[Congressional Record Volume 145, Number 97 (Monday, July 12, 1999)]
[House]
[Pages H5355-H5360]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, this evening I have some of my colleagues, 
and I want to thank the previous speaker, my colleague from Kansas (Mr. 
Moore), for talking about the Patients' Bill of Rights and the need for 
managed care reform.
  The reason that we are here tonight to talk about the Patients' Bill 
of Rights and managed care reform primarily is because the Senate began 
debate today on the Patients' Bill of Rights, and I wanted to point 
out, Mr. Speaker, that while it is true that the debate has begun today 
in the other body, and we are certainly appreciative of that, it was 
only because Democrats over the last few weeks before the July 4 break 
insisted almost to the point of filibustering and saying that they 
would not continue the appropriations process in the Senate if there 
was not an opportunity to bring up the Patients' Bill of Rights and 
deal with the issue of HMO reform.


                Announcement By The Speaker Pro Tempore

  The SPEAKER pro tempore. The gentleman will suspend.
  The gentleman will refrain from characterizing Senate actions.
  The gentleman from New Jersey may continue.
  Mr. PALLONE. Mr. Speaker, what I wanted to point out this evening, 
though, is that even though it is true that the HMO reform debate has 
begun, that we still have a problem in the sense that the Republican 
leadership is unwilling to support or, I think, ultimately even have 
considered particularly here in the House of Representatives the 
Patients' Bill of Rights, and I just wanted to start out this evening, 
if I could, by pointing out a few things that occurred and that were in 
the newspaper the last week or so on this issue, and then I want to 
yield to the two Congresswomen that are here tonight to join me.
  One of the things that was in today's paper, in the New York Times, 
was an article by Robert Pear which is entitled, Managed Care Lobbyist 
Is Ready For The Debate; and essentially what this article says is that 
the HMO industry has commenced because of what is happening in the 
other body, that the HMO industry has commenced a huge lobbying effort 
not only by hiring lobbyists and paying them a lot of money to try to 
put an end to the Patients' Bill of Rights and not allow true HMO 
reform to pass, but also by spending millions of dollars on TV and in 
advertisements to try to kill any kind of HMO reform.
  And just to give my colleagues an example of this, this is in today's 
New York Times. It says, it says specifically here, that the 
association and its business allies, and this is the HMO industry, have 
flooded the air waves and newspapers with advertisements opposing 
legislation to regulate HMOs through an umbrella group known as the 
Health Benefits Coalition.
  They spent $2 million on advertising last year and have already spent 
more than that this year with a new burst of advertising planned for 
this week while the other body debates this issue. The advertisements 
attack the main democratic bill by name, and of course it goes on to 
explain that HMOs are mostly profit making.
  The other thing that particularly galled me was that when they talked 
about the lobbying effort here in the Congress, it says that what they 
are trying to essentially say is that it is not necessary to have new 
laws to regulate HMOs because the HMOs are being told now that they 
should voluntarily adopt a code of conduct that will provide for 
patients' protections.
  I thought that was interesting given the fact that just in the last 
week since we had the July 4 break, we have seen articles in the same 
newspaper, in the New York Times, talking about the long delays by HMOs 
that were cited in a New York report. This came out in New York. It was 
put out by Mark Green, the city's public advocate, and it talks about 
how patients' rights are being ignored.
  Again, if it is not necessary to pass HMO reform, why is it that we 
have a report showing that it is needed and in fact that patient 
protections are being ignored?
  Also the previous Friday in the New York Times was an article that 
said that HMOs will raise Medicare premiums or trim benefits. So not 
only do we have the HMOs essentially saying that they are not going to 
provide the patient protections on a voluntary basis, but also they are 
talking about raising premiums, trimming benefits for their patients 
who are part of their plan.

                              {time}  1930

  So I would maintain, and we are going to talk about this for a long 
time tonight and other days, that in fact we do need legislation. We do 
need the Patient's Bill of Rights. I am pleased with the fact that the 
other body has at least started the debate on this issue.
  Mr. Speaker, I have two Members who are here tonight and who are 
joining me.
  I yield to the gentlewoman from California (Ms. Lee), who I know has 
been an advocate for the Patients' Bill of Rights and for HMO reform 
ever since she started here in the U.S. Congress.
  Ms. LEE. Mr. Speaker, I thank the gentleman for yielding, and also 
for conducting this special order tonight, and for his hard work on 
this.
  Mr. Speaker, let me just say that I rise in strong support of the 
Democratic Patients' Bill of Rights, which will provide fundamental 
measures to fix the current health insurance system, as well as provide 
patients with access to basic needed care.
  Patients should not have to face numerous obstructions when they seek 
basic health care services. The Democratic Patients' Bill of Rights 
will allow patients to have more access to the care that they need. 
With the passage of this bill, individuals will have more access and 
the ability to receive emergency medical services, essential 
medication, as well as necessary services from specialists and OB-GYN 
care.
  It also has provisions for women's and children's health benefits. 
Prescription drugs will be made more readily available to patients. 
Many patients cannot obtain certain prescription drugs because many 
HMOs refuse to pay for them. Unfortunately, patients do not get 
adequate medication needed to successfully treat their condition in 
these instances.
  The Democratic Patients' Bill of Rights allows patients to obtain the 
needed medications, even if their HMO does not have them on their 
approved list. We should not have to gamble with patients' health. The 
quality of life should be a priority in all debates surrounding health 
care issues.
  This bill will allow for more access and freedom for our patients and 
doctors when making decisions concerning an individual's health. 
Appropriate

[[Page H5356]]

health care should be a medical decision, not a business decision.
  This bill addresses the importance of allowing patients to appeal 
their health plan's decision, as well as holding HMOs accountable for 
their actions. This only makes sense. It is outrageous that currently 
consumers have no recourse against HMOs that deny adequate health care 
to them, and they are paying for it. This is wrong. People are growing 
more and more frustrated with an inadequate health care system that 
does not listen to the needs of people.
  I support universal, accessible health care for all, but until we 
have the political will to say that health care is a basic right, and 
that our Federal Government must guarantee this right, regardless of 
income or employment status, this bill is a good first step.
  We must pass legislation with these very modest provisions. We have 
waited long enough and have allowed too many people to suffer. I urge 
my colleagues to support putting people rather than profits first by 
supporting H.R. 358.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman, and I 
think that in many ways that really is the key. What we are talking 
about with the Patients' Bill of Rights are commonsense patient 
protections that, frankly, when we mention them to our constituents, 
they are surprised that they are not already the law, or they are not 
already required.
  I will give the example with the gag rule that says that if a 
particular procedure is not covered by the HMO in the insurance policy, 
the doctor cannot mention it to us, cannot mention that procedure or 
treatment. When I tell that to my constituents, they are shocked to 
think that a doctor can be told by the insurance company that they 
cannot mention a procedure just because it is not covered, the so-
called gag rule.
  We are just looking for commonsense protections here, but the reality 
is that there is so much money being spent to counteract our efforts to 
try to legislate and come up with HMO reform. That is really what we 
are up against. So many of these HMOs are for profit, and basically the 
profit is the bottom line for them.
  We have seen so many examples, and we had a couple before a hearing 
we had about 6 months ago where, because the HMO was seeking to be 
purchased by a larger group, they were actually changing the policy of 
what was covered for certain kinds of procedures in order to save 
costs, because they knew that a few months down the line they wanted to 
be purchased, and they wanted to show that their profits were good, and 
they needed to change the policy on what they would cover as a result 
of it.
  So I think the gentlewoman is right on point when she points out that 
it is profits over patients in many cases.
  Ms. LEE. Mr. Speaker, if the gentleman will continue to yield, I 
think all of us here, regardless of party affiliation, can cite 
instances of patients who have either gotten sicker or who have died as 
a result of certain medical decisions that were not made on the basis 
of the health care benefit to them, but rather, based on the profit 
motive.
  That is just wrong. We want to see that stopped. I am convinced that 
this bill will stop that. We have to make sure that all of our people 
in this country have the best type of medical care, and in fact that 
they and their doctors are the ones making these decisions, not the 
business agents or insurance companies.
  Mr. PALLONE. I appreciate that, Mr. Speaker.
  One of the two issues that I point out constantly that really show 
the distinction between what the Democrats have proposed in the 
Patients' Bill of Rights as opposed to the legislation that the 
Republicans have put forward, one is this whole issue of who is going 
to make the decision of what type of medical procedure we have, what 
type of operation, how long we stay in the hospital.
  The problem right now is that the insurance companies make those 
decisions. What we are saying with the Patients' Bill of Rights, with 
the Democratic bill, is that that decision should be made by the doctor 
and patient.
  The other thing, of course, is the enforcement. We say that there 
should be external independent review, separate and apart from the HMO, 
and if that fails we should be able to go to court and sue the HMO if 
they do not provide the proper care. Of course, the Republican bill 
does not get into that kind of enforcement.
  So I think one of the things we need to do is draw those 
distinctions, if you will, between the Democrats' bill, the Patients' 
Bill of Rights, and some of the other things that are being proposed 
that really do not get to the problem in a comprehensive way.
  Ms. LEE. We absolutely must show the distinction and difference, 
because I don't believe the American public knows that there is a 
difference. People just want to make sure that their medical decisions 
are made between themselves and their physicians. That is what they are 
asking us for.
  Also, people want to make sure that when they are denied, they know 
why they are denied and they can appeal this process. For the life of 
me, I know all of us have constituents who have called us and said, I 
just received a call back or a form in the mail saying that this 
procedure which my physician has designated as the appropriate 
procedure has been denied. What do I do? We cannot respond at all.

  I believe that under our bill, patients will be able to respond very 
effectively and will be able to receive the type of health care that 
they need. Under the Republican bill, they will not. The public needs 
to understand this.
  So I appreciate the gentleman's having this special order tonight, 
because this is the only way we can get the information out to the 
general public.
  Mr. PALLONE. I appreciate what the gentlewoman said. It is just very 
true. One of the biggest problems that people have is that when they 
have been denied certain types of treatment, they are in bad shape, 
they are seeking an operation, they are not feeling well by definition, 
or otherwise they would not need the treatment.
  It is at that very time when they have to go through all these 
hurdles that currently exist, most of which do not lead to anything 
anyway, because under the current law, the HMO can define what is 
medically necessary. Then they can have an internal process to review 
what they have defined as medically necessary. So we never really have 
somebody independent, outside, that can review the decision and take an 
appeal. I want to thank the gentlewoman again.
  Mr. Speaker, the gentlewoman from the Virgin Islands is herself a 
physician, and I know she has been part of our Health Care Task Force 
for a few years now, and has spoken out frequently on the issue of the 
Patients' Bill of Rights. The gentlewoman deals from firsthand 
information.
  Mr. Speaker, I yield to the gentlewoman from the Virgin Islands (Mrs. 
Christensen.)
  Mrs. CHRISTENSEN. Mr. Speaker, I thank the gentleman and I want to 
join the gentlewoman from California (Ms. Lee) in thanking the 
gentleman for leading this special order, and all of the other special 
orders, hearings, and activities to highlight this very important issue 
to all Americans, an issue that is represented quite well in the 
Democratic Patients' Bill of Rights.
  At one time it was thought that managed care was a panacea, not only 
to curb skyrocketing health care costs, but also to provide better 
health care for more people. As a physician from the outside, I had 
serious doubts about the outcome of a health care delivery system 
created to cut costs, rather than to heal and keep people well.
  As time has gone on, my worst fears have actually been realized. For 
2 years now, 2 years or more, we have been trying to pass an important 
piece of legislation, one that the American people care about and one 
that they desperately want and need. It is aptly called the Patients' 
Bill of Rights, and speaks to rights that we Democrats want to return 
to the people and to the doctors that they choose to put themselves 
under their care.
  But it is about something even more important. It is about life and 
it is about the quality of one's life. It is about putting health care 
decisions back in the hands of those who are trained to make those 
decisions.
  Today, after managed care has come to cover the great majority of 
persons who are insured by their employer, what has happened 
paradoxically is that the American people have less access to health 
care, rather than more.

[[Page H5357]]

 We have an obligation to fix that, and that is just what we, the 
Democrats, are trying to do through the Patients' Bill of Rights.
  This Congress must make this commitment to our constituents a 
reality, and then we must move on to provide health insurance for all 
the other Americans, many of them people of color, who have none at 
all.
  I am a physician, a family physician. I was very fortunate to have 
been able to practice the old way, taking the time to speak with and 
getting to know my patients and their families, using what I had 
learned and what I continued to learn to provide preventative care and 
treatment for their illnesses when they needed it, to be free to fully 
inform them of all of their treatment options, to refer them for 
specialty consultation when needed, and remain the manager of their 
care, and yes, even being held accountable for the decisions that I 
made about their health care.
  That is the way medicine should be practiced. It is not that way 
anymore, in many cases, and specifically in most managed care 
organizations. That is why I am here to join the gentleman this evening 
to support the Patients' Bill of Rights. I join my colleagues in 
calling on the leadership of this body to bring the bill to the floor.
  The American people have lost their faith in our health care system, 
and as a physician, I know just how important it is to have confidence 
in the person and the facility where you receive your care.
  They rightfully want to have their doctors make the decisions about 
their health care, not some paperpusher miles away. They want to be 
able to get to an emergency room when, in the judgment of the one who 
knows their body best, themselves, something seems to have gone 
seriously wrong. They want to go there with the peace of mind that they 
will be seen without undue delay, and that the visit will be paid for. 
They want to be able to discuss their care fully with their doctor, to 
know all of the implications and available therapies. They insist on 
participating in the decision on when a specialist is needed, and they 
want to be able to see one when one is.
  Just as the doctor or the provider has always been accountable for 
the judgments they make, the managed care organization, when the 
decision is theirs, must also be held accountable. So just as Americans 
have lost faith in managed care, they are about to lose their trust in 
this body because the leadership has failed to address this issue that 
they, the people of America, rank as the most important to them and 
their families.
  I applaud the other side for taking up S. 6 this week, but it is 
important that they and we pass a comprehensive bill. Piecemealing this 
issue will not fix it. Just as we physicians must treat the whole 
patient or the whole person, this Congress has to fix the entire 
system.
  So before I close, I also want to remind my colleagues that providing 
access to necessary health care, which H.R. 3605, the Democratic 
Patients' Bill of Rights, does, is an important step. It still is a 
part of what we need to do.
  This bill does also begin to address another issue important to 
providers of color and the people we serve. Managed care organizations 
operating in communities of people with color often do not include 
traditional community providers within their system. The providers who 
work there are not always culturally competent. In many localities, 
minority providers are closed out and with them, their patients, who 
are often sicker, and thus undesirable to the HMO because providing 
care for them will cut into the all-important profits.
  Further, there are still too many Americans who do not have any 
insurance coverage at all. The system will not be right until all of us 
have access. This Nation can never be all that it holds out itself to 
be to the rest of the world until all of its citizens and residents 
have access to equitable, quality health care. The Democratic Patients' 
Bill of Rights is a great first step and a very important first step.
  I may have left the practice of private medicine, but seeing that 
good health care is available to all is still very important to me. My 
colleagues on this side of the aisle and I am sure a few on the other 
side will join us as well and continue to work as long as we need to to 
see that this comprehensive bill of rights becomes a reality.
  I thank the gentleman for giving me this time this evening.

                              {time}  1945

  Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman for what 
she said and for being a leader on all of the issues of health care 
reform but particularly on the issue of the Patients' Bill of Rights 
and managed care reform.
  The gentlewoman mentioned some of the piecemeal approaches that we 
are hearing from the Republican leadership, and I just wanted to remind 
my colleagues and maybe we could just spend a few minutes explaining 
why we are here tonight.
  Essentially, the problem that we face as Democrats is that the 
Republican Majority in the House has been unwilling to bring up the 
Patients' Bill of Rights. And since we do not control the procedure 
either in committee or on the floor of the House, we are forced 
essentially just to speak out and explain why it is unfair that the 
Patients' Bill of Rights has not been brought up here in the House of 
Representatives.
  Obviously, what we have tried to do from the beginning of this year 
is to have a hearing on the bill in committee, which has not been 
allowed, and then to mark it up and bring it to the floor. When none of 
that was possible for the last 6 months, we then tried the discharge 
petition process, where we come down to the floor and sign a petition 
the way our constituents petition us and basically the way the rules 
provide that if a majority of us sign a petition, that the bill comes 
to the floor, the Patients' Bill of Rights would come to the floor 
without going to committee. That is, of course, difficult, too, because 
we have to get a majority, and I believe because of the delegate status 
of the gentlewoman from the Virgin Islands, she is not even allowed to 
sign the petition. Or maybe she can sign it, but it does not mean 
anything that she signs it, which I think is also unfortunate and 
should be changed.
  But now that we have gotten a significant number of Members to sign 
the petition, I know we had over 180 before the July 4th break, we are 
starting to see the Republican leadership get a little restless and 
come up with other ideas about how to avoid a debate on this issue.
  One of the things they did was to bring up a series of piecemeal 
bills that took little pieces of the patient protections that we have 
in the Patients' Bill of Rights and basically brought them up in 
committee and tried to get them out of committee. Fortunately, there 
were a few, I think two or three, Republicans who did not want to go 
along with that because, as the gentlewoman said, they wanted a 
comprehensive approach like the Patients' Bill of Rights, so that has 
gotten bogged down.
  Mr. Speaker, I am not sure what the latest tactics are to deal with 
that piecemeal approach. We do have some Republicans that are joining 
us in the effort and feel that this really should be a bipartisan 
issue, but unfortunately it has not been because the Republican 
leadership continues to not allow the Patients' Bill of Rights to be 
brought up.
  Mr. Speaker, I just wanted, if I could, to again say that the problem 
with these piecemeal bills is essentially what I talked about before 
with the gentlewoman from California (Ms. Lee) which is the two key 
points: The fact that doctors and patients should make decisions about 
what kind of treatment or care they get and not the insurance company 
is absent in those piecemeal bills. And, of course, there is no real 
enforcement. There is no real opportunity to go outside the HMO to make 
an appeal. There is no opportunity to sue in a court of law if someone 
is seriously damaged.
  So I think it is important that we keep raising this issue and even 
though we do have the other body now bringing up the issue of HMO 
reform, it is not at all clear whether or not we are going to really 
see action on the Patients' Bill of Rights. So we will have to wait and 
see what develops in that regard.
  Mrs. CHRISTENSEN. Mr. Speaker, I agree with the gentleman from New 
Jersey. He said earlier that it is a common sense bill and it is what 
the people

[[Page H5358]]

of America have said they want. They want their doctors who have been 
trained to sit with them and make the decisions about their health 
care. They want someone that they can have a personal relationship 
with. And that personal relationship between the patient and the 
physician is a very important one, and it is not there in managed care 
the way it is when the doctor can make the decisions.
  And, of course, if the managed care organization is making the 
decisions, then they ought to be held accountable for making those 
decisions. But the Patients' Bill of Rights that we are talking about, 
which is comprehensive, is what the American people have said that they 
want.
  Mr. PALLONE. Mr. Speaker, I will give an example.
  Of course, the insurance companies always say that they do not make 
the decisions and it is really up to the physician. But, as the 
gentlewoman knows, that is not the case.
  I remember when my son was born, he is about 4 years old now, and we 
were at Columbia Hospital for Women here in Washington; and at that 
time my wife delivered him through C-section. I was told that, 
generally, the standard in the industry before HMOs came along was to 
allow the woman to stay in the hospital approximately 4 days.
  We had a standard BlueCross, and this actually was applying not just 
to HMOs but in general, but basically what had happened is that a lot 
of the HMOs have moved to allowing just 1 day for natural delivery and 
then 2 days for C-section. The physician that we had said that he 
really wanted my wife to stay in the hospital at least another day, for 
the third day, but he said that he could not authorize it because the 
insurance company would not allow it. I asked the question at the time, 
I said, ``I do not understand. Aren't you the one that makes the 
decision?'' And he said, ``In theory I am, but if I allow too many 
people stay the extra day then they will penalize me or I may not be 
able to be part of the network or whatever.''
  And so, even though they may say that that it is up to the doctor, 
the reality is that the physicians are under these kind of financial or 
other licensure penalties, not licensure but to be able to stay in the 
network to not allow it. So, effectively, they control the process and 
they make the decisions and that is what we need to change.
  Mrs. CHRISTENSEN. Right. And I believe one of the articles, that we 
had talked about someone who had gone into an emergency room and one of 
the things that our bill provides for is reasonable judgment allowing 
for emergency room care and having that care covered and also allows 
for things like pain, which make a lot of sense to be a reason why 
someone might decide to go to an emergency room.
  There are many stories of persons who have gone into emergency rooms 
with something like chest pain and, while waiting for an approval, 
those first few minutes are some of the most critical minutes, and the 
person had an arrhythmia and died. And so our bill is very important, 
and it is a matter of life, as I said, and quality of life for American 
citizens.
  Mr. PALLONE. Well, basically, being from a legal background, I always 
think about the legal aspects of this. But the way I see it, 
essentially what the Patients' Bill of Rights does in the emergency 
room situation is to essentially put the burden on the HMO in that 
circumstance rather than on the patient. In other words, right now if 
the patient gets chest pains and feels they may be having a heart 
attack and they go to the emergency room, the HMO can find every 
excuse, assuming they did not have a heart attack and they survived, 
the HMO can say that they should have had prior authorization. We would 
have known that chest pain does not necessarily mean a heart attack.

  What we say in our bill is say it is the ``reasonable person'' 
formula. If the average person would think, if they have chest pains, 
that they have to go to the emergency room, that is good enough. They 
do not have to prove after they had the heart attack to justify getting 
the emergency room care paid for, which of course makes sense.
  The other thing, and the gentlewoman would know this better than I, 
the other aspect of our bill is that in order to, as we said since we 
want to leave it to the doctor and the patient to decide what is 
medically necessary, we use the standard practice in that particular 
specialty. So that the reference that the HMO has to make to, for 
example, a certain kind of cardiac care or pediatric care is to the 
standards for that pediatric college or cardiac college. I do not know 
the terms. The standard is that set by that specialty, medical 
specialty, rather than just by the insurance company; and that is a big 
difference as well.
  Mr. Speaker, what I was trying to do tonight, and I appreciate the 
input from the two gentlewomen, the two Congresswoman who so far 
participated in this debate, was to draw a distinction between the 
Democrats' Patients' Bill of Rights and some of the proposals that the 
Republican leadership has put forward. I tried to point out that, on 
the one hand, the Republican leadership here in the House has 
consistently refused to bring up HMO reform, not only the Democrats' 
Patients' Bill of Rights but any kind of legislation, over the last 6 
months in essentially a stalling, delay tactic because of the support 
that the leadership receives from the HMOs and from the insurance 
industry.
  But now that the time has come when it is very difficult for the 
Republican leadership to continue to delay because we have a sufficient 
number of signatures on this discharge petition, that we are getting 
close to the point where we could actually bring the bill up, they are 
now turning to a different device to bring up legislation that they 
pretend is some kind of HMO reform but really is not and does not pass 
the test to really provide comprehensive patient protections to the 
average American.
  Mr. Speaker, I want to make reference in that regard to an op-ed 
article by Bob Herbert in The New York Times that appeared just prior 
to the break on Thursday, July 1. To the extent it talks about the 
action in the other body, I will not get into that because we are not 
supposed to talk about what happened in the Senate.
  But the op-ed does make the point that the Republicans really do not 
want to bring up HMO reform, true HMO reform like the Democrats' 
Patients' Bill of Rights, and that they will do whatever they can to 
try to avoid the issue and prevent a bill from passing here in the 
House of Representatives, even though the American people have 
repeatedly spoken out and say that they want HMO reform and they want 
the type of comprehensive approach that the Democrats have put forward 
in the Patients' Bill of Rights.
  I just wanted to make reference to certain sections of this op-ed 
which I think is very significant, and it refers to the GOP right wing, 
The Restless Radicals, and it talks about the fight. And it says that 
the fight over HMO reform was not over the merits of the legislation 
but over the Republican Majority's refusal to even allow debate on a 
series of Democratic proposals aimed at curbing abuses by insurance 
companies and HMOs.
  I will just quote certain sections here.
  ``There is strong support among the public and among health care 
professionals for the Democratic proposals, known as the Patients' Bill 
of Rights. The Republicans have offered much weaker legislation and 
have not been anxious to permit a public airing of the differences.
  ``Virtually all leading patient and medical groups have supported the 
Democratic proposal'' in the Senate, ``Senator [Tom] Daschle's 
proposal,'' says Senator Edward Kennedy. ``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----''
  The SPEAKER pro tempore (Mr. Gibbons). The gentleman will refrain 
from quoting Members of the other body.
  The gentleman may continue.
  Mr. PALLONE. Mr. Speaker, the references that I will continue with 
are from the article, not from the other body. This is, as I said, an 
opinion that was by Bob Herbert in his column in The New York Times on 
Thursday in which he said, ``A few days ago I spoke by phone with Steve 
Grissom,'' a constituent or someone basically from North Carolina who 
has had health problems. And he said, ``A few days ago I spoke by phone 
with Steve Grissom of

[[Page H5359]]

Cary, North Carolina. He is 50 years old and suffers from leukemia and 
AIDS, which he contracted through a blood transfusion. Mr. Grissom is 
locked in a harrowing dispute with his insurance providers over payment 
for medical equipment and a continuing supply of oxygen that could 
determine whether he lives or dies.
  ``Said Mr. Grissom: I've been a Republican all my life. I don't think 
I've ever missed a vote. Now is the first time in my life that I've 
considered changing my party affiliation because I see a real lack of 
compassion in the Republican Party. They're hearing from the HMOs and 
they're hearing from the lobbyists with their fat checkbooks, and 
they're not hearing from people like me who are in desperate need of 
this kind of consumer protection.''

                              {time}  2000

  Mr. Speaker, I think it really says it all. As we said before when we 
had the two Congresswomen on the floor, the bottom line is that all 
that the Democrats are proposing are common sense patient protections 
within the context of HMOs.
  The only reason that we are getting opposition from the Republicans 
is essentially because of the fact that the insurance companies do not 
want this legislation brought to the floor, do not want a debate, and 
do not want a vote on it.
  I would like to, if I could, just take a few minutes to point to the 
differences substantively between the Democratic bill and the 
Republican bill. There are really a few key points in the Democratic 
bill that I would just summarize right now and why the Democratic 
Patients' Bill of Rights would make a real difference for American 
families.
  First, it holds managed care plans responsible for denial of care 
with real, reliable and enforceable appeals and remedies. This is the 
enforcement that we talked about before that involves an independent 
review of any denial of treatment outside of the confines of the HMO 
and includes also, ultimately, the right to sue the HMO for damages.
  Second, it guarantees patients the right to see a specialist when 
they need to do so. It is so crucial today. So much medical care is 
provided through specialists. If one does not have access to a 
specialist within the network of one's HMO, one should be able to go 
outside the network to get a specialist who can cover the concern or 
deal with the medical concern that one has.
  Third, it guarantees that vulnerable patients can stay with their own 
doctor even if their own doctor is no longer in their health care plan.
  Fourth, it bans financial incentives to reward physicians for 
prescribing less care.
  Fifth, it returns health care decisions to health care professionals 
and their patients, which again we discussed earlier this evening.
  Now, if I could just elaborate on a few of these points. When we talk 
about providing patients with access to care, which is so important, 
there are really a number of things in the Democratic bill that relate 
to access. Some of them we discussed a little bit earlier this evening.
  One is access to emergency room care. The Democrats' Patients' Bill 
of Rights allows patients to go to any emergency room during a medical 
emergency without having to call a health plan first for permission. 
Emergency room physicians can stabilize patients and begin to plan for 
post-stabilization care without fear that health plans will later deny 
coverage.
  Another access point, access to needed specialists. The Democrats' 
Patients' Bill of Rights ensures that patients who suffer from a 
chronic condition or disease that requires care by a specialist will 
have access to a qualified specialist. If the HMO network does not 
include specialists qualified to treat a condition such as a pediatric 
cardiologist to treat a child's heart defect, it would have to allow 
the patient to see a qualified doctor outside its own network at no 
extra cost.
  The Patients' Bill of Rights also allows patients with serious 
ongoing conditions to choose a specialist to coordinate care or to see 
their doctor without having to ask their HMO for permission before 
every visit.
  Another access, very important obviously for women, access to an OB/
GYN. The Democrats' Patients' Bill of Rights allows a woman to have 
direct access to OB/GYN care without having to get a referral from her 
HMO. Women would also have the option to designate their OB/GYN as 
their primary care physician.
  Also on the issue of access, my colleague from California mentioned 
earlier that Democratic Patients' Bill of Rights makes needed 
prescription drugs available to patients. Currently, many HMOs refuse 
to pay for prescription drugs that are not on their preapproved list of 
medications. As a result, patients may not get the most effective 
medication needed to treat their condition.
  The Democrats' Patients' Bill of Rights ensures that patients with 
drug coverage would be able to obtain needed medications even if they 
are not on their HMOs approved list.
  Now, the other issue that was mentioned by the gentlewoman from the 
Virgin Islands (Mrs. Christensen), who is a physician who has 
practiced, is the idea of freeing doctors to practice medicine. This is 
what so many of my constituents complain about, that accountants should 
not make medical decisions. Yet, some managed care organizations 
interfere with doctors' medical decisions and restrict open 
communication between patients and doctors. The Democrats' Patients' 
Bill of Rights protects the doctor/patient relationship and frees 
doctors to practice medicine.
  Most important, it prohibits insurers from gagging doctors. Patients 
have a right to learn from their doctor all of their treatment options, 
not just the cheapest. The Democrats' bill prevents HMOs from 
interfering with doctors' communications with patients. Doctors cannot 
be penalized for referring patients to specialists or discussing costly 
medical procedures.
  The Patients' Bill of Rights provides that doctors and patients, 
rather than insurance company bureaucrats, are once again allowed to 
make medical decisions. Now, how do we do that? Well, under our bill, 
HMOs are prevented from inappropriately interfering with doctors' 
judgments and cannot mandate drive-through procedures or set arbitrary 
limits on hospital lengths of stay.
  In addition, doctors and nurses who advocate on behalf of the 
patients will be protected from retaliation by HMOs. Also important in 
this whole idea of allowing doctors to freely practice medicine is to 
limit improper financial incentives.
  Some managed care organizations use improper financial incentives to 
pressure doctors to deny care to their patients. The Democrats' 
Patients' Bill of Rights limits insurance companies' ability to use 
financial incentives to get doctors to deny care. HMOs and insurers 
also would have to disclose to all patients information about any 
incentives that they use.
  Now, I just want to talk about one more aspect of the Democratic 
bill, and then I want to talk briefly about the Republican bill that is 
being put up in opposition to it. This is with regard to enforcement 
and the whole idea of bringing the appeal when one has been denied 
treatment.
  When health plans deny needed care, patients and doctors reserve the 
right to appeal the decision and to receive a timely response. To 
protect patients and give them a meaningful right to appeal, the 
Democrats Patients' Bill of Rights establishes a sound, independent and 
timely external appeals process. What we do with our bill is to ensure 
that patients who are denied care by an insurance company can appeal 
the decision to an independent reviewer with medical and legal 
expertise and receive a timely decision that is binding on the HMO.
  Finally, I would like to talk a little bit about why it is necessary 
to have the ability to sue. I think a lot of people do not realize that 
they can sue the HMO if they have been denied treatment or if they have 
suffered damages because they did not get proper treatment.
  But today, even if an HMO has been involved directly in dictating, 
denying, or delaying care for a patient, it can use a loophole in the 
statute called ERISA, the Employment Retirement Income Security Act of 
1974. The HMO can use ERISA to avoid any responsibility for the 
consequences of its actions.

  ERISA was designed to protect employees from losing pension benefits

[[Page H5360]]

due to fraud, mismanagement, and employer bankruptcies during the 
1960s. But it has had the effect of leaving patients harmed by their 
HMO's decisions to deny or delay care with no effective remedy.
  Now, what the Democrats do in our Patients' Bill of Rights is to 
close this loophole and ensure that, like any other industry, HMOs can 
be held accountable for their actions. Since HMOs have the financial 
incentive to deny care to patients, they should bear responsibility if 
such denials cause harm. Employers, under our bill, are shielded from 
liability unless they make the decision to deny care. But the HMO is 
not. The HMO can be sued because they are in fact making the decision.
  Now I just wanted to, if I could, briefly talk about these sham 
piecemeal bills that the Republican leadership has brought up in the 
last few weeks after we started to get a number of signatures to our 
discharge petition and it seemed as though at some point in the near 
future we were likely to get enough signatures to bring the Patients' 
Bill of Rights to the floor. So the Republican leadership has rolled 
out eight piecemeal bills which they call HMO reform but are really 
not.
  Let me just point out some of the things that are left out in this 
Republican approach. First of all, the bills only cover people who 
obtain health insurance through their employer. They fail to extend 
patient protections to the millions of people that purchase health 
insurance individually.
  Obviously, the patient protections that we are talking about should 
apply to all health plans, not just plans that are provided by the 
employer. Also, the Republican bills pretend to secure patients' 
rights, but they contain no way to enforce those rights other than the 
weak penalties currently available through ERISA. So the outside 
independent review, the ability to sue is not there.
  The piecemeal bills are inconsistent and incomplete. For example, one 
of them is supposed to protect against so-called gag clauses where the 
physician is told that he cannot speak out about a particular procedure 
that is not covered. But it does not. But the bill the Republicans have 
put forward to try to deal with these gag clauses does not prohibit 
plans from retaliating against doctors who discuss the plans' financial 
incentives. Well, the reality then is essentially the doctors are still 
gagged and cannot speak their mind.
  There are so many other examples. Let me give one other example in an 
effort to try to address the Democrats' initiative with regard to OB/
GYN care. The Republican bill purports to guarantee women direct access 
to routine OB/GYN care, but it would allow a plan to require a woman to 
obtain such services from a generalist.
  So these are the kinds of games that we are seeing with this 
piecemeal approach that the Republicans have put forward. They pretend 
that they are dealing with some of the patient protections, but in fact 
they do not.
  Mr. Speaker, what I would really like to point out is that, on the 
one hand, I am pleased to see that the other body is taking up the 
issue of HMO reform, but I think that it is crucial, first of all, that 
we in the House bring up the issue and allow for a debate on the 
Patients' Bill of Rights.
  But even more so, it is necessary for us to bring up a bill, a strong 
comprehensive approach like the Democrats' Patients' Bill of Rights, 
allow it to be brought to the floor, vote on it, go to conference with 
the Senate, and have a strong piece of legislation like the Patients' 
Bill of Rights go to the President.
  President Clinton has repeatedly said that he would sign the 
Patients' Bill of Rights if it comes to his desk. I notice that, during 
the break, actually over this past weekend, he again used an 
opportunity I think when he was out on the West coast in Los Angeles to 
criticize the GOP, the Republican leadership, for trying to avert a 
vote on true HMO reform.
  We are not going to rest, those of us in our party, and I know some 
of the Republicans as well who care about this issue are not going to 
rest until we have a comprehensive bill passed by both houses and on 
the President's desk.
  This is what the American people demand. This is what they deserve. 
It only makes sense to do so if we are really going to provide 
protections for patients throughout the country.

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