[Congressional Record Volume 145, Number 98 (Tuesday, July 13, 1999)]
[Senate]
[Pages S8312-S8313]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        ACCESS TO EMERGENCY CARE

  Ms. MIKULSKI. Mr. President, I rise today to continue the discussion 
of the Patients' Bill of Rights and lend my voice to the Graham 
amendment for access to emergency care without penalty by an HMO when 
any prudent person presents their symptoms.
  Before I do that, I congratulate the Senator from Rhode Island for 
his most eloquent and insightful remarks. For my colleagues, the 
Senator from Rhode Island has devoted his life to protecting the lives 
of Americans. As a West Point graduate serving in the U.S. military, he 
did that abroad, and now he does it in the Senate Chamber standing up 
for America's children. I thank him for his devotion and his gallantry. 
I am happy to be an able member of the Reed platoon.
  I am pleased today to join with Senator Bob Graham and other 
colleagues in speaking out about the people who go to an emergency room 
and want to be treated for their symptoms without fear of not having 
their visit covered by their HMO. When it comes to emergency care, 
people are afraid of both the symptoms they face as well as being 
denied coverage by their insurance company.
  ``ER'' is not just a TV show; it is a real-life situation which 
thousands of Americans face every day. Yet I hear countless stories 
from friends and neighbors and constituents, as well as from talking to 
ER docs in my own State, who tell me they are afraid to see their 
doctor or take their child or parent to the emergency room because they 
will not be reimbursed and will be saddled with debt.
  Patients must be covered for emergency visits that any prudent person 
would make. That means if they have symptoms that any prudent person 
says could constitute a threat to their life and safety, they should be 
reimbursed. The prudent layperson standard is at the heart of this 
amendment. It is supported by the American College of Emergency 
Physicians which has stated that the way the Republican bill is 
written, it ``must be interpreted as constraints on a patient's use of 
the `prudent layperson' standard.''
  The Republican bill only goes part way. We need to restore common 
sense to our health care system.
  Let me give an example, the case of Jackie, a resident of Bethesda, 
MD. She went hiking in the Shenandoah mountains. She lost her footing 
and fell off a 40-foot cliff. She had to be airlifted to a hospital. 
Thanks to our American medical system, she survived. After she regained 
consciousness and was being treated at the hospital for these severe 
injuries, Jackie learned that her HMO refused to pay her hospital bill 
because she did not get prior authorization. This is outrageous. 
Imagine falling off of a 40-foot cliff, waking up in a hospital and 
being told that your HMO will not cover your bills because you did not 
call while you were unconscious.

  In America, we think if you need emergency care, you should be able 
to call 911, not your HMO's 800 number.
  Incredibly, some of my colleagues in the Senate say that all these 
stories are anecdotes and they are horror stories. These are not 
anecdotes. We are talking about people's lives.
  If you would come with me to the emergency rooms at Johns Hopkins 
Hospital, the University of Maryland, Salisbury General on a major 
highway on the Eastern Shore, all over the State, you would learn that 
many people come to the ER because of not only accidents but they are 
experiencing symptoms where they wonder if their life could be 
threatened or the life of

[[Page S8313]]

their child. The child is having acute breathing, and you do not know 
if that child is having an undetected asthma attack; or a man sitting 
at Oriole Park suddenly has shortness of breath, pains in his left side 
and leaves to go to the ER at the University of Maryland next to Camden 
Yards. Should they call 911 or should they call 800 HMO? I think they 
should call 911, and they should worry about themselves and their 
family and not about reimbursement.
  So when we come to a vote, I really hope that we will pass the Graham 
amendment. The Republicans say they have an alternative. But it does 
not guarantee that a patient can go to the closest emergency room 
without financial penalty. Do not forget, it covers only 48 million 
Americans; it leaves out 113 million other Americans.
  Let's do the right thing. Let's make sure that patients with 
insurance cannot be saddled with huge bills after emergency treatment.
  I thank the Senate and yield the floor.
  The PRESIDING OFFICER. The time of the Senator has expired.

                          ____________________