of paying for his health care needs. Recently 
he suffered a heart attack, and his coverage was threatened when he 
went to an emergency room because he had not called 24 hours in advance 
to notify the insurance company.
  Another farmer, Bob Zinser--he is a farmer in Peoria and is also a 
chiropractor--told me in no uncertain terms that the HMO and PPO plans 
were total garbage. Mr. Zinser says, ``It seems like insurance 
companies have infinite wisdom on what's right and what's wrong.''
  These farmers I met were angry about how they were treated by 
insurance companies. They wanted action.
  Under the GOP version--the Republican version--of managed care 
reform, these farmers I have just spoken about are not protected. They 
have written a bill which literally leaves behind 115 million Americans 
and provides no insurance reform. They do some things for small groups. 
But unlike the Democratic bill, which covers the vast majority of 
people with health insurance, the Republican bill leaves many behind, 
including the farmers and other self-employed people I just mentioned.
  When I described this to the farmers at the gathering, they couldn't 
believe it: You are talking about health insurance reform on the floor 
of the Senate, and yet it won't help us and our families? I said: The 
Republican version of the bill will not; the Democratic version will.
  Last night I flew to the Chicago area and went to Highland Park and 
met with a cardiologist. His story was chilling. Let me tell you 
exactly what he told me last night.
  He said a patient came to his office--a woman--on Thursday 
complaining of chest pains. He didn't think she was in an emergency 
situation but he wanted her to go to the hospital the next day--the 
next morning--for a catheterization, a very common diagnostic procedure 
used in cardiology, to determine just what her heart problem might be.

  So they called her insurance company, and the insurance company said: 
No, we will not let her have a catheterization on Friday, because that 
hospital that you want to send her to is not covered by her health 
insurance. So the doctor said: What would you have her do? They said: 
Let us make an appointment for her. We will call on Saturday to see 
what we can find.
  She passed away on Sunday. A decision about a hospital ended up 
jeopardizing this woman's health and her life.
  This doctor said to me: What am I supposed to tell her family?
  Think of how vulnerable each and every one of us is, going into a 
doctor's office hoping to get the very, very best diagnosis or 
treatment but always wondering if we will be second guessed by some 
bureaucrat at an insurance company. That is what this debate is all 
about.
  I understand the frustration of the Republican leadership. Those of 
us on the Democratic side for 2 weeks now have been pressing to bring 
this issue to the floor. We have said we will take the outcome of the 
vote, whatever it might be, but let us have this debate. America is 
looking for us to initiate that debate. But, sadly, there are those on 
the Republican side who do not want to face these votes. They don't 
want to have to vote yes or no. They don't want to have to decide 
between the insurance companies' agenda and the agenda of families 
across the Nation.
  That is a sad commentary on the state of affairs in the Senate, 
because the men and women I spoke to in that machine shed at the farm 
in Farmington, IL, and the doctor I spoke with in Highland Park 
understand full well

[[Page S7698]]

that this is an issue that can't be delayed.
  There are certainly important bills for us to consider. We have a 
myriad of important appropriations bills to consider. I hope we can 
come to them soon. But we have taken the position on the Democratic 
side that we are only prepared to move to the appropriations bills once 
we have an agreement from the Republican side that we will debate 
health insurance reform, we will debate the Patients' Bill of Rights. 
Unfortunately, as of this moment we do not have that agreement.
  There is also a question of accountability. I think this is a bottom 
line thought: The doctor who told me the story about the woman he 
wanted to refer for a heart catheterization but was told she couldn't 
go to the hospital that he wanted and the insurance company would come 
up with another one, I hope that doctor is never sued by anyone because 
of that decision. But those things do happen to doctors and hospitals. 
Despite the fact that the insurance company made the decision--the 
insurance company took her out of that doctor's care and said she had 
to go to another hospital--under current law in the United States of 
America, that health insurance company is protected from liability in 
court except for the cost of the procedure. If there is suffering, if 
there is pain, if there is loss of income, or if there is death, the 
insurance company, having made the decision which it did, will not be 
held liable.
  You say, well, certainly there must be other companies in America 
which enjoy this kind of special privilege. And the answer is no--not 
any; none. No other company in America enjoys this protection from 
liability or enjoys this exemption from accountability like health care 
insurance companies.
  Some on the Republican side have argued, oh, you Democrats just want 
to bring the health insurance companies in court to make lawyers 
wealthy. Of course, lawyers would be involved. It would be naive to say 
they wouldn't be involved. But the bottom line is, if you do not 
believe that your corporate decision--your insurance company decision--
is something you can be held accountable for, how careful will you be? 
You will make a decision based on the bottom line profit: What is good 
for my company? How much money will be there at the end of the year? If 
you make the wrong decision in the interest of the patient, will you be 
held accountable? Not under the law as written today.
  The Democratic Patients' Bill of Rights says no; health insurance 
companies, as every other company in America, will be held accountable 
for their conduct. Currently only foreign diplomats and health 
insurance companies cannot be brought into court in America. We think 
that should change. When it changes, we think health insurance 
companies, as in the example I used of the cardiologist, will think 
twice: Well, Doctor, perhaps you send that letter for a catheterization 
at the nearest hospital on Friday morning. No. We will not play with 
the insurance policy. We will work it out later. Let's take care of her 
health condition.
  But they didn't. They decided, let's stick to the letter of the 
insurance policy.
  How frustrating it is for doctors who face this. The doctors I talk 
to feel helpless.
  You read in the paper last week that the American Medical Association 
is talking about forming a union--the ``International Brotherhood of 
Physicians'' or something. What would bring what is typically viewed as 
a conservative political group such as the AMA to a moment in time 
where they have decided they have had enough, that they have no voice 
when it comes to medical decisions, and they have to come together and 
bargain collectively with insurance companies?
  I will tell you what has brought them to this point--the example that 
I used, and some others, where they realize that they have been 
overruled time and time again. They are frustrated. They are angry. 
That is why they have decided to start exploring the possibility of 
forming a union.
  The message is here, America. This is an issue which cannot wait. 
When the Republican leadership comes to the floor and accuses us of 
stalling tactics, we are not trying to stall this process; we on the 
Democratic side are trying to accelerate this process.
  Let's bring this bill to the floor. This is our last week before the 
Fourth of July recess. Let's dedicate this week to the Patients' Bill 
of Rights. Let's make sure that when we go home on Independence Day and 
walk down the parade route, the people we are looking at, who are 
waving sometimes at us, realize we have done our best, we have done our 
best to address an issue that is critical to every American.
  The Rand study said that 115 million Americans have had a bad 
experience with a health insurance company or know someone in their 
family, or close friend, who has. The cases I have cited to you are not 
isolated examples. The letters stack up in our office from people all 
across my State of Illinois and all across this Nation. I have been 
speaking on the floor the last couple of weeks on this issue, and I 
have started receiving these letters. I have asked people to send 
letters to me in my office and to tell me about their experience with 
health insurance.
  Every single letter tells the same story--letters where women who 
have chosen an OB/GYN as their primary care physician, a person they 
are confident of, a person they want to work with, have been overruled 
by insurance companies that said: We have a new doctor for you; 
situations where people, as I described earlier, will go into an 
emergency room only to learn that they are denied coverage because they 
picked the wrong hospital or they didn't call in advance for an 
emergency room.
  Can you imagine, racing to the hospital with a son who has just 
fallen out of a tree in the backyard, trying to remember the number of 
the insurance company? Is that the last thing on your mind? It 
certainly would be on mine. I can remember taking my son to an 
emergency room when he decided to catch a baseball with his teeth 
instead of the glove. Those things happen. And you race off to the 
emergency room. You don't want to fumble in the glove compartment to 
find the insurance policy. You are worried about that little boy whom 
you love like everything in this world, and you want to get him to a 
good doctor as quickly as possible. You don't want to get tangled up in 
an insurance company bureaucracy.
  Many times we find that the people, for example, who need specialists 
for medical care learn that they are being overruled by insurance 
companies that say: No; even though a doctor told you you needed a 
certain specialist, we don't approve of it.
  One doctor who kept calling insurance companies and receiving 
frustrating answers finally asked the clerk on the phone: Are you a 
doctor? The voice at the insurance company said no.
  He said: Are you a nurse? The voice said no.
  He then asked: Do you have a college degree? No.
  Do you have a high school diploma? Yes.
  What qualifies you on the other end of this telephone to overrule me 
after years of education and medical school? The clerk said: I've got 
the rules in front of me. They are in writing. They are very clear, and 
we disagree.
  That is what it comes down to. That is how the decisions are made. 
That is what this debate would be about. The debate will decide how 
many Americans will be protected by quality health care, debate will 
decide whether health insurance companies, as every other company in 
America, can be held accountable in court if they make a decision which 
takes away the life of a loved one, causes pain or loss of income--
decisions as to whether or not medical necessity will rule when doctors 
make decisions, including the procedure you should have, what emergency 
room you can use, things that most Americans think are just common 
sense. That is what this debate would be about.
  At 5 o'clock, we will start a series of four cloture votes. It is an 
effort by the Republican majority to stop this side of the aisle from 
offering this debate on the floor of the Senate. They are trying to 
stop this side from amending any bill so we can bring up these issues. 
They do not want to talk about these issues. They do not want to face 
these votes. If they can prevail--and on this side of the aisle hope 
they will not--if they can come up with the requisite votes, they can 
shut down the debate

[[Page S7699]]

and move on to some other issues. If the Republicans are successful in 
stopping this debate on health insurance reform, they will, as will 
Senators on this side of the aisle, one day soon have to go home. When 
they go home, they are going to face families such as those I faced 
over the weekend, living and dying with this problem every day and 
every week.
  They will have to answer possibly the hardest question posed to any 
Senator: Why didn't you do something? What stopped you, Senator? Don't 
you understand? Don't you care about people like us?
  That is what it is all about. I say to my friends on the Republican 
side of the aisle, please join in this debate. Don't be afraid of these 
votes. Try to look for some opportunities where, frankly, Republicans 
might find a Democratic amendment they like. I will look for Republican 
amendments I might like. Let's try to put something together. Let's put 
politics aside. Let's realize the families across America are not just 
Democratic families; they are Republican families, Independent 
families, and families who couldn't give a hoot about politics. But 
they are hopeful that this system of government and the men and women 
serving in this Senate care about them, care enough to bring this 
debate forward.
  At 5 o'clock I will vote against the motion for cloture, to keep on 
the floor this debate on health insurance.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from West Virginia is recognized.
  Mr. BYRD. Madam President, I support the Patients' Bill of Rights.
  Let me thank my friend from Illinois, who is one of the newer Members 
of this body. He has had much experience in the other body. He comes to 
this body with a tremendously versatile mind. He can speak almost at 
the drop of a hat. He is very conversant on every subject. He fights 
today for a cause which is important. I congratulate him. He has been 
speaking on the floor for several days on this subject. He speaks with 
great eloquence. I congratulate him and look forward to hearing him on 
other occasions. I hope in this situation he and we will be successful 
at some point.
  I support the Patients' Bill of Rights. This is important legislation 
that, if enacted, will provide important protections to the many 
millions of Americans who receive their health care from managed care 
companies. It is therefore critically important that the Senate conduct 
a full debate on this issue. I am saddened that supporters of this 
legislation have been put in the position of offering this measure to 
an appropriations bill, thereby temporarily stalling progress on 
funding programs that are a priority for yet other Americans.
  While I consider a vote on the Patients' Bill of Rights imperative in 
this Congress, I am also very concerned that putting important issues 
at loggerheads with one another may ultimately interfere with the 
smooth operation of the government. We should all strive to avoid a 
repeat of the train wreck that resulted in last year's Omnibus 
Consolidated Appropriations bill. Putting the Senate in the position of 
having to choose between competing critical needs is a dangerous game 
that we should not play. It is bad public policy. There is still enough 
room on the calendar for both a thorough debate on the Patients' Bill 
of Rights and for timely progress on the important work of passing the 
Fiscal Year 2000 appropriations bills. I urge the leadership to move 
forward in a fair manner--to allow this bill to be fully considered and 
debated, and to let amendments to the Patients' Bill of Rights be 
called up and debated and voted on--voted up or down or amended again.
  Action on the Patients' Bill of Rights has been delayed for too long. 
As the Congress stalls, problems with managed care companies increase. 
According to a Kaiser Family Foundation/Harvard University survey, the 
number of people reporting having problems with their health plan, or 
who know someone who has had a problem with their health plan, rose 
from 96 million in 1996 to 115 million in 1998. With 85 percent of all 
insured employees in managed care plans, this issue is too far-reaching 
to be delayed.
  While managed care has been successful in stemming health care 
inflation in recent years, it has too often compromised patients' 
health care needs. Unfortunately and tragically, some health insurers 
have put saving money ahead of patients' well-being. Instead of patient 
care, we are getting ``investor care,'' with health plans keeping a 
constant eye on shareholder profits. Our Patients' Bill of Rights would 
provide important and necessary protections for families to ensure they 
get the care they need.
  Too often, managed care plans erect barriers that interfere with 
patients getting the medical services they need when confronted with an 
emergency. Under this measure, patients do not have to fear that their 
emergency room care will not be covered if they have reason to believe 
they need emergency care. They will not have to call for permission 
first and waste precious time hoping for clearance. Someone who 
experiences chest pain and believes he or she is having a heart attack 
should not have to check to see whether the health plan will cover the 
emergency room care. The ``prudent layperson'' standard gives patients 
the ability to seek emergency room care with the assurance that it will 
be covered.
  Comprehensive managed care reform legislation should also provide 
women in managed care plans important protections. Oftentimes, women 
use their ob/gyn as their primary care provider. Having managed care 
plans recognize this fact will eliminate time-consuming and costly 
administrative barriers women face in getting the care they need. A 
woman and her doctor should be able to make the decision, for example, 
as to how long she needs to stay in the hospital after a mastectomy, 
not some health plan bureaucrat.
  In recent years, health plan coverage of patients' participation in 
clinical trials has declined. This is a troubling trend. Under S. 6, of 
which I am a cosponsor, health plans would be required to cover the 
routine costs associated with a patient's participation in certain 
clinical trials. This is an important provision because in some cases 
clinical trials may be the only option for patients who have not 
responded to conventional treatments.
  The Patients' Bill of Rights also has special protections for 
children's access to care. The bill provides guaranteed access to 
pediatric specialists. When a child has a chronic condition our bill 
allows standing referrals to pediatric specialists which eliminates the 
extra step of seeking the consent of the primary care provider. Under 
our bill, if a pediatric specialist is not included in the health 
plan's network, your child would have the right to see a specialist 
outside the network without having to pay more.
  Patients undergoing treatment need to know that, if their doctor is 
dropped by the health plan or if their employer changes their health 
plan, they can still see their doctor. S. 6 offers continuity of 
coverage by requiring a 90-day transition period during which treatment 
is continued. For example, a terminally ill patient should not have to 
go through the disruption of changing doctors as that patient faces 
death.
  I have long been concerned about West Virginians' access to health 
care and, over the years, I have been successful in bringing facilities 
and technologies to the State to expand my constituents' access to 
quality care. Marshall University's Rural Health Center; the VA 
hospitals and clinics; and Mountaineer Doctor Television (MDTV), West 
Virginia's Statewide telemedicine program, are projects that have 
broadened West Virginians' ability to receive quality care in West 
Virginia. As managed care continues to grow in the State, it is 
important that common-sense protections are in place so that patients 
can get the care they need.
  The Republicans have introduced their own managed care reform 
legislation in response to the Democrat's Patients' Bill of Rights. 
But, the Republican plan would leave over 100 million Americans without 
protection. By applying reforms only to self-funded employer plans, the 
Republican bill leaves those most in need of protection--people who buy 
their insurance without the assistance of their employer and those who 
work for small businesses--out in the cold.
  Scope of coverage is not the only weakness of the Republican plan. 
Even the protections provided to a limited number of Americans under 
their plan

[[Page S7700]]

do not go far enough. While differences exist in the shape and scope of 
the reform proposals, one thing is clear. There is a crying need in the 
lives of real Americans for action to address these health care 
problems. We need a thorough debate, an open debate about this issue, a 
debate which is not constrained by limits on amendments or by a desire 
to hold such a critical matter hostage to partisan politics, and we 
need it now. We also need to move forward on appropriations bills which 
fund important programs all across the spectrum of American life. I can 
only hope that reason will prevail in this body, and that we will allow 
all of these important matters to proceed in a timely and sincere 
manner as soon as possible.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana is recognized.
  Mr. BURNS. Madam President, this weekend I traveled across my home 
State discussing the issues that are before us today, and also had the 
opportunity to travel into Canada to talk about agriculture, to try to 
solve some of the problems that face agricultural producers today.
  What is happening here is a matter of fact. The hostages are those 
folks who depend on food stamps, those folks who depend on the WIC 
Program--young women with children and infants who depend on those 
nutritional programs.
  What is happening is we are trying to do the business of the Nation, 
and that is funding the programs that Americans want. Yes, agriculture 
is in tough straits. We have seen in this past year commodity prices 
dip way below the prices they were during the Great Depression. Yet we 
expect our agriculture producers to produce. We expect our grocery 
stores to stay full. We expect to buy those foods in any amount, 
prepared in any way; to be handy--and they are. This Nation is truly a 
blessed nation in that we have producers like that.
  While I realize the debate on health care is very important, let's 
not lose sight of the Nation's business. Let's not take our eye off the 
ball. The Nation's business, first and foremost, is to pass the 
appropriations bills to fund those Departments and those programs that 
depend on those bills, and then debate health care or Medicare reform. 
Nobody on either side of the aisle underestimates the importance of 
that debate. But the business of the Government is to finance and 
provide funds for programs so this Nation can operate. That is what is 
being held hostage.
  Madam President, 23 percent of the gross national product depends on 
agriculture. No other part of the American economy contributes so much 
to our gross national product. Yet here we stand, talking about an 
amendment to an agriculture bill that is strong enough to be debated as 
a stand-alone piece of legislation.
  I talk to my farmers in Montana. They want the agriculture 
appropriations bill passed. In this bill there is research money. In 
this bill there is money needed to open up export markets, to let 
agriculture producers take advantage of added value to their own 
products. It allows them to find niche markets. It allows them to live.
  The health care bill has nothing to do with agriculture--nothing. You 
cannot claim germaneness. You cannot claim anything. I think the health 
care issue deserves a stand-alone debate, but it should not block the 
financing of Government programs. That is too important. The lives of 
too many producers are on the line, as are their farms and their 
ranches.
  We hear complaints all the time about legislation on appropriations 
bills. In the majority of these cases, the amendments at least have 
some relationship or some germaneness to the issue at hand. But what 
significant relationship does a Patients' Bill of Rights have to 
agricultural production? We should pass the appropriations bills, get 
them into conference, send them down to the President, and let him sign 
them. There is ample time left to debate health care in the United 
States.

  My farmers and ranchers are a little bit baffled. They do not have a 
clue as to what is really happening. I say that somewhat in jest 
because the majority of them do know what is happening. They are being 
held hostage. How do I explain to them that the money allocated to 
programs important to them is being held up entirely for a debate on an 
issue which should be a stand-alone issue?
  Let's pass these appropriations bills. Let's get them out of the way. 
Let's assure the American people we can do the Nation's business. Let's 
assure the American farm and ranch people their programs will be passed 
and financed. Let's tell those who depend on food stamps their money is 
going to be there. Let's tell the elderly people who depend on Meals on 
Wheels it is going to be there. Let's tell the young mothers with 
infants and children who depend on nutritional programs the money will 
be there.
  There is no sickness in the world worse than starvation. Do you want 
to drive health care costs higher? Then disregard the nutritional 
programs found in this agricultural appropriations bill. Whom are we 
hurting? Those who can afford it least. Let's get back on track. My 
farmers and ranchers are tired of waiting and so are the folks who 
depend on these programs.
  I thank the Chair, and 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. REED. Madam President, I ask unanimous consent that the order of 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REED. Madam President, I ask unanimous consent that the order of 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. REED. I thank the Chair.
  Madam President, I want to spend a few moments talking about aspects 
of the Patients' Bill of Rights, which is an amendment to the 
agricultural appropriations bill before us this afternoon. We are faced 
with a very clear choice: Are we going to finally debate and consider 
in some detail a Patients' Bill of Rights which will give every 
American a clear opportunity to have the kind of quality health care we 
all support and we all want them to have, or will we continue to be 
shut out, will we continue to avoid confronting a critical issue which, 
to the people of Rhode Island, is probably one of the most critical 
issues they face.
  If one goes to the people in my State and talks to them about their 
concerns, particularly since there has been an economic revival, a 
primary concern for them is whether they will have adequate health care 
for their families and themselves, particularly for their children, 
when they need it.
  One of the aspects of the Democratic bill, which I think is very 
salutary and commendable, is with regard to accountability. It provides 
not only for internal and external review, but also for patient 
advocacy and patient protection.
  There are three procedural points that should be included in any 
Patients' Bill of Rights. First, there has to be clear liability 
directed against a health plan if they make mistakes in the care of 
their patients.
  One of the great ironies of our system is that physicians can be sued 
for their malpractice, yet insurance companies are invulnerable to such 
suits. To put it in balance, since so many health care decisions are 
now being made not by physicians but by review specialists, 
accountants, and analysts, the insurance company itself should also be 
liable for its decisions.
  We also have internal and external appeals processes so there is no 
rush to the courthouse, but an individual can get relief quickly and 
efficiently for a health plan decision. When people are dealing with 
their health insurer, all they want is the best care for themselves and 
their families. They want their medical problems to be resolved, they 
want access to the specialists they need, and they want the plan to 
respond to their needs. In fact, they simply want what they paid for.
  There is another aspect to consider--that is to help consumers 
negotiate through the intricate maze of health insurance rules and 
regulations and to give them the leverage that will level the playing 
field between health care consumers and the bureaucrats who run health 
care plans.
  Toward that end, Senator Wyden, Senator Wellstone, and I have 
introduced a separate legislation which

[[Page S7701]]

would provide for a health care consumer assistance, or ombudsman 
program, in every State. It would establish a mechanism whereby States 
would be able to provide information and counseling services to assist 
health care consumers.
  This provision has been incorporated in the Patients' Bill of Rights, 
and it is a necessary provision because people are not getting the 
information they need to make the health care system work effectively 
for them. For instance, studies show that the existing appeals process, 
both internal and external, are being underutilized. In fact, there is 
a very deep suspicion, not only in my mind but the minds of many, that 
health plans make it almost impossible to get adequate review.
  They put up procedural hurdles. They have set up a series of barriers 
that leave the average consumer without any redress and, as a result, 
they become frustrated and give up.
  Another suspicion which undermines the faith in the managed care 
industry is that this frustration is a deliberate, calculated attempt 
by companies to reduce their costs. They are hoping that the consumer, 
rather than pressing for their rights, will just go away, will give up, 
and will accept whatever the health plan offers.

  I believe we can improve this system dramatically if we have consumer 
assistance centers in place throughout the United States. These systems 
will help consumers understand their rights, and will also help to 
understand in some cases where they do not have a legitimate grievance. 
One of the virtues of this approach is it will give a consumer of 
health care an objective place to get an answer. Today some people call 
the insurance company, where they get different answers and they may 
get suggestions of what the contract does and does not cover.
  Unfortunately, it seems that they get everything except straight 
answers. As a result, they do not have confidence in the health care 
system. Consumer assistance, or ombudsman centers that are administered 
by States can restore a measure of confidence in the system.
  Interestingly, this Senate is already familiar with the concept of a 
health care ombudsman, and at the time, it was supported virtually 
unanimously. On the Armed Services Committee, we have been studying the 
issues of managed care in the military, the TriCare system. Many of the 
complaints with the TriCare system are the same types complaints we 
hear about managed care in general: Quality is not good, we can't get 
care, we can't get answers.
  As a result, we responded in the defense authorization bill this 
year. One of the things we did was create within the TriCare system an 
ombudsman program, an advocacy program, so when military men and women 
have questions about their families' health, they do not have to get 
the runaround from the local insurance company; they can go to the 
ombudsman who can give them help, support, and assistance to get their 
claim resolved or, in some cases, to explain that the insurance company 
is well within its rights to make the decision they made.
  I find it interesting and ironic that an ombudsman provision could 
sweep through the defense authorization bill and be endorsed as 
something not only noncontroversial but terribly helpful. Yet, as we 
consider managed care reform, we are struggling with this issue, among 
many others.

  My view is simple: If it makes sense for our military personnel--and 
we are all committed to giving them the best health care--we should 
have the same type of sensitivity for the broader population of our 
country. That is why the Reed-Wyden-Wellstone bill, which is part of 
the Democratic managed care initiative, is an integral part and one 
that should be considered, debated, and, I hope, adopted when we get--
we hope--to the debate and the votes on managed care.
  Our consumer assistance, or ombudsman, program would perform several 
functions.
  First, let me point out that our proposal would establish a 
competitive grant program for States. It would give them the 
flexibility to set up a program according to their best sense of how to 
be of assistance and also that it be cost effective. They would, 
however, be required to meet certain general guidelines.
  One of the functions of the ombudsman, would be to inform people 
about health care plan options that would be available. There are lots 
of examples where consumers do not find out about their health care 
coverage until they have a health care crisis.
  I was reading the case of a mother who had a daughter who required 
eye therapy. The daughter was suffering from autism. One of the 
complications of that disease is eye problems which requires detailed 
exercises for the eyes. If that is not done, the child rapidly loses 
the ability to see, the ability to function appropriately.
  She went to her health plan and said: I was told to ask you to give 
my daughter a referral to an eye specialist for therapy. They said: No; 
you can't do that, because it is not covered under your contract. She 
went back and read the contract--all the fine print, all the pages and 
pages and pages--and discovered, much to her disappointment, much to 
her chagrin, that indeed this was an excluded service.
  The point is, if there is a place that parents or anyone can go to 
beforehand and say: I have a daughter who has a condition, and there 
are complications with her sight, and other things; what advice do you 
have for me about plans? what are the best plans? what knowledge do you 
have about the plans that are available to me? that would be an immense 
help to the families of America.
  The other thing that would be created is a 1-800 telephone hotline to 
respond to consumer questions. Again, why don't we have this? Why don't 
we have a place where a consumer can say: I have just talked to my 
health care plan; they told me I can't do this?
  Why can't we have at least a hotline? In effect, we have lots of 
little fragmented hotlines. Every one of our offices is a 1-800 hotline 
for people who are frustrated with their health care. We do it in an ad 
hoc way. We try to help our constituents. But, frankly, we could do it 
better and more consistently through an ombudsman program.
  Also, what we want to do is help people who think they have been 
improperly denied care. We want to help them, and not in an adversarial 
way, but to provide technical advice. It could be helping them write a 
letter to the insurance company to make an appeal, or explaining their 
appeal rights to them.
  As I said before, many people simply do not understand their appeal 
rights. It could be that insurance companies do not want them to 
understand their appeal rights, that they would like them to walk away 
frustrated, but it not costing the insurance companies any extra money. 
So for all these reasons, I think an ombudsman program is an absolutely 
critical part of any managed care reform.
  One other reason why an ombudsman program is important is that it 
could be a way to reduce the potential for litigation. This could be a 
way to solve problems before they get to the point that the only 
alternative a consumer thinks he or she has is to get a lawyer. This 
could be a way to make the system work better without running the 
risk--and I know this risk is conjured up by the insurance companies 
every day--of litigation run amok across the United States. So for many 
reasons, I believe an ombudsman program makes so much sense.

  This is not a theoretical response to hypothetical problems. Let me 
offer a couple of real cases which beg for the kind of consumer 
assistance we are suggesting in the Democratic alternative.
  This is the story of Ms. Carolyn Boyer. Ms. Boyer is a 50-year-old 
woman who has been battling breast cancer for about 6 years. Like so 
many patients, she has had to wage a separate battle with her insurance 
company. Time and time again, her health plan has tormented her with 
payment followups and a host of bureaucratic hurdles that prevented her 
from getting timely payment for the services she needs.
  This is one example. In the spring of 1996, Ms. Boyer received a bill 
for a bone scan from Washington Sibley Memorial Hospital. She learned 
that the total cost of the scan was $711.50 and that her portion of the 
bill, the copayment, was $142.30. She paid her portion of the bill. 
Thirteen months later, Ms. Boyer received a balance due notice from 
Sibley Hospital for $569.20, the amount the hospital had indicated was

[[Page S7702]]

covered by the insurer a year earlier. Then she got a bill from Sibley 
a few days later for the entire $711.
  This was now a battle about who was at fault. Of course, the hospital 
said it was the insurance company; the insurance company said it was 
the hospital. Nevertheless, Ms. Boyer struggled through this situation. 
She had already paid her portion, and now she was going to have to pay 
more than the original cost if she responded to the last bill.
  Now, 3 years later, after much travail, the insurer has paid their 
full original amount. In fact, they gave Ms. Boyer a refund for the 
$142.30 she had paid.
  This is a daily occurrence. For every one of our constituents, if you 
ask them, either it has happened to them or it has happened to someone 
close to them. One of the interesting things about this is, I suspect 
strongly that the reason Ms. Boyer was successful in her battle with 
the insurance company was that at the time of her diagnosis she was a 
lobbyist for the Health Insurance Association of America. She knew a 
little bit about the way HMOs and insurance companies work. Before 
that, she was a lawyer for the Internal Revenue Service.
  Ask yourself, what about the truck driver who is confronted with this 
dilemma? Ask yourself, what about the single mother with children? When 
they are confronted with this dilemma, where do they go? What kind of 
legal expertise can they call upon? The answer is, very little or none 
at all. As a result, they often do not get the care they need, or they 
pay what they should not pay, or they end up paying all they have, and 
many of them find themselves almost in bankruptcy, if not worse.
  The protections that are built in the Democratic Patients' Bill of 
Rights will help these people. They will give them access to people who 
know how to deal with the insurance companies--not unfairly, but 
objectively.
  Let me give you another example of how these ombudsman programs have 
been helpful.
  The Rafferty family in Sacramento, CA, were able to get their problem 
resolved after they appealed to the California Health Rights Hotline. 
The metropolitian Sacramento area has its own hotline to address 
problems and questions with managed care plans.
  In September 1998, Lynmarie Rafferty gave birth, by cesarean section, 
to premature twins, Paige and Hannah. Each only weighed 2 and a half 
pounds. The girls were admitted to the hospital's neonatal intensive 
care unit in a very medically fragile condition. The Raffertys had 
chosen the hospital in part because of its intensive care facilities 
and its location close to their home.
  Two weeks later, the Raffertys received a call from their health 
plan's medical director. He informed them that Hannah and Paige were 
going to be transferred to another hospital that day--not in a few 
days, but that same day. He told the Raffertys that if the newborns 
were not transferred on that day, the plan would not pay their hospital 
bill. The family was devastated. They had two premature babies in 
fragile medical condition suddenly being ordered out of the hospital. 
And if they didn't leave, then the thousands and thousands of dollars 
in bills that the Raffertys thought were being paid by the insurance 
company would suddenly be their bills.

  They also had another young child at home, and the proximity of the 
new hospital was much further away than the hospital where the twins 
were currently hospitalized.
  Well, the Raffertys went to the plan, told them of their concerns, 
but to no avail. They went to the physician. Finally, they called the 
California health rights hotline. The hotline reviewed their plan's 
contract and informed the Raffertys of their rights. Then the Raffertys 
said to their health insurance plan: We are not going to give consent 
to moving our daughters.
  The plan still fought them and said: These babies have to leave. 
Fortunately, with the help of the hotline, the Raffertys were able to 
draft an appeal letter outlining the reasons why transferring the 
newborns would violate their rights. Finally, the health plan backed 
down and accepted the responsibility for the care of the children, 
which at that point was over $80,000.
  Now, can you imagine where a struggling young family, with a child at 
home and two newborns, were going to get $80,000, if the insurance 
company had prevailed, if there was no hotline, if there were no 
advocates?
  I believe very strongly that this kind of patient protection should 
be an integral part of the legislation we consider for managed care 
reform. The Democratic alternative provides those types of protections. 
It provides for internal reviews and external reviews that are 
objective, not a situation where the insurance company has picked the 
individuals who reviewing their own decisions, but truly objective. It 
also applies the principle that if the insurance company has caused 
grievous harm, they, just like the doctor, should be liable before a 
court of law.
  It also goes a step further and says: Let's see if we can prevent 
these troubles before they start. Let's create consumer assistance 
centers. Let's create an ombudsman who can work with individuals and 
try to resolve their claims long before they reach the stage where it 
is a matter of life or death or a matter of financial ruin.
  I believe our greatest responsibility today is to move on to this 
debate in a meaningful way, to talk about the issues of health care, to 
debate them because there are points of difference that are principled 
and we should vigorously discuss and debate them. But we have to get 
into that debate. The health of America depends upon it.
  I will mention one other area which I am particularly concerned 
about. I have spent some time talking about the issue of the appeals 
process, the procedural protections that we have to build in to any 
patient protection legislation that moves forward.
  There is one other area of concern, among many, but one that 
particularly concerns me. That is that we have to have legislation that 
is particularly sensitive to the needs of children. The Rafferty 
example is a good one: Two premature babies who basically are being 
threatened with eviction from the hospital. We need to be dealing with 
the issue of children's health care in the managed care system.
  We have to recognize, and too often we don't, that there is a 
difference between adults and kids. Kids are different. They are 
particularly different when it comes to health care.
  Let me suggest some important differences which argue for special 
treatment for children within managed care reform legislation. Once 
again, I believe the Democratic alternative incorporates these special 
treatments.
  First, children are developing. This is not an issue that is 
confronted in the context of adults who are ill. So developmental 
issues immediately and automatically create differences in the 
way children must be dealt with. Between birth and young adulthood, 
children change and grow. They develop intellectually. They develop 
physically.

  These developmental issues are seldom part of the equation when it 
comes to making decisions about managed care because their models deal 
with adults. Their models deal with very specific adult diseases and 
adult outcomes.
  For one reason, they can measure them much better. Many times 
families are faced with extreme difficulties in getting care from their 
HMO because the rules that are set for adults don't work for kids. 
Take, for example, the rule which is common in managed care, that you 
can only have two sets of crutches in the course of your contract, or 
year or two. That is fine if you are a fully grown person, if you are 
an adult. But if you are a developing child, you are going to need 
different types of crutches, because you are going to get bigger, we 
hope. The same thing is true with wheelchairs. Children with spina 
bifida have changes in their bodies and changing needs, much more so 
than adults. These rules, arbitrary as they may be for adults, are 
completely inappropriate for children because of this developmental 
issue. We have to recognize that.
  The other thing we have to recognize is, symptoms in children which 
might be dismissed in adults as minor could be the precursors to 
significant problems down the road that won't develop and be truly 
obvious for years ahead. That is another reason why children have to 
have access to pediatric specialists, not general practitioners, who 
are used to seeing adults. And if you

[[Page S7703]]

have some sniffles, you don't feel right, take two aspirins and get 
some rest, that could mean something much more significant and much 
more serious in a developing child.
  There is another issue, too, with respect to children that makes them 
quite different from the grownup population. They are dependent. One of 
the major measures of health care outcomes in the United States is 
independent functioning. Can the person function independently? Can 
they get up and move about? When you are talking about children, they 
are, by definition, dependent--dependent on adults; in many cases, they 
are dependent upon adults to explain their medical problems. It takes 
their parents or the care givers to explain to the physician what is 
wrong in many cases. That is a difference that seldom is appreciated in 
managed care plans because they don't have the kind of pediatric 
specialists or pediatric primary care providers that are so necessary.
  The patterns of injury are different between adults and children. The 
good news is, the children are generally very healthy. But the bad news 
is, when a child has a serious disease, it is usually a combination of 
many different conditions, unlike serious adult diseases which are 
typically a single disease. Again, these complicated, interrelated 
conditions that threaten development argue for access to pediatric 
specialists early in the process. That doesn't happen. It doesn't 
happen enough in managed care plans.
  The answer is not because managed care executives don't like kids; 
managed care executives have some sort of animus towards children. It 
happens because of dollars and cents. If you have a very small pool of 
sick children, why are you going to go out and make arrangements to 
have pediatric specialists in your care network? That is a lot of 
overhead for just a couple of kids.
  We have a market failure. We have a situation in which the market 
dictates to these companies to do something which in the aggregate 
harms greatly the health of the American child. That is why we have to 
act.
  Again, this is all part of the Democratic alternative. This is part 
of what we have to do. In addition, I would add that we need to develop 
quality measures that actually track children's health, in addition to 
adult health. We have to go beyond some of the simple things, such as 
immunization rates. We need to get into more complicated measures and 
make parents aware of these statistics so they make informed choices 
about their health plans. Another thing health plans need to begin 
doing more is looking at children in the context of some of exposures 
that are unhealthy, but are not directly, traditionally medical; 
environmental exposures like lead poisoning; community exposures like 
violence, and the stress and strain of living in difficult 
circumstances. Our HMOs have to also begin to think about how, then, 
they can do what we all thought they were going to do originally--
emphasize preventive care, particularly with kids, coordinate not just 
with their own physicians and medical providers in their networks, but 
with the schools and community-based care centers, all of the 
institutions that must be allied together to help the children of 
America.

  Once again, the legislation that we have introduced--the Democratic 
Patients' Bill of Rights--does this. I can't think of two more 
compelling reasons to move to this legislation in a meaningful way than 
the opportunity to give every family a true voice in their health care 
through the procedural reforms that we have introduced and to give 
every child in this country the opportunity to get the best health care 
they can possibly get. I think we owe it to the people who sent us 
here. I hope we can find a way to move beyond this deadlock and move to 
vigorous debate on the Patients' Bill of Rights. If we do that, then we 
will be serving very well the interests of the American people.
  I yield the floor.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts is recognized.
  Mr. KENNEDY. Mr. President, just a week ago efforts were made by 
Members on this side of the aisle to try to encourage our Republican 
leadership to schedule what is known as the Patients' Bill of Rights 
legislation, which Senator Daschle has introduced and many of us have 
cosponsored. The underlying point of the Patients' Bill of Rights is 
very basic and simple: to make sure that medical decisions are going to 
be made by the trained medical professionals and the patients, and not 
by accountants or insurance companies. That is basically the concept 
behind that legislation.
  We have tried over the past week to have that legislation before the 
Senate. There are differences with the membership here on various 
provisions. During March of this year, we had an opportunity in our 
Health and Education Committee to have a discussion and debate on some 
of these matters, and the committee itself reported out legislation. At 
that time, we had more than 20 different amendments dealing with a 
range of different issues. Those were handled in a relatively 
reasonable period of time. People were familiar with the subject 
matter, as I think they are here in this body. We had that legislation 
reported out more than three months ago. I think many of us expected 
that, given the statements that were made by the majority leader in 
January of this year on several different occasions, the Patients' Bill 
of Rights would be brought up before the Senate by now for an 
opportunity to debate and discuss it.
  We have not had that opportunity to do so. We had hoped that was 
going to be the case last week when we discussed it, and we hoped, at 
least if we were unable at that time to have this measure actually laid 
down before the Senate on Tuesday or Wednesday, that the Republican 
leadership would indicate that we would have the chance to bring it up 
and debate it now.
  It seemed that we might have the chance to bring it up today, with 
the opportunity to offer amendments, and conclude the legislation by 
the end of the week, prior to the Fourth of July recess. In the 
meantime, it seemed that the Democratic leader had given strong 
assurances that he would do everything he possibly could in urging the 
Members on this side to work in every possible way to expedite the 
consideration of various appropriations bills. I think he spoke for all 
the Members--I am sure he did--on this side on this issue. There are 
some particular items and some of those measures that should be brought 
to the Senate for resolution. I thought that when he had indicated he 
thought it was reasonable that we could conclude a number of the 
appropriations bills and conclude this legislation, that was a very 
reasonable suggestion to the leadership.
  Now, Mr. President, as those who follow this issue know, this is not 
the first time the Senate has been effectively closed down--closed 
down--closed down over their refusal to consider this legislation. That 
is effectively what is happening here. We will have some procedural 
kinds of votes, but the American people ought to understand what is 
really happening here--that these procedural votes that we are going to 
have later this afternoon really have nothing to do with the underlying 
legislation; that is, the four different appropriations bills. It is 
basically an attempt by the leadership to prohibit the debate and 
discussion on the Patients' Bill of Rights. The American people are 
beginning to understand that more clearly.
  I found when I was back in Massachusetts over this past weekend, 
talking with various groups, more people are focused on this, more 
people are paying attention, more people are aware of what is being 
attempted by the Republican majority--that is, denying us the 
opportunity for even a reasonable debate and discussion on the 
Patients' Bill of Rights--than most other issues.

  I have taken the time of the Senate before--and I won't take it again 
this afternoon--to review where we were a little over a year ago. Over 
a year ago, we were in the exact same position. We were denied the 
opportunity to bring this measure up for consideration of the Senate. 
The Republican leadership at that time said that the Democrats were not 
going to dictate what the agenda will be.
  The only problem with that is that it isn't the Democrats who are 
attempting to dictate the agenda. It's the American people. It's every 
health care organization that has taken a position in favor of the 
proposal introduced by Senator Daschle and against the one introduced 
by Senator Frist and the Republican leadership. Virtually all

[[Page S7704]]

leading patient and medical groups have supported the Democratic 
proposal, Senator Daschle's proposal. We could understand why, if we 
had an opportunity to actually debate these issues.
  These groups do not care whether Democrats or Republicans are on a 
piece of legislation; they just want a strong bill. And virtually every 
single leading medical group in our country supports ours. None support 
theirs.
  You would think that at some time in this body, on a matter that 
affects all of the families of this country, we would have an 
opportunity to have some decisionmaking and be ready to call the roll. 
Of course, if the ramifications weren't so serious, many of us would 
have been amused by the statements that were made last week by the 
assistant majority leader when he said: We are not going to let the 
Members on our side vote because their votes might be misconstrued for 
political purposes. That would be laughable if it did not relate to an 
issue as important as the Patients' Bill of Rights.
  Imagine a political leader saying they are refusing to permit Members 
to vote because their votes may be interpreted in ways which might be 
misconstrued. I think most of us feel that we can stand on our own two 
feet in facing various votes. I always appreciate their leadership in 
trying to protect our various interests. But we are not talking about 
some narrow special interests, we are talking about the people's 
interests.
  As I have mentioned before, this matter is important because it is a 
children's issue. Virtually every major children's health group in our 
country--all those that advocate for children's health--has supported 
and recognized the importance of our legislation in protecting the 
interests of children.
  They haven't gotten a single organization that is committed to the 
advancement of the interests of children on their side. We have all of 
them. We have all of them because of some very important reasons. One 
of the most obvious ones is that we insist that a child who has some 
special need is not only going to have a pediatrician--but is also 
going to have a specialist trained in the area of the particular need 
of that child. If the child has cancer, the child should be treated by 
a pediatric oncologist. A doctor that specializes in children and also 
children's cancer.
  When our colleagues on the other side say: We don't understand why 
the Democrats are talking about specialists because we guarantee 
specialists; they say, ``We guarantee that a sick child will see a 
pediatrician.'' But that is not the issue. The question is will a child 
with a specific need for specialty care have access to a pediatric 
specialist, meaning a pediatric cardiologist, or a pediatric surgeon, 
or a pediatric oncologist. Under the Republican bill, the answer is no. 
Under our bill, the answer is yes.
  This is a children's bill. The children's groups have spoken 
passionately, actively, and enthusiastically in support of our program.
  This is a women's issue. The women in this country--the groups that 
have specialized in women's health generally, and particularly those 
that have been most concerned about issues, for example, of breast 
cancer--know the importance of having access to OB/GYN professionals, 
and to be able to designate that OB/GYN as the primary care doctor for 
women. We have had voluminous testimony about the importance of that.
  It makes sense. Women also understand, particularly those who may be 
afflicted by the devastation of breast cancer, the importance of 
clinical trials. When they are talking with their doctor, and the 
doctor says: Well, we know that there is a clinical trial out there 
that can make a difference in terms of your survival. We know when that 
patient then asks to be enlisted in that clinical trial--and the doctor 
says I can't because your HMO won't permit me to do it, the HMO has 
overridden my judgment on that--that denying access to it is not in the 
health interest of that woman. It is not in the health interest of her 
family, and it puts her at greater risk.
  These are not tales. We had the testimony. We have given the examples 
of what is happening out there. This isn't a diminishing threat. To the 
contrary, the system is becoming more of a threat to women. Women 
understand that. This is an enormously important issue with regard to 
women. That is why virtually all of the major women's groups and 
organizations support our legislation.
  This legislation is also enormously important to those who have some 
physical or mental disability. We don't necessarily like to use the 
word ``disability'' because it implies that people may not be able--and 
we know that those who do have some challenge are able, and in many 
instances gifted and talented in many different ways. But they often 
need specialized attention, treatment, and medicine. Prescription drug 
formularies can deny access to critically important medications. Yet we 
find that, while you can always go off the particular HMO's formulary, 
you may have to pay exorbitant prices for the treatment.

  I listened to the handful of those who spoke on the other side in the 
period last week who said: Oh, they can always go off the formulary. Of 
course they can--and pay an additional arm and a leg. I think most 
families in this country understand what the problem is in terms of 
prescription drugs. They sign up for health insurance--and the HMO 
takes their premium--and when the time comes for them to get the kind 
of treatment that they need, the HMO denies it.
  We understand how important that is. We want to be able to debate 
these measures, and these matters.
  We had an excellent amendment by the Senator from California talking 
about ``medical necessity.'' Let us use the best definition in terms of 
``medical necessity.'' Let's include in the various HMO plans what is 
going to be necessary in terms of treatment and what is going to 
represent the best in terms of medical practice. That seems to make 
sense. That is not a guarantee today.
  I read in the Record last week about some of the various HMOs and 
their definitions of what was going to be included and what was going 
to be excluded. Listen to what is in the Republican bill, as offered in 
an amendment by the majority leader last week. On page 27, it says only 
that HMOs have to provide a description of the definition of ``medical 
necessity'' used in making coverage determinations by each plan--each 
plan.
  Do we understand that? It isn't what is the best in terms of health 
care. It is whatever each plan decides. So any of the HMOs can 
effectively develop whatever they want to use as a definition for 
``medical necessity.'' Your doctor might say to you: This is what the 
best medicine is to save your life, or your child's life, or your 
wife's life, or your husband's life. And the medical plan will say: No 
way, Joe Smith. You signed our contract. You signed that contract. And 
in that contract, we say that treatment is not medically necessary. 
Make no mistake, the Republican bill says ``a description of the 
definition of medical necessity'' will be a determination by your plan. 
That is the HMO.
  Come on. Don't we think this body should be able to make a decision 
as to whether you want the Republican plan, which on page 27, line 20, 
provides patients with ``a description of the definition of medical 
necessity used in making coverage determinations by each plan,'' or, on 
the other hand, you want medical decisions to be dictated by the best 
medical practice in the United States of America?
  That is what is in the Feinstein amendment.
  Why shouldn't we be able to have 1 hour of debate on that, and have a 
rollcall in here and make a decision? Where are the Republican 
principles? Why is it that they are denying the American people the 
chance to hold their elected Representatives accountable?
  That is what they are doing. We can't hold them accountable because 
the other side won't permit us to get a vote on that particular issue. 
That is what is going on here. We should have the chance. We will have 
the chance to go through that legislation.
  Remember all of last week they were talking about a description of 
``medical necessity''--the definition of medical necessity used to make 
coverage determinations is decided by each such plan under the 
Republican leadership's bill.
  That ought to chill every Member of the opposite side--to think that 
is the

[[Page S7705]]

position that they are stuck with. That is in their Republican bill.
  What we are trying to do with the amendment of the Senator from 
California is to change that to make sure that decisions of medical 
necessity will be based on the best that we have in terms of treatment, 
and in terms of the opinions of trained individuals and research.
  Let's let the American people understand who is on our side on this 
particular issue, and who is on the side of the insurance companies. 
The HMOs are fundamentally the ones that refuse to use the best medical 
science in terms of their definitions.
  This is just one example. It is a very powerful one, but I believe 
that if we had been able to get on this legislation last week when the 
Feinstein amendment was actually brought up, we would have been on the 
appropriations bill this week. We might have concluded several of those 
various appropriations bills. Instead the whole of last week has passed 
without any progress, and we are starting over again evidently in 
anticipation of this week's activity.
  Now, apparently, we are going to take a good part of this week just 
to deny the Senate the opportunity of making a judgment on whether 
medical decisions should be made by doctors and patients, or by HMO 
accountants. They won't permit a number of amendments. They won't even 
permit Members a chance to debate and conclude this in five days. We 
took 7 to 9 days on the Y2K legislation to try and deal with some 
anticipated problem regarding the computer industry, but we won't be 
able to take the few days necessary to protect the American people.
  I yield the floor.


                             Cloture Motion

  The PRESIDING OFFICER. The cloture motion having been presented under 
rule XXII, the Chair directs the clerk to read the motion.
  The legislative assistant read as follows:

                             Cloture Motion

       We, the undersigned Senators, in accordance with the 
     provisions of rule XXII of the Standing Rules of the Senate, 
     do hereby move to bring to a close debate on the Agriculture 
     Appropriations bill:
         Senators Trent Lott, Thad Cochran, Ben Nighthorse 
           Campbell, Susan M. Collins, Craig Thomas, Mike Crapo, 
           Kay Bailey Hutchison, Robert F. Bennett, Larry E. 
           Craig, Connie Mack, Charles E. Grassley, Christopher S. 
           Bond, Richard C. Shelby, Tim Hutchinson, Ted Stevens, 
           and Mike Enzi.


                            Call of the Roll

  The PRESIDING OFFICER. By unanimous consent, the quorum call under 
rule XXII has been waived.


                                  Vote

  The PRESIDING OFFICER. The question is, Is it the sense of the Senate 
that debate on S. 1233, the agricultural appropriations bill, shall be 
brought to a close?
  The yeas and nays are required under the rule. The clerk will call 
the roll.
  The legislative assistant called the roll.
  Mr. NICKLES. I announce that the Senator from Washington (Mr. 
Gorton), the Senator from Arkansas (Mr. Hutchinson), the Senator from 
Oklahoma (Mr. Inhofe), the Senator from Vermont (Mr. Jeffords), and the 
Senator from Alaska (Mr. Murkowski) are necessarily absent.
  Mr. REID. I announce that the Senator from California (Mrs. Boxer), 
the Senator from Connecticut (Mr. Dodd), the Senator from North 
Carolina (Mr. Edwards), the Senator from Wisconsin (Mr. Kohl), the 
Senator from New Jersey (Mr. Lautenberg), the Senator from Connecticut 
(Mr. Lieberman), the Senator from New Jersey (Mr. Torricelli), and the 
Senator from Minnesota (Mr. Wellstone) are necessarily absent.
  The result was announced--yeas 50, nays 37, as follows:

                      [Rollcall Vote No. 184 Leg.]

                                YEAS--50

     Abraham
     Allard
     Ashcroft
     Bennett
     Bond
     Brownback
     Bunning
     Burns
     Campbell
     Chafee
     Cochran
     Collins
     Coverdell
     Craig
     Crapo
     DeWine
     Domenici
     Enzi
     Fitzgerald
     Frist
     Gramm
     Grams
     Grassley
     Gregg
     Hagel
     Hatch
     Helms
     Hutchison
     Kyl
     Lott
     Lugar
     Mack
     McCain
     McConnell
     Nickles
     Roberts
     Roth
     Santorum
     Sessions
     Shelby
     Smith (NH)
     Smith (OR)
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Voinovich
     Warner

                                NAYS--37

     Akaka
     Baucus
     Bayh
     Biden
     Bingaman
     Breaux
     Bryan
     Byrd
     Cleland
     Conrad
     Daschle
     Dorgan
     Durbin
     Feingold
     Feinstein
     Graham
     Harkin
     Hollings
     Inouye
     Johnson
     Kennedy
     Kerrey
     Kerry
     Landrieu
     Leahy
     Levin
     Lincoln
     Mikulski
     Moynihan
     Murray
     Reed
     Reid
     Robb
     Rockefeller
     Sarbanes
     Schumer
     Wyden

                             NOT VOTING--13

     Boxer
     Dodd
     Edwards
     Gorton
     Hutchinson
     Inhofe
     Jeffords
     Kohl
     Lautenberg
     Lieberman
     Murkowski
     Torricelli
     Wellstone
  The PRESIDING OFFICER (Mr. Fitzgerald). On this vote, the yeas are 
50, the nays are 37. Three-fifths of the Senators duly chosen and sworn 
not having voted in the affirmative, the motion to invoke cloture is 
rejected.
  Mr. LOTT addressed the Chair.
  The PRESIDING OFFICER. The majority leader.
  Mr. LOTT. I ask unanimous consent that the remaining votes in this 
series be limited to 10 minutes in length.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________