[Congressional Record Volume 145, Number 115 (Wednesday, September 8, 1999)]
[House]
[Pages H7966-H7968]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PATIENT PROTECTION LEGISLATION
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 1999, the gentleman from Iowa (Mr. Ganske) is recognized for
60 minutes as the designee of the majority leader.
Mr. GANSKE. Mr. Speaker, I welcome back all my colleagues from across
the country, both sides of the aisle.
Congress has a lot of work to do in the last couple months of this
year. Part of that work that many of us would like to see completed, at
least in the House, and get to conference would be to pass a bill here
in the House on patient protection legislation.
Now it is now September, Mr. Speaker, and the Speaker of the House,
the gentleman from Illinois (Mr. Hastert) had told us that in June that
we would see a patient protection bill on the floor before the August
recess. In fact, he personally told me that it is his, quote, intent to
have managed care reform legislation on the floor in July before our
August recess.
Unfortunately, Mr. Speaker, it did not happen, so we went off to our
August recesses, talked to our constituents, and the managed care
industry continued their $100 million advertising campaign against this
legislation.
Now there are only 435 Members of this House, Mr. Speaker. If you
divide that into a hundred million, that is an awful lot of money that
a special interest group is using to try to defeat a common-sense piece
of legislation. But the August recess gave them their
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chance to go on TV, go on the radio, initiate phone calls into
offices, and do my colleagues know what? I welcome that.
{time} 2100
Because it identified a number of people in my office, for instance,
who are interested in healthcare, and when we had a chance to explain
to them the bill, the bipartisan bill, H.R. 2723, the Bipartisan
Consensus Patient Protection Bill of 1999, overwhelmingly the people
who were stimulated to phone in to my office by the opponents to this
legislation said, You know what? That does not sound like it is such a
bad piece of legislation. In fact, we have a neighbor or a family
member who has had problems with their HMO, and we think you ought to
do something about it.
Well, as I said, the managed care industry initiated this big
advertising blitz over the August recess. What did they accomplish? I
think the polling will show that two-thirds of the American people
continue to want to see managed care patient protection legislation
passed. Overwhelmingly, people think doctors ought to be able to tell
their patients all of their treatment options.
Overwhelmingly, the American public think that they ought to be able
to go to an emergency room if they are truly having an emergency. If
they are, for instance, having crushing chest pain and they have seen
that the American Heart Association says that could be a heart attack,
you better get right to that emergency room, they think we ought to
pass legislation that would say if you have that common layperson's
definition of an emergency, your HMO should have to pay the bill, even
if afterwards it turns out you did not have something quite as serious
as a heart attack, because if you delay getting to the emergency room,
you may end up dead before you get to the emergency room.
Well, over the last month, since the gentleman from Georgia (Mr.
Norwood), the gentleman from Michigan (Mr. Dingell), myself and others
introduced the bipartisan Consensus Patient Protection Act of 1999, we
have had a number of organizations from across the country sign on
endorsements for this piece of legislation. In fact, Mr. Speaker, I
would like to introduce a list of 156 endorsing organizations for H.R.
2723, the Bipartisan Consensus Managed Care Improvement Act of 1999.
Let me just read through some of these letters of endorsement. I
think they make good points. Now, I am not reading these in any
particular order. I am not going to have time in this 1-hour special
order to read every letter of endorsement, but I think that many of
them deserve being shared with my colleagues.
The first one I have is the American Nursing Association endorses the
bipartisan managed care bill. The American Nursing Association
represents 2.6 million registered nurses throughout its 53 constituent
organizations. This is what it had to say about the bipartisan managed
care reform bill:
``The American Nurses Association is pleased to endorse this bill and
encouraged by the cooperation and compromises made to achieve real
reform, real progress on managed care reform,'' said ANA President
Beverly Malone.
``It is heartening to see Congress working together to solve
problems. This is how Congress should be working. Given the nursing
profession's preeminent role in patient advocacy, the American Nursing
Association is particularly heartened by the steps proposed to protect
registered nurses and other healthcare professionals from retaliation
from HMOs when they, the nurses, advocate for their patients' health
and safety. As the Nation's foremost patient advocates, nurses need to
be able to speak up about inappropriate or inadequate care that would
harm their patients. Nurses at the bedside know exactly what happens
when care is denied, comes too late or is so inadequate that it leads
to inexcusable suffering, which is why we need to maintain strong
whistleblower protection language in this bill. Nurses want to see
strong comprehensive patient protection legislation enacted this
year.''
Mr. Speaker, shortly before the August recess this House
overwhelmingly voted to protect federal employees who blow the whistle
on contractors or others who are breaking the law. There is a well-
known case that has been reported in the press about a Department of
Defense employee who blew the whistle and was punished by her superiors
for it, and this House, Republicans and Democrats, overwhelmingly voted
to support the whistleblower protections that my own Senator from Iowa,
Senator Grassley, has been a strong proponent of.
I would ask my colleagues, look, if we think a strong whistleblower
protection is good enough for federal employees, do we not also think
it is important that nurses who are on the front lines, who see the
effects of HMOs decisions, that they are able to speak their minds
freely without fear that they could lose their jobs? Well, that is the
American Nursing Association endorsement.
Here I have the endorsement by the American Medical Association:
``The 300,000 physician student members of the American Medical
Association strongly urge the House of Representatives to pass
meaningful patient protection legislation.'' The AMA endorses H.R.
2723, the Bipartisan Consensus Managed Care Improvement Act of 1999,
introduced by the gentleman from Georgia (Mr. Norwood) and the
gentleman from Michigan (Mr. Dingell).
Then the AMA goes through why they think this is a good bill. It has
a strong external appeal section. All patients should be guaranteed
access to an external appeals process whenever a denial of benefits
involves medical judgment or concerns medical necessity. But we have a
situation, Mr. Speaker, where, because of past federal law, people who
receive their insurance through their employers do not have that
protection. If you purchase your insurance as an individual, you are
under State insurance commissioner protection. But if you receive your
insurance through your employer, Congress 25 years ago passed a bill
that basically say said that health plan can give a definition of
whatever they want to medical necessity.
Now, let me explain what that means. Before coming to Congress I was
a reconstructive surgeon. I took care of children with cleft lips and
palates, a hole in the lip and a hole in the roof of the mouth. The
prevailing standard of care for treatment of that is surgical
correction so that the child can learn to speak, so that food does not
come out of his nose.
There are health plans, HMOs, that define medical necessity as the
cheapest, least expensive care, quote-unquote. So what would that mean
to a child with a cleft palate? It would mean that that health plan
could say, Hey, we are not going to give you surgery to fix that defect
that you are born with; we are just going to give you a piece of
plastic to shove up into that hole. Will that little boy or girl be
able to speak correctly? No. But it does not matter, because under
federal law the health plan can determine medical necessity.
We need to change that. That change is in the bill that the AMA is
endorsing.
The AMA talks about accountability of health plans. If they are
making medical decisions, they ought to be responsible for those: point
of service, emergency services, prohibiting gag clauses that will keep
physicians from being able to tell a patient all of their treatment
options.
Let us say that I have just examined a patient, a woman, with a lump
in her breast, and she belongs to an HMO, and that HMO has a gag clause
that says before you tell a patient her treatment options, you have to
first get an okay from us.
So I listen to this patient's story, I examine her, and then I have
to say, Excuse me, go out to the phone, get an HMO on the line and say,
This patient has three treatment options, one of which may be more
expensive than the other. Is it all right to tell her about them? That
is absurd. It is ridiculous. But do you know what? Those types of
practices have happened. Those types of contracts exist, or at least
have existed until we started to shine the light of the disaffected
upon those practices. We need to make sure that I can tell that patient
her treatment options, whether her plan covers it or not. She deserves
to know all of her treatment options.
Those are important reasons why, for instance, the American Medical
Association has given its endorsement to
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the bipartisan Consensus Managed Care Improvement Act.
How about the American Osteopathic Association? The American
Osteopathic Association represents the Nation's 43,000 osteopathic
physicians. Eugene Oliveri, Dr. Oliveri says, ``As president, I am
pleased to let you know that the AOA endorses the Bipartisan Consensus
Managed Care Improvement Act of 1999. Why? Because physicians are
allowed to determine medical necessity. Health plans are accountable
for their actions, a fair and independent appeals process is available
and the protections apply to all Americans. Employers and patients,''
this letter says, ``are tired of not receiving the care they are
promised, they pay for and they deserve, and H.R. 2723 will help bring
quality back into health care.''
Here I have another letter of endorsement. This is from the American
Dental Association:
``On behalf of the 144,000 members of the American Dental
Association, we wish to endorse H.R. 2723, the Bipartisan Consensus
Managed Care Improvement Act of 1999. This is the first truly
bipartisan comprehensive patient protection bill in the 106th
Congress.'' This was a letter to Congressman Norwood.
``By joining forces with Representative Dingell, you have breathed
new life into the movement to establish a few basic rules to protect
all privately insured Americans from unfair and unreasonable delays and
denials of care.''
The letter goes on: ``We recognize that powerful groups that oppose
managed care reform will continue spending millions of dollars in their
relentless efforts to scare the public and badger lawmakers who attempt
to improve the health care system. However, we will do all we can to
make sure that our members know of your courageous efforts on behalf of
them and our patients. Patient protection is a genuine grassroots issue
that cuts across geographic, economic and political boundaries, and we
believe that only bipartisan action will achieve the goal that you
want.''
Here I have a news release from the American Academy of Family
Physicians: ``Today the 88,000 member American Academy of Family
Physicians announces its support for H.R. 2723.''
I have here a letter of endorsement from the American College of
Physicians, the American Society of Internal Medicine: ``The American
College of Physicians, ASIM, is the largest medical specialty society
in the country, representing 115,000 physicians who specialize in
internal medicine and medical students. The American College of
Physicians believes that any effective patient protection legislation
must apply to all Americans, not just those in employer plans, require
that physicians rather than health plans make determinations regarding
medical necessity, provide enrollees with a timely access to a review
process that is independent, offer all enrollees in managed care plans
a point of service that enables them to obtain care from physicians
outside the network and hold all health plans accountable.''
Mr. Speaker, I have a letter of endorsement from the American Academy
of Pediatrics: ``On behalf of the 55,000 general pediatrician-pediatric
medical specialists and pediatric surgical specialists, I am writing to
express our strong support of H.R. 2723. We are especially pleased that
your legislation recognizes the unique needs of children and addresses
them appropriately. Children are not little adults. Their care should
be provided by physicians who are appropriately educated in unique
physical and developmental issues surrounding the care of infants. You
clearly recognize this, and have included access to appropriate
pediatric specialists, and we are endorsing your bill.''
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