[Congressional Record Volume 145, Number 115 (Wednesday, September 8, 1999)]
[House]
[Pages H7968-H7983]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  2115

  I have here an endorsement from the American College of Surgeons: 
``We are pleased to note that H.R. 2723 requires health plans to allow 
patients to have timely access to specialty care and to go outside the 
network for specialty care at no additional costs if an appropriate 
specialist is not available in the plan.''
  This is important. A lot of health plans have incomplete physician 
panels. If the patient ends up with a complicated procedure, they need 
assurances their plan will cover them.
  This letter of endorsement from the American College of Surgeons goes 
on: ``If health plans continue to make medical determinations, then 
they should be held liable to at least the same degree as the treating 
physician. We are pleased to note that H.R. 2723 would allow patients 
to hold health plans liable when the plans' decisions cause personal 
injury or death. Additionally, the College agrees that it is reasonable 
to prohibit enrollees from suing their health plan for punitive damages 
if the health plan abides by the decision of the independent external 
review entity.''
  Let me expand on this, Mr. Speaker. What we are saying in this bill 
is that if there is a dispute on an item of coverage, let us say a 
patient's physician recommends a type of treatment, the HMO says no, 
then the patient would be able to appeal that decision in his plan. If 
the plan still says no, then the patient could take that appeal to an 
external independent peer panel of physicians and say, I really think 
that common standards of practice show that I should get this 
treatment.
  Under our bill, that independent panel could make that determination. 
If they say, yes, we agree with you, and the health plan follows that 
recommendation, then the health plan is free of any punitive damages 
liability. That is a fair, commonsense compromise on this issue.
  Furthermore, in our bill we have a provision that says, you know, if 
an employer simply contracts with an HMO, the HMO makes the decision, 
the employer has had nothing to do with the decision, then the employer 
cannot be held liable, either. The responsibility lies with the entity 
that makes a decision that could result in a negligent harm to a 
patient.
  What kind of problems are we talking about? Let me give one example. 
A few years ago a young mother was taking care of her infant son, 6-
month-old infant son, in the middle of the night. The family lived 
south of Atlanta, Georgia.
  Little Jimmy Adams had a temperature of 105 degrees. Mom looked at 
this baby and knew that baby Jimmy was pretty sick, so she gets on the 
phone. She does what she is supposed to. She is in an HMO. She phones a 
1-800 number. She gets some voice from thousands of miles away and 
explains the situation.
  The reviewer, the HMO bureaucrat, says, all right, I will let you 
take Jim. I will authorize an emergency room visit for little Jimmy, 
but only at this hospital. If you go to any other hospitals, then you 
are going to pay the bill.
  It so happens that the hospital that was authorized was 70-some miles 
away. It is 3:30 in the morning. Mom and dad wrap up little Jimmy. They 
get into the car. They start to drive this long distance to the 
emergency room, even though Jimmy is looking really sick. But his mom 
and dad are not health professionals. On their way to Hospital X they 
pass three other hospital emergency rooms, but they are not authorized 
to stop there. They know that they would get stuck with the bill.
  They do not know exactly how sick Jimmy is, so they drive on. Before 
they get to the designated hospital, little Jimmy has a cardiac arrest 
and stops breathing. Imagine, dad driving frantically, mom trying to 
keep baby Jimmy alive. They swing finally into the emergency room. Mom 
jumps out with baby in her arms, saying, help me, help me. A nurse 
comes out and starts mouth-to-mouth resuscitation. They put in the IVs. 
They give the medicines. Somehow or other they get little Jimmy back 
and he lives. But because of the medical decision that that HMO made, 
saying no, you cannot go to the nearest emergency room, Jimmy is really 
sick, you have to go 70 miles away, and he has this arrest because of 
that decision, well, little Jimmy is alive, but because of that arrest 
he ends up with gangrene in both hands and both feet, and both hands 
and both feet have to be implemented.
  So I phoned Jimmy's mother recently to find out how he is doing. He 
is learning how to put on his leg prostheses. He has to have a lot of 
help to get on his bilateral hooks. He will never play basketball. I 
would tell the Speaker of the House that he will never

[[Page H7969]]

wrestle. When he grows up and gets married, he will never be able to 
caress the cheek of the woman that he loves with his hand.
  Do Members know what that HMO is liable for under Federal law? 
Nothing, nothing, other than the cost of the amputations. Is that fair? 
Is that justice? I will tell the Members what, these victims of managed 
care, that the managed care companies just call anecdotes, if you prick 
their finger, if they have a finger, they bleed. They are our 
neighbors, or they may be our own families. I could tell hundreds of 
stories like this.
  That is why these organizations say a primary part of this 
legislation should involve responsibility for an HMO that makes medical 
decisions.
  Here I have a letter of endorsement from the American College of 
Obstetricians and Gynecologists: ``The American College of 
Obstetricians and Gynecologists is pleased to offer its support for the 
bipartisan consensus Managed Care Reform Act of 1999. This legislation 
would guarantee direct access to OB-GYN care for women enrolled under 
managed care,'' pretty important.
  Here is a letter of endorsement from the American Psychological 
Association. ``The American Psychological Association expresses our 
strong support for H.R. 27. Broad bipartisan support for this 
legislation represents a major breakthrough on behalf of patients' 
rights. An analysis of the bill shows that the insurance and managed 
care industry could generate income of $280 million for every 1 percent 
of claims that are delayed over 1 year.''
  That is the provision that is in the other body. Our provision in 
this bill makes for timely appeals. We appreciate the endorsement of 
the American Psychological Association.
  The American Occupational Therapy Association endorses this bill. 
``Over the August recess we have notified our members, asking them to 
talk to their legislators. Please let us know if we can assist you in 
your efforts to have comprehensive managed care legislation addressed 
on the House floor.''
  The American Public Health Association, which represents more than 
50,000 public health professionals, endorses the bipartisan bill 
because the bill would ``improve access to emergency services, allow 
more people to enter clinical trials,'' something the HMO industry has 
run away from, ``provide patients with a fair appeals process for 
denied claims, lift barriers to specialists, and hold plans 
responsible.''
  ``We understand,'' this letter says, ``that some within the managed 
care industry oppose any government regulation. But this issue is a 
very important one for consumers, health care providers, and the public 
health community. H.R. 2723 is a significant and welcome step towards 
achieving new patient protections for managed care patients.''
  Here I have an endorsement by the American Association for Marriage 
and Family Therapy: ``On behalf of the 46,000 marriage and family 
therapists throughout the United States, we want to applaud Congressman 
Norwood and Representative Dingell for their effort to provide 
Americans with comprehensive patient protections. Provisions of 
significance to our organization include an independent review process 
for determination of medical necessity, the ability of people with 
special health care needs and chronic conditions to continue to access 
their doctors, such as a person who had a rheumatoid arthritis being 
able to continue to see their rheumatoid arthritis doctor.''
  We have an endorsement from the American Counseling Association: 
``H.R. 2723 provides a wide array of consumer protections, including 
key components for mental health providers and their clients.''
  I have an endorsement from the American Academy of Ophthalmology. I 
am so proud of the provider groups who have given endorsements for this 
bill, because this bill is a patient protection bill. It is not a 
provider bill. There are issues that separate some of these groups. Not 
all of these groups see eye to eye on health care policy.
  Here is an example. We have an endorsement by the American Academy of 
Ophthalmology and an endorsement by the Opticians Association. 
Sometimes these groups have policy disagreements, but on this issue 
they are in 100 percent agreement that patients need protection, basic 
protection, commonsense protection, from HMO abuses.
  The opticians say, ``This bill gives basic, commonsense protections 
to millions of Americans, and it is certainly refreshing to see the 
bipartisan way it was approached.''
  I have a letter of endorsement from the American Podiatric Medical 
Association, foot doctors, foot specialists. I have the same 
endorsement from the orthopedic surgeons.
  I have an endorsement here from the Association for Oral and 
Maxillofacial Surgeons. We have an endorsement from the National 
Organization of Doctors Who Care. They say, ``We strongly support H.R. 
2723 because it ensures fairness and accountability in our health care 
delivery system lacking in the bill that passed the Senate,'' and other 
legislation that has gone before, and they are referring to a bill that 
passed this House of Representatives in the last Congress.
  They go on and say in their letter, and I think this is important, 
``We are not against managed care. It does have a place. However, we 
are strongly against managed care plans not towing the line; i.e., not 
wanting to be held accountable for their medical decisions which 
adversely affect patient care.''
  I have here an endorsement from Physicians for Reproduced Choice in 
Health Care. This organization is especially pleased that H.R. 2723 
would ensure that medical judgments are based solely by health care 
providers. This is particularly important in that women should have 
direct access to women specialists.''
  We have the National Patient Advocate Foundation endorsing this bill. 
They go on and say in this endorsement, ``Please note our strong 
endorsement of the bipartisan consensus Managed Care Improvement Act of 
1997, our endorsement for each of the cosponsors of this legislation, 
and for each member of our United States House of Representatives who 
has contributed to this debate and to this resulting legislation in the 
last 3 years.''
  They say, ``As one whose companion organization, the Patient Advocate 
Foundation, served over 6,000 patients last year who confronted 
insurance denials, of which more than 50 percent involved employer 
plans, our cases reflect an urgent need for a timely resolution and 
remedy for ERISA enrollees.''
  Then we have an endorsement from the Patient Access Coalition. This 
includes a lot of groups. I cannot name all 128 of the groups under 
this umbrella organization, but I want to just go through some of them, 
because this organization encompasses a lot of patient advocacy groups, 
groups that work for patients, for instance, that have multiple 
sclerosis or arthritis.
  Some of these organizations are the Digestive Disease National 
Coalition, the Epilepsy Foundation. Remember, these organizations which 
I am reading are endorsing organizations for H.R. 2723.
  There is the Guillain-Barre Foundation, the Huntington's Disease 
Society of America, the Infectious Disease Society of America, the 
Lupus Foundation, the National Committee to Preserve Social Security 
and Medicare, the National Hemophilia Foundation, the National Multiple 
Sclerosis Society, the National Psoriasis Foundation, the Paget 
Foundation for Paget's Disease, the Pain Care Coalition, the Patient 
Advocates for Skin Disease Research, Scoliosis Research Society, the 
Society for Excellence in Eye Care, United Ostomy Association. The 
American Heart Association is an endorsing organization. The American 
Liver Association is, the American Lung Association. These are all 
organizations that have endorsed the bipartisan Managed Care Reform 
Act.
  Continuing, there is the Amputee Coalition of America, the Arthritis 
Foundation, the Asthma and Allergy Foundation, the Cooley's Anemia 
Foundation, the Crohn's and Colitis Foundation, the American Diabetes 
Association.

                              {time}  2130

  These are just a few of the 128 organizations in this one umbrella 
organization that has endorsed the Bipartisan Consensus Managed Care 
Reform Bill.
  Why are these patient advocacy groups endorsing this bill? One of the 
main things that they are interested

[[Page H7970]]

 in, the American Cancer Society, the American Heart Association, the 
American Lung Association, the American Liver Association is because 
there is a provision in this bill that says, if a patient is getting 
standard treatment, and it is not working, the patient is out of luck, 
that that patient should be able to qualify for an experimental study; 
that the HMO would not incur the cost of the special treatment in that 
study, but that the HMO should be liable for standard care.
  I am going to give my colleagues a personal example. Over the August 
recess, my father was in the hospital for 3 weeks with congestive heart 
failure. He had to receive intravenous medication in order to keep his 
heart pumping strong enough so that his kidneys would work. He could 
not get out of the hospital. Well, an HMO could have said, ``Well, his 
time is up. We are not going to authorize any payments for any 
treatment related to a clinical trial.''
  Fortunately, my dad is not in an HMO like most Americans are, so he 
was able to qualify for an experimental study in which a special type 
of cardiac pace maker was inserted into both sides of his heart which, 
when it was turned on, gave his heart enough boost so that, within 
about 24 hours, he made a remarkable recovery; and he is now out of the 
hospital, and he is walking in the malls.
  A lot of HMOs would say, ``Well, that is experimental treatment. We 
are not going to even cover the cost of the hospital room.'' But our 
bill says that, if a patient has no other options, then the HMO has to 
pick up routine costs, not the costs of the device or the medicine, but 
the ancillary things like the cost of the hospitalization or the cost 
of the blood work. That is fair and reasonable. But HMOs, they look at 
the bottom line.
  I had a pediatrician once who worked just outside of Washington come 
into my office. She is now working in the National Institutes of 
Health. She had managed a pediatric intensive care unit.
  I said, ``Why did you decide to go back into academic medicine?'' She 
said, ``I just could not put up with the HMO bureaucracies anymore. Let 
me give you an example. A few years ago, we had a little boy come into 
our intensive care unit. He had drowned. He was still alive, but he was 
a victim of drowning. We had him on the ventilator. We had the IVs 
running. We were giving him special medication. And the doctors and the 
parents and the family were standing around the bed praying for signs 
of life. He had only been in the hospital like 4 hours, and the phone 
rings in the ICU, and it is some bureaucrat in an HMO saying, `Well, 
how is this little boy doing?' `Well, he is on the ventilator. Chances, 
you know, are he is not going to do too good.' Well, the answer came 
over the telephone, `If he is on the ventilator and his prognosis is 
poor, why do you not just send him home on a ventilator?' ''
  Now think about that for a minute. One is a mom and dad, and one's 
little boy is drowned. He is now in the hospital. He has been there a 
few hours. People are fighting to save his life, and an HMO bureaucrat 
is saying, well, his prognosis is not good just send him home. Our bill 
would prevent that type of abuse.
  Here we have another letter of endorsement from the Paralysis Society 
of America. They represent 20,000 people with spinal cord injury and 
disease. This letter says, ``Particular attention is given to those 
portions of the legislation covering freedom of choice, specialists, 
and clinical trials.'' Very important issue for them.
  Here I have a letter of endorsement from the American Cancer Society, 
and it is a good letter. I would like to read all of it for my 
colleagues, but I do not have the time. ``On behalf of the American 
Cancer Society and its 2 million volunteers, 2 million volunteers, I 
commend you for sponsoring H.R. 2723, the Bipartisan Consensus Managed 
Care Improvement Act of 1999. More than 140 million insured Americans 
are in some kind of managed care. This includes many of the 
approximately 1.23 million people diagnosed with cancer each year. In 
addition, the National Cancer Institute estimates that 8 million 
Americans today have a history of cancer. Your legislation adequately 
addresses our concerns in a way that will help individuals affected or 
potentially affected by cancer be assured access to the care that they 
need.'' That is their endorsement.
  Here I have an endorsement from the National Association of Mental 
Illness. ``On behalf of the 208,000 members and 1,200 affiliates for 
the National Alliance of the Mentally Ill, I am writing to express our 
support for your legislation, the Bipartisan Consensus Managed Care 
Improvement Act.'' ``This protection,'' this letter says, ``is 
critically important for people with serious brain disorders such as 
schizophrenia and manic-depressive illness who depend on newer 
medications as their best hope for recovery.''
  Here I have a letter of endorsement from the American Federation of 
Teachers. This is from Charlotte Fraas, Director of Federal 
Legislation. ``I am writing on behalf of over 1 million members of the 
American Federation of Teachers to urge you to support H.R. 2723, the 
Bipartisan Consensus Managed Care Empowerment Act of 1999. The AFT is 
proud to represent over 53,000 health care professionals who know such 
protections for patient advocacy are essential for quality health 
care.''
  I have a letter of endorsement from the Service Employees 
International Union. ``On behalf of the 1.3 million members of Service 
Employees International Union, I am writing in support of the 
Bipartisan Consensus Managed Care Improvement Act of 1999, H.R. 2723.
  ``As a union representing over 600,000 frontline health care workers, 
we know how important it is to protect health care workers who speak 
out against patient care deficiencies. Employers should be prohibited 
from firing or retaliating against such workers if we are going to 
encourage health professionals to report patient care problems.''
  I mean, do my colleagues want their nurse or their health care 
professional gagged? This bill will help prevent that.
  Here I have a letter of endorsement from the American Federation of 
State, County and Municipal Employees, AFSCME. ``On behalf of the 1.3 
million members'' we thank you for your leadership on the Bipartisan 
Consensus Managed Care Improvement Act. They are endorsing this bill.
  I have a letter here of endorsement from the Center from Patient 
Advocacy. ``Since our founding in 1995, the Center for Patient Advocacy 
has been a leading supporter of strong enforceable managed care reform 
legislation. Every day we work with patients across the country who 
have experienced problems with managed care. We know firsthand the 
barriers to care that patients face, including limits on access to and 
coverage for specialty care, emergency room care, arbitrary medical 
decisions based on cost rather than a patient's specific medical need 
and the lack of a timely independent and fair appeals process. Most 
alarming, however, is that managed care plans, not patients and their 
doctors, continue to make medical decisions without being held 
accountable for their decisions that harm patients.''
  I have here a letter of endorsement from the Friends Committee on 
National Legislation. This is a Quaker lobby in the public interest. 
This letter from Florence Kimball says, ``I am writing on behalf of the 
Friends Committee on National Legislation to express our strong support 
for the Bipartisan Consensus Managed Care Improvement Act of 1999.
  ``The Friends Committee on National Legislation supports a health 
care system whose primary goal is improving health in the population. 
In recent years, managed care has taken over as a dominant health care 
delivery system. Managed care organizations are under strong pressure 
to keep costs down. They operate on a for-profit basis. We are 
sensitive to the economic issues in health care, but we believe that 
reform and regulation are necessary in order to ensure that managed 
care organizations hold the interests of patients as their prime 
focus.'' I would add to that not, necessarily the bottom line.
  I have here a letter of endorsement from the United Church of Christ. 
This is a letter to the gentleman from Georgia (Mr. Norwood). ``I am 
writing to thank you for your leadership in sponsoring the Bipartisan 
Consensus Managed Care Improvement Act of 1999.
  ``The United Church of Christ, Office for Church in Society, endorses 
the bill

[[Page H7971]]

as written.'' This is important, and I appreciate Dr. Pat Conover's 
letter here from the United Church of Christ. He says that, ``In the 
event that the bill is weakened, or if `poison pill' amendments are 
added, such as Medical Savings Accounts, it is likely that we would 
then oppose the bill.''
  This speaks to the fact that we need to pass a clean patient 
protection bill, not something that has untried ideas such as 
Healthmarts or association health plan extensions of Federal law that 
would enable more people to escape quality oversight by their State 
insurance commissioners.
  I think that we could add, for instance, a provision to this bill 
that would improve the tax status for purchasing one's insurance. I 
think we could get bipartisan support for that. But if we start adding 
a lot of extraneous items, then I think we weaken the bill.
  I have here a letter of endorsement from Network. This is a National 
Catholic Social Justice lobby. It is a letter to the gentleman from 
Georgia (Mr. Norwood). ``A National Catholic Social Justice Lobby 
supports the Bipartisan Consensus Managed Care Improvement Act of 1999 
(H.R. 2723). Having participated in the lobbying for patient 
protections over the past 2 years, Network applauds your efforts and 
those of Representative Dingell'' and myself ``and the cadre of 
Republican physicians in facing down the serious opposition from the 
House GOP leadership. You have stood firm against this and other 
daunting forces mobilized against you. We commend you for your 
efforts.''
  Network affirms the Catholic social teaching and the UN Declaration 
of Human Rights that health care is a basic right. We support H.R. 
2723, and we wish you luck.
  I have here a letter of endorsement from the National Partnership for 
Women and Families. This is from the letter: ``For women and families, 
few issues resonate as profoundly and pervasively as the need for 
quality health care. Survey after survey shows Americans' growing 
dissatisfaction with the current health care system. Many feel the 
system is in crisis. We need common-sense patient protections to 
restore consumer confidence and tip the balance back in favor of 
patients and the health care providers they rely on.''
  That is an endorsement by the National Partnership, and I want to 
build on that statement. None of us who are sponsoring this 
organization want to see the demise of HMOs. Some HMOs are providing 
good care for their families. I think people ought to have a choice. It 
may be that an HMO is a good choice for that family. But because of 
this past Federal law that was past 25 years ago, really for pensions 
but then expanded into health plans, we have a situation where the 
regulatory oversight was taken away from the States, and nothing was 
put in its place at the Federal level. This has enabled a few bad 
actors to do some truly horrible things to their patients like the 
decision that cost little Jimmy Adams his hands and his feet, for 
instance.
  So I think that, actually, contrary to what the HMO lobby says about 
this legislation, I see this legislation as improving patients' 
choices. People will feel more comfortable with a managed care company 
knowing that there are some guidelines that apply to it and that that 
managed care company cannot just arbitrarily deny them the kind of care 
that they deserve.
  I have here a letter of endorsement from the National Association of 
School Psychologists. ``The National Association of School 
Psychologists is an organization that represents 21,500 psychologists. 
If H.R. 2327 is passed, this provision will have an important positive 
impact on health care provided to adults with severe mental health 
illness, children with serious emotional disturbances, and other people 
with significant mental disorders who are increasingly being served in 
managed care settings.''
  Here is a letter of endorsement from the organization Alliance for 
Children and Families. The Alliance and International Nonprofit 
Association representing child and family serving organizations 
supports this important legislation. Alliance members serve more than 5 
million individual each year in more than 2,000 communities. We support 
your bill because it includes needed patient protections, strong 
reforms in managed care, and due process protections.

                              {time}  2145

  I have here a letter of endorsement from an organization called 
Patients Who Care. This letter says: ``We support the Bipartisan 
Consensus Managed Care Improvement Act of 1999. We strongly feel it 
ensures fairness and accountability. These qualities have been lacking 
in what the House and Senate have passed in previous legislation.''
  I have here a letter of endorsement from Families USA, the Voice for 
Health Care Consumers: ``Dear Congressman Norwood: Congratulations on 
the introduction of the Bipartisan Consensus Managed Care Improvement 
Act. We are well aware of the efforts you and others have made to make 
this bill a reality. As you know, the American public is losing faith 
in our health care delivery system. Managed care companies that began 
with a promise of providing high quality care at an affordable price 
are not always delivering on that promise. Unfortunately, this has 
resulted in consumers being worried that they will not get the care 
they need even though they are covered with health insurance.''
  And I would add to this letter that everyone here, either through 
deductions in their salary or just out-of-pocket, is paying a lot of 
money to those HMOs. Now, that is fine as long as we and our family 
members stay healthy. But what happens if we become sick? We may have 
an experience like Helen Hunt did in the movie ``As Good As It Gets'', 
where she describes to a physician the abysmal care an HMO has given to 
her son with asthma. I cannot repeat on the floor the words she used, 
but those who have seen the movie can remember that line very well 
because it got a standing ovation from most of the audience.
  I have here a letter from the National Black Women's Health Project: 
``We are strong supporters of your legislation. It offers significant 
protections for all Americans. Of great import is the improvement of 
patient access to medical treatment and therapies, including clinical 
trials, and this is highly significant for women of color.''
  I have here an endorsement of our bill from the American Association 
of University Women. They say in this letter: ``H.R. 2723 is 
particularly important to women because it ensures that women have 
direct access to OB-GYN services. It ensures that pregnant women can 
continue to see the same health care provider throughout their 
pregnancy if their provider leaves the plan. It ensures access to 
specialists when appropriate, specialists outside a network's plan. It 
ensures access to clinical trials for new treatment options that may 
save women's lives.''
  I have here a letter of endorsement from the National Breast Cancer 
Coalition: ``On behalf of the National Breast Cancer Coalition and the 
2.6 million women living with breast cancer, I am writing to thank you 
for your leadership in offering H.R. 2723, the Bipartisan Consensus 
Managed Care Improvement Act of 1999.'' This was sent to the gentleman 
from Georgia (Mr. Norwood) and the gentleman from Michigan (Mr. 
Dingell). ``The National Breast Cancer Coalition is a grass roots 
advocacy organization made up of more than 500 member organizations and 
60,000 individual members dedicated to the eradication of breast cancer 
through advocacy and action. One of our top concerns has been access to 
clinical trials, and your bill has that in it.''
  I have here a letter of endorsement from the American Lung 
Association: ``Health consumers deserve quality health insurance. Far 
too often we hear of cases where health insurers have obstructed or 
denied insured patients the care they need. Your legislation will help 
end many of the abuses.''
  Well, Mr. Speaker, I have gone through just some of the letters of 
endorsement that I have received and others have received in endorsing 
H.R. 2723, the bipartisan patient protection legislation. But the hour 
is getting late. We have another speaker who has come to do a special 
order, so I will just close with this comment to my colleagues on both 
sides of the aisle.
  It is now September. The Speaker of the House, the gentleman from 
Illinois

[[Page H7972]]

(Mr. Hastert), indicated back in July that we would see a full and fair 
debate on this floor in July. It did not happen. We have had our August 
recess. The Speaker has said now that he expects we will see a full 
managed care debate on this floor in September. Those are the words of 
the Speaker of the House. I think we should hold the Speaker to his 
promise.
  This is an important issue. There are lots of patients out there at 
this very moment that may not be getting the type of treatment that 
they need to save their lives because we have not passed this 
legislation. Mr. Speaker, I call on my colleagues on both sides of the 
aisle to support a bipartisan bill that can be signed into law; that 
can go a long ways towards correcting the abuses we hear about from our 
constituents.
  Mr. Speaker, I include for the Record the letters and other documents 
I referred to earlier.

   Groups Endorsing H.R. 2723, the Bipartisan Consensus Managed Care 
                        Improvement Act of 1999

         1. Alexandria Graham Bell Association for The Deaf, Inc.
        2. Allergy and Asthma Network-Mothers of Asthmatics, Inc.
        3. Alliance for Children & Families
        4. American Academy of Allergy and Immunology
        5. American Academy of Child & Adolescent Psychiatry
        6. American Academy of Facial Plastic and Reconstructive 
     Surgery
        7. American Academy of Family Physicians
        8. American Academy of Neurology
        9. American Academy of Ophthalmology
       10. American Academy of Otolaryngology-Head and Neck 
     Surgery
       11. American Academy of Pain Medicine
       12. American Academy of Pediatrics
       13. American Academy of Physical Medicine & Rehabilitation
       14. American Association for Hand Surgery
       15. American Association for Holistic Health
       16. American Association for Marriage and Family Therapy
       17. American Association for the Study of Headache
       18. American Association of Clinical Endocrinologists
       19. American Association of Clinical Urologists
       20. American Association of Hip and Knee Surgeons
       21. American Association of Neurological Surgeons
       22. American Association of Oral and Maxillofacial Surgeons
       23. American Association of Orthopaedic Foot and Ankle 
     Surgeons
       24. American Association of Orthopaedic Surgeons
       25. American Association of Private Practice Psychiatrists
       26. American Association of University Women
       27. American Cancer Society
       28. American College of Allergy and Immunology
       29. American College of Cardiology
       30. American College of Foot and Ankle Surgeons
       31. American College of Gastroenterology
       32. American College of Nuclear Physicians
       33. American College of Obstetricians and Gynecologists
       34. American College of Osteopathic Surgeons
       35. American College of Physicians-American Society of 
     Internal Medicine
       36. American College of Radiation Oncology
       37. American College of Radiology
       38. American College of Rheumatology
       39. American College of Surgeons
       40. American Counseling Association
       41. American Dental Association
       42. American Diabetes Association
       43. American EEG Society
       44. American Federation of Teachers
       45. American Federation State, County, and Municipal 
     Employees
       46. American Gastroentrological Association
       47. American Heart Association
       48. American Liver Foundation
       49. American Lung Association
       50. American Medical Association
       51. American Medical Rehabilitation Providers Association
       52. American Nurses Association
       53. American Occupational Therapy Association
       54. American Orthopaedic Society for Sports Medicine
       55. American Osteopathic Academy of Orthopedics
       56. American Osteopathic Association
       57. American Osteopathic Surgeons
       58. American Pain Society
       59. American Physical Therapy Association
       60. American Podiatric Medical Association
       61. American Psychiatric Association
       62. American Psychological Association
       63. American Public Health Association
       64. American Society for Dermatologic Surgery
       65. American Society for Gastrointestinal Endoscopy
       66. American Society for Surgery of the Hand
       67. American Society for Therapeutic Radiology and Oncology
       68. American Society of Anesthesiology
       69. American Society of Cataract and Refractive Surgery
       70. American Society of Dermatology
       71. American Society of Dermatophathology
       72. American Society of Echocardiography
       73. American Society of Foot and Ankle Surgery
       74. American Society of General Surgeons
       75. American Society of Hand Therapists
       76. American Society of Hemotology
       77. American Society of Nephrology
       78. American Society of Nuclear Cardiology
       79. American Society of Pediatric Nephrology
       80. American Society of Plastic and Reconstructive 
     Surgeons, Inc.
       81. American Society of Transplant Surgeons
       82. American Society of Transplantation
       83. American Thoracic Society
       84. American Urological Association
       85. Amputee Coalition of America
       86. Arthritis Foundation
       87. Arthroscopy Association of North America
       88. Association of American Cancer Institutes
       89. Association of Freestanding Radiation Oncology Centers
       90. Association of Subspecialty Professors
       91. Asthma & Allergy Foundation of America
       92. California Access to Specialty Care Coalition
       93. California Congress of Dermatological Societies
       94. Center for Patient Advocacy
       95. Congress of Neurological Surgeons
       96. Cooley's Anemia Foundation
       97. Crohn's and Colitis Foundation of America
       98. Diagenetics
       99. Digestive Disease National Coalition
       100. Endocrine Society
       101. Epilepsy Foundation of America
       102. Eye Bank Association of America
       103. Families USA
       104. Federated Ambulatory Surgery Association
       105. Friends Committee on National Legislation
       106. Gullain-Barre Syndrome Foundation
       107. Huntington's Disease Society of America
       108. Infectious Disease Society of America
       109. Lupus Foundation of America, Inc.
       110. National Alliance for the Mentally Ill
       111. National Association for the Advancement of Orthotics 
     and Prosthetics
       112. National Association of Medical Directors of 
     Respiratory Care
       113. National Association of School Psychologists
       114. National Black Women's Health Project
       115. National Breast Cancer Coalition
       116. National Catholic Social Justice Lobby
       117. National Committee to Preserve Social Security and 
     Medicare
       118. National Foundation for Ectodermal Dysplasias
       119. National Hemophilia Foundation
       120. National Multiple Sclerosis Society
       121. National Organization of Physicians Who Care
       122. National Partnership for Women & Families
       123. National Patient Advocate Foundation
       124. National Psoriasis Foundation
       125. National Rehabilitation Hospital
       126. North American Society of Pacing and Electrophysiology
       127. Opticians Association of America
       128. Oregon Dermatology Society
       129. Orthopaedic Trauma Association
       130. Outpatient Ophthalmic Surgery Society
       131. Paget Foundation for Paget's Disease of Bone and 
     Related Disorders
       132. Pain Care Coalition
       133. Paralysis Society of America
       134. Patient Access Coalition (represents 129 of the groups 
     on this list)
       135. Patient Advocates for Skin Disease Research
       136. Patients Who Care
       137. Pediatric Orthopaedic Society of North America
       138. Pediatrix Medical Group: Neonatology and Pediatric 
     Intensive Care Specialist
       139. Physicians for Reproductive Choice and Health
       140. Physicians Who Care
       141. Pituitary Tumor Network
       142. Renal Physicians Association
       143. Scoliosis Research Society
       144. Service Employees International Union
       145. Sjogren's Syndrome Foundation Inc.
       146. Society for Cardiac Angiography and Interventions
       147. Society for Excellence in Eyecare
       148. Society for Vascular Surgery
       149. Society of Cardiovascular & Interventional Radiology
       150. Society of Critical Care Medicine
       151. Society of Gynecologic Oncologists
       152. Society of Nuclear Medicine
       153. Society of Thoracic Surgeons
       154. TMJ Associations, Ltd.
       155. United Church of Christ
       156. United Ostomy Association
                                  ____


            Membership List of the Patient Access Coalition

       Allergy and Asthma Network--Mothers of Asthmatics, Inc.

[[Page H7973]]

       The Alexandria Graham Bell Association for the Deaf, Inc.
       American Academy of Allergy and Immunology
       American Academy of Child & Adolescent Psychiatry
       American Academy of Dermatology
       American Academy of Facial Plastic and Reconstructive 
     Surgery
       American Academy of Neurology
       American Academy of Ophthalmology
       American Academy of Orthopaedic Surgeons
       American Academy of Otolaryngology--Head and Neck Surgery
       American Academy of Pain Medicine
       American Academy of Physical Medicine & Rehabilitation
       American Association for Hand Surgery
       American Association for Holistic Health
       American Association for the Study of Headache
       American Association of Clinical Endocrinologists
       American Association of Clinical Urologists
       American Association of Hip and Knee Surgeons
       American Association of Neurological Surgeons
       American Association of Oral and Maxilofacial Surgeons
       American Association of Orthopaedic Foot and Ankle Surgeons
       American Association of Private Practice Psychiatrists
       American College of Allergy and Immunology
       American College of Cardiology
       American College of Foot and Ankle Surgeons
       American College of Gastroenterology
       American College of Nuclear Physicians
       American College of Osteopathic Surgeons
       American College of Radiation Oncology
       American College of Radiology
       American College of Rheumatology
       American Dental Association
       American Diabetes Association
       American EEG Society
       American Gastroentrological Association
       American Heart Association
       American Liver Foundation
       American Lung Association
       American Medical Rehabilitation Providers Association
       American Orthopaedic Society for Sports Medicine
       American Osteopathic Academy of Orthopedics
       American Osteopathic Surgeons
       American Pain Society
       American Physical Therapy Association
       American Podiatric Medical Association
       American Psychiatric Association
       American Psychological Association
       American Sleep Disorders Association
       American Society for Dermatologic Surgery
       The American Society of Dermatophathology
       American Society for Gastrointestinal Endoscopy
       American Society for Surgery of the Hand
       American Society for Therapeutic Radiology and Oncology
       American Society of Anesthesiology
       American Society of Cataract and Refractive Surgery
       American Society of Clinical Pathologists
       American Society of Colon Rectal Surgery
       American Society of Dermatology
       American Society of Echocardiography
       American Society of Foot and Ankle Surgery
       American Society of General Surgeons
       American Society of Hand Therapists
       American Society of Hemotology
       American Society of Nephrology
       American Society of Pediatric Nephrology
       American Society of Plastic and Reconstructive Surgeons, 
     Inc.
       American Society of Transplantation
       American Society of Transplant Surgeons
       American Thoracic Society
       American Urological Association
       Amputee Coalition of America
       Arthritis Foundation
       Arthroscopy Association of North America
       Association of American Cancer Institutes
       Association of Freestanding Radiation Oncology Centers
       Association of Subspecialty Professors
       Asthma & Allergy Foundation of America
       California Access to Specialty Care Coalition
       California Congress of Dermatological Societies
       College of American Pathologists
       Congress of Neurological Surgeons
       Cooley's Anemia Foundation
       Crohn's and Colitis Foundation of America
       Cystic Fibrosis Foundation
       Diagenetics
       Digestive Disease National Coalition
       The Endocrine Society
       Epilepsy Foundation of America
       Eye Bank Association of America
       Federated Ambulatory Surgery Association
       Gullain-Barre Syndrome Foundation
       Huntington's Disease Society of America
       Infectious Disease Society of America
       Joint Council of Allergy, Asthma and Immunology
       Lupus Foundation of America, Inc.
       National Association for the Advancement of Orthotics and 
     Prosthetics
       National Association of Epilepsy Centers
       National Association of Medical Directors of Respiratory 
     Care
       National Committee to Preserve Social Security and Medicare
       National Foundation for Ectodermal Dysplasias
       National Hemophilia Foundation
       National Multiple Sclerosis Society
       National Organization of Physicians Who Care
       National Osteoporosis Foundation
       National Psoriasis Foundation
       National Rehabilitation Hospital
       National Right to Life Committee
       North American Society of Pacing and Electrophysiology
       Oregon Dermatology Society
       Orthopaedic Trauma Association
       Outpatient Ophthalmic Surgery Society
       The Paget Foundation for Paget's Disease of Bone and 
     Related Disorders
       Pain Care Coalition
       Patient Advocates for Skin Disease Research
       Pediatric Orthopaedic Society of North America
       Pediatrix Medical Group: Neonatology and Pediatric 
     Intensive Care Specialist
       Pituitary Tumor Network
       Renal Physicians Association
       Scoliosis Research Society
       Sjogren's Syndrome Foundation Inc.
       The Society for Cardiac Angiography and Interventions
       Society for Excellence in Eyecare
       Society for Vascular Surgery
       Society of Cardiovascular & Interventional Radiology
       Society of Critical Care Medicine
       Society of Gynecologic Oncologists
       Society of Nuclear Medicine
       Society of Surgical Oncology
       Society of Thoracic Surgeons
       The TMJ Associations, Ltd.
       United Ostomy Association
                                  ____


               ANA Endorses Bipartisan Managed Care Bill


ANA Encourages Congress to Continue Working Together & Pass Bipartisan 
                                  Bill

       Washington, DC.--The American Nurses Association (ANA) 
     today applauded the introduction of a bipartisan consensus 
     bill that would reform managed care. The bill, H.R. 2723, 
     ``The Bipartisan Consensus Patient Protection Bill of 1999,'' 
     was introduced on August 8, 1999, by Rep. Charlie Norwood (R-
     GA). Rep. John Dingell (D-MI) is the lead co-sponsor.
       ``The American Nurses Association is pleased to endorse 
     this bill and encouraged by the cooperation and compromises 
     made to achieve real progress on managed care reform,'' said 
     ANA President Beverly L. Malone, PhD, RN, FAAN. ``It is 
     heartening to see Congress working together to solve 
     problems--this is how Congress should be working.''
       ANA has been a strong supporter of managed care reform 
     legislation and believes every individual should have access 
     to health care services along the full continuum of care and 
     be an empowered partner in making health care decisions. 
     Given the nursing profession's preeminent role in patient 
     advocacy, ANA is particularly heartened by the steps proposed 
     to protect registered nurses (RNs) and other health care 
     professionals from retaliation when they advocate for their 
     patients' health and safety.
       ``As the nation's foremost patient advocates, RNs need to 
     be able to speak up about inappropriate or inadequate care 
     that would harm their patients,'' said Malone. ``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.''
                                  ____



                                 American Medical Association,

                                     Chicago, IL, August 30, 1999.
     Hon. Charlie Norwood,
     House of Representatives,
     Washington, DC.
       Dear Congressman Norwood: The 300,000 physician and student 
     members of the American Medical Association (AMA) strongly 
     urge the House of Representatives to begin debate on and pass 
     meaningful patient protection legislation.
       The AMA has endorsed H.R. 2723, the ``Bipartisan Consensus 
     Managed Care Improvement Act of 1999,'' introduced by 
     Representatives Charles Norwood and John Dingell, which would 
     guarantee meaningful protections to all patients and enjoys 
     broad bipartisan support. The AMA also continues to work with 
     Representatives Tom Coburn and John Shadegg, who are in the 
     process of drafting patient protection legislation. Whichever 
     bill becomes the vehicle for reform, it must include the 
     following key provisions, embodied in H.R. 2723, that ensure 
     genuine patient protections.
     External Appeals
       All patients must be guaranteed access to an external 
     appeals process whenever a denial of benefits involves 
     medical judgment or concerns medical necessity. All patients 
     deserve access to an independent external review entity if 
     they have been improperly denied a covered medical benefit. 
     External reviewers must also be independent from the health 
     plan or issuer. For the external appeals system to work in a 
     fair and unbiased manner, external reviewers must not have a 
     conflict of interest with the plan or issuer. In addition, 
     treatment decisions or recommendations made by physicians 
     must be reviewed only by actively practicing physicians (MDs/
     DOs) of the same or similar specialty. External reviewers 
     must be properly qualified to ensure a meaningful external 
     review process.
       External reviews must be conducted on a timely basis, not 
     to exceed specified time periods, with shorter periods 
     applicable under

[[Page H7974]]

     exigent circumstances. Plans and issuers cannot be permitted 
     to intentionally delay an appeals process--or ``slow-walk'' 
     enrollees who are seeking benefits to which they are 
     entitled. The external reviewers' decisions must also be 
     binding on the plans and issuers. Unless external review 
     entities' decisions are binding, any right to an external 
     review would be worthless for the patient.
     Medical Necessity
       Truly independent external reviewers must decide ``medical 
     necessity'' according to generally accepted standards of 
     medical practice. External appeal entities, when making 
     ``medical necessity'' determinations, should not be bound by 
     arbitrary health plan definitions. In addition, ``medical 
     necessity'' determinations and other decisions involving 
     medical judgment must be made by physicians (MDs/DOs) who are 
     independent from the plans and issuers.
     Accountability
       All patients, even those covered by ERISA plans, should 
     have the right to seek legal recourse against managed care 
     plans when the plan's negligent medical decisions result in 
     death or injury. Health plans must be held accountable for 
     their decisions. Employers who do not make medical treatment 
     decisions should not be held liable.
     Point Of Service
       All patients must have the opportunity to choose, at their 
     own expense, an option that allows them to seek care from 
     outside the network of health care professionals chosen by 
     their employers. If an employer selects a small, closed-panel 
     HMO for its employees, the employees should be able to obtain 
     medical treatment from a physician outside the panel and bear 
     any additional costs.
     Emergency Services
       A ``prudent layperson standard'' must be the basis for 
     determining when emergency medical services are appropriate 
     and require coverage by a plan. Establishing this as a 
     standard is not only fair, but essential for protecting 
     patients. For instance, a patient who is suffering severe 
     chest pain and honestly believes he or she is having a heart 
     attack should be able to go to the nearest emergency room and 
     be covered for treatment received.
     Prohibition On Gag Clauses
       Health plans and insurance issuers must be prohibited from 
     including gag clauses within their contracts with physicians. 
     Gag clauses seek to prevent physicians from discussing with 
     their patients plan or treatment options or disclosing 
     financial incentives that may affect the patient's treatment. 
     These clauses strike at the heart of the patient-physician 
     relationship and can create real conflicts between patients 
     and their physicians.
     Information Disclosure
       Group health plans and health insurance issuers must be 
     required to provide enrollees with important and basic 
     information about their medical coverage. Plans and issuers 
     should identify the benefits offered--including covered 
     benefits, benefit limits, coverage exclusions, prior 
     authorization rules, appeals procedures, and other basic 
     information. Patients deserve to know exactly what they are 
     paying for.
       In conclusion, the AMA appreciates the bipartisan efforts 
     by House members to introduce legislation that would promote 
     fairness in managed care. We urge you to support legislation 
     containing these essential protections for all patients and 
     to request prompt floor action on managed care reform 
     legislation in September.
           Respectfully,
     E. Ratcliffe Anderson, Jr., MD.
                                  ____

                                               American Academy of


                                            Family Physicians,

                                   Kansas City, MO, Sept. 7, 1999.

                        Health Care Steps Taken


                     patient care remains priority

       Washington, D.C.--The 88,000-member American Academy of 
     Family Physicians (AAFP) today announced its support for two 
     major managed care reform bills that are likely to be 
     considered by the U.S. House of Representatives this fall: 
     H.R. 2723, The Bipartisan Consensus Managed Care Improvement 
     Act of 1999, introduced by Representatives Charles Norwood 
     (R-GA) and John D. Dingell (D-MI); and for Health Care 
     Quality and Choice Act of 1999, to be introduced by 
     Representatives Tom Coburn (R-OK) and John Shadegg (R-AZ) 
     when Congress reconvenes in September.
       ``Both bills go a long way to address the patient 
     protections that are needed in today's health care system,'' 
     said Lanny R. Copeland, M.D., president of the AAFP. ``We are 
     very appreciative of the work of the authors of these two 
     bills and of their willingness to listen to our concerns.''
       Both bills contain provisions that will allow patients to 
     get the best healthcare and physicians to provide it:
       All plans: Patient protections apply to all health plans, 
     not just ERISA plans.
       Gag clauses: Both bills would prohibit contract provisions 
     between physicians and health plans that restrict or prevent 
     medical communication between physicians and their patients.
       Patient advocacy: Both bills contain some protections for 
     physicians who advocate on behalf of a patient within a 
     health plan or before an external review panel.
       External review: Both bills would establish external review 
     mechanisms independent of health plans.
       Medical necessity: Such external review processes would not 
     be bound by the health plans' definition of medical 
     necessity.
       Liability: Both bills permit patients to sue in state 
     court.
       Women's health care: The Coburn/Shadegg legislation would 
     include family physicians among those designated as qualified 
     women's health providers. H.R. 2723 would not preclude 
     patients from going to family physicians for their women's 
     health needs.
       Children's health care: The Coburn/Shadegg legislation 
     includes family physicians among those designated as 
     qualified primary care physicians for children H.R. 2723 
     would not preclude patients from going to family physicians 
     for their children's health needs.
       ``These legislators are being responsive to patients and to 
     the public good,'' said Copeland. ``We urge the House of 
     Representatives to expeditiously pass legislation reflecting 
     these principles.''
                                  ____



                                     Patient Access Coalition,

                                    Bethesda, MD, August 16, 1999.
     Hon. Greg Ganske,
     U.S. House of Representatives, Washington, DC.
       Dear Rep. Ganske: On behalf of the 130 patient advocacy and 
     provider organizations that comprise the Patient Access 
     Coalition, we deeply appreciate and acknowledge your 
     demonstrated commitment to moving strong and meaningful 
     patient protection legislation to the House floor for 
     consideration this year. Your support of this issue has 
     unquestionably sparked a new level of dedication and 
     enthusiasm amongst your colleagues for making patient 
     protections a top legislative priority when the House 
     reconvenes in September.
       Because the health of millions of Americans is dependent 
     upon the care provided by managed care plans, the issue of 
     patient protections is one of national importance and 
     urgency. It is clear that the only way to achieve passage of 
     strong patient protection legislation this year is with the 
     bipartisan support of Congress, and we are pleased that you 
     are working toward that end.
       The Patient Access Coalition has been working tirelessly 
     for the past six years, in a bipartisan manner, to guarantee 
     basic federal protections for all patients who are enrolled 
     in managed health care plans. We believe there is now a very 
     strong consensus in the country and in Congress to do so, and 
     our commitment to reach that goal remains stronger than ever.
       We look forward to working with you and other members of 
     Congress to ensure that meaningful patient protection 
     legislation is enacted into law this year.
           Sincerely,
     Nancey McCann,
       Co-Chair.
     Camille S. Sorosiak,
       Co-Chair.
                                  ____

                                      NETWORK, A National Catholic


                                         Social Justice Lobby,

                                                   Washington, DC.
     Hon. Charles Norwood,
     House of Representatives, Washington, DC.
       Dear Representative Norwood: NETWORK, A National Catholic 
     Social Justice Lobby supports the Bipartisan Consensus 
     Managed Care Improvement Act of 1999 (HR 2723). Having 
     participated in the lobbying for patient protections over the 
     past two years, NETWORK applauds your efforts and those of 
     Reps. Dingell (D-MI), Ganske (R-IA), and the cadre of 
     Republican physicians in facing down the serious opposition 
     from the House GOP Leadership. You have stood firm against 
     this and the other daunting forces mobilized against you. We 
     also commend those who bolstered your efforts.
       NETWORK will lobby in support of HR 2723, hoping that the 
     bill will be strengthened in the process. Our membership 
     nationally has already been alerted. But we wish to stress, 
     Representative Norwood, that NETWORK believes that the long 
     journey toward HR 2723, and hopefully its passge, further 
     underscores the need for a national dialogue on health care.
       The prolonged debate which began with the President's 
     Commission on Patients' Protections, the subsequent 
     introduction of patients' protection legislation and the 
     militancy and funding of those who championed opposition to 
     strong protections are proof positive of the dangers we face 
     as a nation in the commercialization of health care.
       When HMO's/insurance companies and pharmaceuticals begin to 
     shift priorities from the rights of the patient to the 
     success of the stockholder, we have entered a dangerous zone 
     in human rights. The situation calls for a national ethical 
     moral debate on what constitutes an authentic health care 
     system.
       NETWORK affirms the tenet of Catholic social teaching and 
     the U.N. Declaration of Human Rights that health care is a 
     basic human right and that the government has an obligation 
     to protect that right out of responsibility for the common 
     good. Consequently, we have supported past initiatives to 
     protect that right through legislation which would provide 
     for all citizens access to affordable quality health care.
       That those initiatives have failed is a travesty of 
     justice, leaving us the only industrialized nation in the 
     world without a guarantee of health care for all its 
     citizens.
       Sadly, at this point, the nation's non-system is hopelessly 
     fragmented while the number of uninsured grows daily. As the 
     need for patients' protections indicates, even those 
     privately insured under a variety and complexity of health 
     care plans--the details of

[[Page H7975]]

     which often elude them--are not guaranteed necessary, timely 
     and quality health care.
       Therefore, as we support HR 2723, we urge you to use the 
     lessons of these two years as a launching pad toward 
     universal access to quality, affordable health care. 
     Universal access to affordable quality health care will be 
     for NETWORK and many of our allies a critical election issue.
           Sincerely,
     Kathy Thorton, RSM,
       National Coordinator.
     Catherine Pinkerton, CSJ,
       NETWORK Lobbyist.
                                  ____

                                                  National Patient


                                          Advocate Foundation,

                                Newport News, VA, August 19, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives, Washington, DC.
       Dear Representative Norwood: On behalf of our patient and 
     health care constituents, I write to commend your leadership 
     in bringing a Bipartisan Consensus Managed Care Improvement 
     Act of 1999 (H.R. 2723) to the United States House of 
     Representatives. Many members of the House of Representatives 
     have sought to support reform that would improve patient 
     access to care and patient autonomy in decision making with 
     their physicians during their medical experience while 
     assuring patients access to independent, external review and 
     offering plan accountability for decisions made. Each member 
     who has contributed to this debate has achieved success in 
     the form of the Bipartisan Consensus Managed Care Improvement 
     Act of 1999.
       The Bipartisan Consensus Managed Care Improvement Act of 
     1999 reflects an understanding that insurance should not 
     dictate or control health care of Americans rather it should 
     facilitate and finance health care for Americans. Our 
     organization strongly endorses H.R. 2723 citing specifically 
     the following advantages:
       The Bill is one of bipartisan consensus and it does reflect 
     the health care matters that have long been debated on both 
     sides of the aisle with resulting legislation that serves 
     patients and medical providers fairly and equitably while 
     supporting our managed care industry through the development 
     of a clearly defined set of critiera that health plans must 
     meet to conform to the federal law as defined in H.R. 2723.
       The Bill affords protections to all people with employment-
     based insurance (including state and local government 
     workers) and people who buy their insurance on their own 
     which we feel affords an equitable opportunity for regulation 
     and enforcement of industry standards for the majority of 
     insured Americans.
       The Bill establishes a uniform standard of accountability 
     for health plans who make coverage decisions which is 
     consistent with the level of accountability that exists for 
     every business and industry that provides service to 
     Americans and that becomes legally accountable for poor 
     business practices or judgements that cause harm to our 
     citizens. With 79 percent of our citizens in an ERISA plan 
     that currently offers few venues of remedy for those citizens 
     whose benefits are denied, the Bipartisan Consensus Managed 
     Care Improvement Act of 1999 does offer improved remedy and 
     uniform regulations. As one whose companion organization, the 
     Patient Advocate Foundation served over 6,000 patients last 
     year who confronted insurance denials of which more than 50 
     percent involved ERISA plans, our cases reflect an urgent 
     need for timely resolution and remedy for ERISA enrollees. 
     This Bill improves the system of clarifying responsibilities, 
     systems of appeal and opportunity for timely remedy. Patients 
     confronting life threatening conditions must have timely, 
     external, independent review and closure to their cases.
       The Bill assures that medical judgements are being made by 
     medical experts and their patients.
       It is our position that the provisions of this legisation 
     that assure patient access to Clinical Trials, access to 
     prescription drug not on the HMO's predetermined formulary 
     when the treating physican deems the medication as needed for 
     optimum benefit of patient care and the provision that 
     doctors and nurses will not confront retaliation when they 
     report quality problems all combine to assure higher 
     standards of quality care for patients that will enhance 
     disease survival and extend life.
       Please note our strong endorsement of the Bipartisan 
     Consensus Managed Care Improvement Act of 1999, our 
     endorsement for each of the co-sponsors of this legislation 
     and for each member of our United States House of 
     Representatives who has contributed to this debate and to 
     this resulting legislaiton over the course of the last three 
     years. It was our recent pleasure to honor both you and 
     Congressman Dingell with our National Health Care 
     Humanitarian Award July 22, 1999 in Washington. Certainly the 
     leadership that you both exhibit in the development, 
     sponsorship and negotiation of this bill as you seek to 
     position it on the floor of the House for debate is 
     consistent with our evalution of each of you as recipients of 
     our award. Thank you for your noble leadership in addressing 
     the matters embodied in this Managed Care Improvement Act. We 
     encourage House Speaker Dennis Hastert to place this Bill on 
     the floor of the House for debate and to allow your peers in 
     the House of Representatives to vote their conscience in 
     support of H.R. 273.
           Respectfully submitted:
                                            Naney Davenport-Ennis,
     Founding Executive Director.
                                  ____



                                 American College of Surgeons,

                                  Washington, DC, August 31, 1999.
     Hon. Charlie Norwood,
     U.S. House of Representatives, Washington, DC.
       Dear Representative Norwood: On behalf of the 62,000 
     Fellows of the American College of Surgeons, I am pleased to 
     offer the College's endorsement of Bipartisan Consensus 
     Managed Care Improvement Act of 1999, H.R. 2723. This 
     legislation encompasses all of the provisions that the 
     College believes are critical to ensuring that all privately 
     insured patients have access to the most appropriate medical 
     care. This legislation stands in stark contrast to the 
     inadequate managed care reform legislation that the Senate 
     passed in July.
       The College believes that all patients should have timely 
     access to appropriate specialty care. Patients should not be 
     forced by their health plan to endure unnecessary delays in 
     accessing specialty care nor should they be forced to receive 
     care from a specialist who does not have the appropriate 
     training and experience to treat their condition. We are 
     pleased to note that H.R. 2723 requires health plans to allow 
     patients to have timely access to specialty care and to go 
     out-of-network for specialty care at no additional cost if an 
     appropriate specialist is not available within the plan.
       Once a patient is able to see an appropriate specialist, 
     health plans are frequently restricting the patient's care by 
     unilaterally determining the most appropriate medical 
     treatment. This determination often is contrary to the advice 
     of the patient's treating physician. It is also often 
     formulated on the basis of cost rather than the patient's 
     best interest. H.R. 2723 would protect patients by requiring 
     health plans to offer their enrollees an opportunity for 
     independent external review of their case. The external 
     reviewer would then produce a binding determination. The 
     College further commends you for including a requirement that 
     the independent external entity determine the appropriate 
     treatment by considering the recommendations of the treating 
     physician along with other reasonable evidence and to do so 
     without being bound to the health plan's definition of 
     medical necessity.
       Another issue of deep concern to our Fellows is that 
     surgeons and other physicians being forced to bear all of the 
     liability involved in providing health care services when 
     health plans are often restricting the services they can 
     provide and the setting in which the care can be provided. If 
     health plans continue to make medical determinations, then 
     they should be held liable to at least the same degree as the 
     treating physician. We are pleased to note that H.R. 2723 
     would allow patients to hold health plans liable when the 
     plan's decisions cause personal injury or death. 
     Additionally, the College agrees that it is reasonable to 
     prohibit enrollees from suing their health plan for punitive 
     damages if the health plan abides by the decision of the 
     independent external review entity.
       All of these provisions, along with the numerous other 
     provisions included in H.R. 2723, address critical patient 
     needs in our nation's changing health care system. Once 
     again, the College is pleased to offer its support for the 
     Bipartisan Managed Care Improvement Act of 1999 and we look 
     forward to working with you, the Republican and Democratic 
     leadership, and, in fact, all the Members of the House of 
     Representatives to ensure that comprehensive managed care 
     reform legislation is enacted this year.
           Sincerely,
                                      George F. Sheldon, MD, FACS,
     President.
                                  ____

         Office for Church in Society United Church of Christ,
                                  Washington, DC, August 10, 1999.
     Hon. Charlie Norwood,
     U.S. House of Representatives, Washington, DC.
       Dear Representative Norwood: I am writing to thank you for 
     your leadership in sponsoring the Bipartisan Consensus 
     Managed Care Improvement Act of 1999.
       The United Church of Christ, Office for Church in Society, 
     endorses the bill as written.
       In the event that the bill is weakened, or if ``poison 
     pill'' amendments are added, such as Medical Savings Accounts 
     it is likely that we would then oppose the bill.
       Thanks again for your effort to help protect patients from 
     inappropriate denial of care and to make sure that the 
     services promised in managed care contracts will be fully 
     available from competent health professionals.
           Sincerely,
                                             Rev. Dr. Pat Conover,
     Policy Advocate.
                                  ____

         American College of Physicians, American Society of 
           Internal Medicine,
                                  Washington, DC, August 12, 1999.
     Hon. Charles Norwood,
     House of Representatives,
     Washington, DC.
       Dear Representative Norwood: The American College of 
     Physicians-American Society of Internal Medicine (ACP-ASIM) 
     is the largest medical specialty society in the country, 
     representing 115,000 physicians who specialize in internal 
     medicine and medical students. ACP-ASIM is in a unique 
     position to evaluate patient protection legislation as our 
     members represent the full range of internal medicine 
     practitioners. We believe

[[Page H7976]]

     that any patient protection legislation must be comprehensive 
     and provide patients with the necessary basic rights and 
     protections they need.
       ACP-ASIM believes that any effective patient protection 
     legislation must:
       Apply to all insured Americans, not just those in ERISA 
     plans.
       Require that physicians, rather than health plans, make 
     determinations regarding the medical necessity and 
     appropriateness of treatments. ACP-ASIM supports language 
     that defines medical necessity in terms of generally accepted 
     principles of professional medical practice, as supported by 
     evidence on the effectiveness of different treatments when 
     available.
       Provide enrollees with timely access to a review process 
     with an opportunity for independent review by an independent 
     physician when a service is denied.
       Offer all enrollees in managed care plans a point-of-
     service option that will enable them to obtain care from 
     physicians outside the health plan's network of participating 
     health professionals, and
       Hold all health plans, including those exempt from state 
     regulation under ERISA, accountable in a court of law for 
     medical decisions that result in death or injury to a 
     patient.
       In addition to these protections, we also believe that it 
     is important to address the need to ensure access to 
     affordable health insurance coverage for all Americans. 
     Patient protections are meaningless if patients lack health 
     insurance coverage. ACP-ASIM calls on the Congress to 
     guarantee the most basic right of all Americans--the right to 
     insurance coverage--by crafting legislative solutions that 
     will reduce, with a goal of eventually eliminating, the 
     growing numbers of uninsured citizens.
       As the U.S. House of Representatives considers this 
     legislation, ACP-ASIM encourages the continuation of a 
     bipartisan approach. We thank you for sponsoring the 
     Bipartisan Consensus Managed Care Improvement Act, H.R. 2723, 
     containing the key elements needed for effective patient 
     protection and demonstrating the bipartisan support for such 
     legislation in the House. ACP-ASIM looks forward to the 
     consideration of a comprehensive bill on the floor of the 
     House in September that will be fully capable of providing 
     Americans in managed care and other health plans with needed 
     protections. We stand ready to assist in this effort.
           Sincerely,
                                         Alan R. Nelson, MD, FACP,
     Associate Executive Vice President.
                                  ____



                               American Academy of Pediatrics,

                                   Washington, DC, August 9, 1999.
     Hon. Charlie Norwood,
     House of Representatives,
     Washington, DC.
       Dear Congressman Norwood: On behalf of the 55,000 general 
     pediatrician, pediatric medical subspecialist, and pediatric 
     surgical specialist members of the American Academy of 
     Pediatrics, I am writing to express our strong support of 
     your recently introduced legislation, the Bipartisan 
     Consensus Managed Care Improvement Act of 1999 (HR 2723). We 
     look forward to working with you and other members of 
     Congress to ensure that strong patient protection legislation 
     becomes law this year.
       We are especially pleased that your legislation recognizes 
     the unique need of children and addresses them appropriately. 
     Children are not little adults. Their care should be provided 
     by physicians who are appropriately educated in the unique 
     physical and developmental issues surrounding the care of 
     infants, children, adolescents and young adults. You clearly 
     recognize this and have included access to appropriate 
     pediatric specialists, as well as other important protections 
     for children, as key provisions of your legislation.
       Thank you for your efforts and we look forward to working 
     with you to enact strong patient protection legislation. 
     Please do not hesitate to contact me or Graham Henson of our 
     Washington office if we can be of assistance.
           Sincerely,
                                         Joel J. Alpert, MD, FAAP,
     President.
                                  ____

                                            American Psychological


                                                  Association,

                                  Washington, DC, August 10, 1999.
     Hon. Charlie Norwood,
     House of Representatives,
     Washington, DC.
       Dear Dr. Norwood: On behalf of the 159,000 members and 
     affiliates of the American Psychological Association (APA), I 
     am writing to express our strong support for the bipartisan 
     Consensus Managed Care Improvement Act (H.R. 2723), which you 
     have introduced with Representative John D. Dingell.
       Broad bipartisan support for this new legislation 
     represents a major breakthrough on behalf of patients' 
     rights. You bill covers all persons with private insurance 
     and includes much needed patient protections, strong reforms 
     of the managed care industry and due process protections for 
     providers. APA is especially grateful that you have continued 
     to champion our top legislative priority, removing the ERISA 
     shield from health plan legal accountability. As in your 
     previous bills that APA has endorsed since 1996, H.R. 2723 
     permits persons who have been injured by decisions of health 
     plans that delay or deny care to hold them legally 
     accountable. We believe that removal of this special 
     exemption will be a strong incentive for health plans to 
     deliver clinically necessary care, obviating the need for 
     lawsuits.
       Improvements to an appeals process without legal 
     accountability clearly would not be sufficient. A new 
     analysis of the Senate-passed bill, S. 1344, shows that the 
     insurance and managed care industry could generate interest 
     income of $280 million for every one percent of claims that 
     are delayed for the full 377 days permitted. This 
     PricewatershouseCoopers analysis helps refocus the debate on 
     the need for incentives to ensure that correct decisions are 
     made by health plans to begin with and that health plans do 
     not abuse an appeals process.
       H.R. 2723 also includes the requirements that those in 
     closed panel health plans be offered a point of service plan 
     at the time of enrollment, enabling care outside of a 
     network. The bill reflects a procompetitive provision banning 
     health plans from excluding a class of providers based solely 
     on licensure. Medical necessity decisions would be made by 
     clinical peers in a fair and independent appeals process, 
     moving the system away from some of its worst abuses.
       APA appreciates your continued leadership on these vital 
     issues and will continue to work with you to win enactment of 
     comprehensive managed care quality legislation.
           Sincerely,
     Russ Newman, Ph.D., J.D.
                                  ____

                                                 Service Employees


                                          International Union,

                                  Washington, DC, August 19, 1999.
     Hon. Charlie Norwood,
     House of Representatives,
     Washington, DC.
       Dear Representative Norwood: On behalf of the 1.3 million 
     members of the Service Employees International Union, I am 
     writing in support of the Bipartisan Consensus Managed Care 
     Improvement Act of 1999, H.R. 2723.
       We are very pleased that a truly comprehensive bipartisan 
     patient protection bill has been introduced. This is a bill 
     that addresses the concerns that many working families have 
     about the failure of managed care plans to ensure access to 
     quality health care and puts medical decisions in the hands 
     of medical experts not insurance company bureaucrats. Unlike 
     the Senate bill, H.R. 2723 would:
       Cover all Americans who have private insurance's.
       Provide true access to emergency services, specialists, 
     continuity of care, and clinical trials
       Provide for an internal and an independent external appeals 
     process that ensures a timely process for consumers for whom 
     health care is denied or withheld
       Hold health plans accountable for treatment decisions that 
     result in injury or death.
       Additionally, H.R. 2723 includes a vitally important 
     patient advocacy/whistleblower provision. As a union 
     representing over 600,000 frontline health care workers, we 
     know how important it is to protect health care workers who 
     speak out against patient care deficiencies. Employers must 
     be prohibited from firing or retaliating against such workers 
     if we are going to encourage health professionals to report 
     patient care problems.
       We commend you and your leadership in putting forward a 
     bill that provides real patient protections. SEIU looks 
     forward to working with you to pass H.R. 2723.
           Sincerely,
                                                  Andrew L. Stern,
     International President.
                                  ____

                                           The American College of


                               Obstetricians and Gynecologists

                                  Washington, DC, August 11, 1999.
     Hon. Charles Norwood,
     Longworth House Office Building,
     5Washington, DC.
       Dear Congressman Norwood, The American College of 
     Obstetricians and Gynecologists (ACOG) is pleased to offer 
     its support for the Bipartisan Consensus Managed Care 
     Improvement Act of 1999. This legislation would guarantee 
     direct access to ob-gyn care for women enrolled in managed 
     care.
       Women need the assurance that they can receive care for 
     their women's health needs from their ob-gyns without the 
     added time, expense, and inconvenience of first having to get 
     permission from their primary care physicians. Your 
     legislation would ensure this fundamental patient protection 
     to all women in managed care plans.
       Today, many managed care plans require women--even pregnant 
     women--to get permission slips from their primary care 
     physicians before they can see their ob-gyns. Sixty percent 
     of ob-gyns in managed care plans report that their 
     gynecologic patients are either limited or barred from seeing 
     their ob-gyns without first getting permission from another 
     physician. An astounding 28% report that their pregnant 
     patients must first receive another physician's permission 
     before seeing their ob-gyns. To make matters worse, nearly 
     75% of ob-gyns report that their patients have to return to 
     their primary care physicians for permission before their ob-
     gyn can provide necessary follow-up care.
       Direct access to ob-gyns for all covered obstetric and 
     gynecological follow-up care, as under your plan, will help 
     to ensure quality health for women, including pregnant women 
     and their infants. Thank you for your leadership and 
     commitment to these vital goals.

[[Page H7977]]

     We look forward to working closely with you as this 
     legislation moves toward enactment.
           Sincerely,
                                              Ralph W. Hale, M.D.,
     Executive Vice President.
                                  ____



                                  Center for Patient Advocacy,

                                       McLean, VA, August 9, 1999.
     Hon. Charlie Norwood,
     Longworth House Office Bldg.,
     Washington, DC.
       Dear Congressman Norwood: The Center for Patient Advocacy 
     is pleased to support the ``Bipartisan Consensus Managed Care 
     Improvement Act of 1999.''
       Since our founding in 1995, the Center for Patient Advocacy 
     has been a leading supporter of strong, enforceable 
     comprehensive managed care reform legislation. Every day the 
     Center works with patients across the country who have 
     experienced problems with managed care. We know first-hand 
     the barriers to care that patients face, including limits on 
     access to and coverage for speciality care and emergency room 
     care, arbitrary medical decisions based on cost rather than a 
     patient's specific medical needs, and the lack of a timely, 
     independent and fair external appeals process to name a few. 
     Most alarming, however, is that managed care plans--not 
     patients and their doctors--continue to make medical 
     decisions without being held legally accountable for their 
     decisions that harm patients.
       The Bipartisan Consensus Managed Care Improvement Act is a 
     common-sense approach that addresses these problems. In this 
     era where the pressure to reduce costs often comes at the 
     expense of the patient, it is not only appropriate, but 
     imperative that Congress act and pass legislation to protect 
     patients from managed care abuses.
       We commend your continued leadership in the managed care 
     reform debate and your tireless efforts to secure a strong, 
     enforceable and bipartisan solution to the problems patients 
     across the country are facing. As we have continued to 
     emphasize, patients are not calling on Congress to pass a 
     Republican or Democrat bill. They are calling on Congress to 
     pass bipartisan legislation that will truly provide them with 
     needed protections and empower patients and their physicians 
     with the decisions affecting their health care. And we 
     believe that the Bipartisan Consensus Managed Care 
     Improvement Act will do just that.
           Sincerely,
                                              Terre McFillen-Hall,
     Executive Director.
                                  ____



                             American Osteopathic Association,

                                  Washington, DC, August 27, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives, Washington, DC.
       Dear Congressman Norwood: The American Osteopathic 
     Association (AOA) represents the nation's 43,500 osteopathic 
     physicians. As President, I am pleased to let you know that 
     the AOA endorses your bill, the ``Bipartisan Consensus 
     Managed Care Improvement Act of 1999'' (H.R. 2723).
       The AOA advocates, on behalf of patients, for Congress to 
     enact strong, meaningful, and comprehensive protections. 
     After six years of debate and delay, we believe that H.R. 
     2723 is the bipartisan legislation that will ensure the AOA's 
     long sought principles. These include: physicians allowed to 
     determine medical necessity; health plans held accountable 
     for their actions; a fair and independent appeals process 
     available to patients, and protections which apply to all 
     Americans.
       Over the last two decades, managed care has become less 
     interested in delivering quality healthcare to patients. 
     Instead, the focus seems entirely on the bottom line. It is 
     time to bring the focus back to our patients and away from 
     HMO profits. Employers and patients are tired of not 
     receiving the care they are promised, pay for and deserve. 
     H.R. 2723 will help bring the quality back into healthcare 
     and allow osteopathic physicians to care for our patients in 
     accordance with the high principles guiding our profession.
       Again, thank you for your leadership on this critical 
     issue. We are encouraged by the broad bipartisan support your 
     legislation has received. The AOA pledges to work with you 
     and all Members of Congress to ensure swift enactment of H.R. 
     2723. Please feel free to contact Michael Mayers, AOA 
     Assistant Director of Congressional Affairs, in our 
     Washington office with any further comments or questions.
           Sincerely,
                                          Eugene A. Oliveri, D.O.,
     President.
                                  ____



                                  American Dental Association,

                                  Washington, DC, August 13, 1999.
     Hon. Charlie Norwood,
     1707 Longworth House Office Building, Washington, DC.
       Dear Representative Norwood: 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. 
     By joining forces with Representative Dingell, you have 
     breathed new life into the movement to establish a few basic 
     rules to protect all insured Americans from unfair and 
     unreasonable delays and denials of care.
       We recognize that the 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 all of our 
     members know of your courageous efforts on behalf of them and 
     their patients.
       Patient protection is a genuine grassroots issue that cuts 
     across geographic, economic and political boundaries. We 
     believe that only bipartisan action will solve the problems 
     in the health care system, and your bill represents a major, 
     positive step in the right direction.
           Sincerely,
                                    S. Timothy Rose, D.D.S., M.S.,
                                                        President.
                                             John S. Zapp, D.D.S.,
                                               Executive Director.


                                   Physicians for Reproductive

                                            Choice and Health,

                                    New York, NY, August 30, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives, Washington, DC.
       Dear Representative Norwood: Physicians for Reproductive 
     Choice and Health (PRCH) is pleased to support the Bipartisan 
     Consensus Managed Care Improvement Act of 1999 (H.R. 2723). 
     We applaud your leadership, as well as that of Representative 
     Dingell and the additional supporters of the legislation. The 
     mission of PRCH is to enable concerned physicians to take a 
     more active and visible role in support of universal 
     reproductive health. We represent more than 3,000 physicians 
     and non-physician supporters from around the country. PRCH is 
     committed to ensuring that all people have the knowledge, 
     access to quality services, and freedom of choice to make 
     their own reproductive health decisions, and we believe this 
     legislation is an important step toward that goal.
       The American health care system is changing rapidly. PRCH 
     believes it is vital that those changes do not come at the 
     expense of quality care for patients. The Bipartisan 
     Consensus Managed Care Improvement Act includes many 
     important patient protections. As a physician membership 
     organization, PRCH is especially pleased that H.R. 2723 would 
     ensure that medical judgments are rendered solely by health 
     care providers, who are in the best position to guard the 
     interests of their patients. Other particularly important 
     provisions would assure that women have direct access to ob-
     gyn care from their choice of participating health care 
     providers; protect health care professionals who report 
     quality problems from retaliation by insurance plans and 
     others; and prohibit health care plans from financially 
     rewarding health care professionals for limiting a patient's 
     care.
       We commend your leadership in the struggle to ensure that 
     patients' rights are established in federal law.
           Sincerely,
                                                       Jodi Magee,
                                               Executive Director.
                                          Seymour L. Romney, M.D.,
     Chair.
                                  ____



                                      American Cancer Society,

                                                  August 27, 1999.
     Hon. Charlie Norwood,
     U.S. House of Representatives, Washington, DC.
       Dear Congressman Norwood: On behalf of the American Cancer 
     Society and its 2 million volunteers, I commend you for 
     sponsoring H.R. 2723, the ``Bipartisan Consensus Managed Care 
     Improvement Act of 1999,'' legislation that meets the needs 
     of cancer patients. As the largest voluntary health 
     organization dedicated to improving cancer care, we urge 
     support of such legislation that would help ensure patients, 
     especially those affected by cancer, access to quality and 
     appropriate medical care. Specifically, we are pleased that 
     the provisions in your legislation will benefit all 161 
     million Americans in private health insurance and employer-
     sponsored plans and that your legislation provides patients 
     with direct access to clinical trials.
       More than 140 million insured Americans are in some kind of 
     managed care plan and this includes many of the approximately 
     1.23 million people diagnosed with cancer each year. In 
     addition, the National Cancer Institute estimates that 8 
     million Americans alive today have a history of cancer. While 
     managed care has greatly improved access to needed 
     prevention, early detection, and cancer treatment, we are 
     concerned about some of the gaps that remain in getting 
     quality care to the patient.
       Your legislation adequately addresses some of our concerns 
     in a way that will help ensure that individuals affected or 
     potentially affected by cancer will be assured improved 
     access to quality care. H.R. 2723 grants patients with life 
     threatening diseases access to specialists, including an out-
     of-network specialist if one is not available within their 
     health plan; ensures continuity of care if an employer 
     switches to a plan that does not include their physician who 
     is providing on-going treatment or if a treating physician is 
     no longer with the health plan; and permits for a specialist 
     to serve as the primary care physician for a patient who is 
     undergoing treatment for a serious or life-threatening 
     illness.
       Most importantly, your bill includes a clinical trials 
     provision strongly supported by the American Cancer Society. 
     H.R. 2723 recognizes that coverage of the routine patient 
     care costs for patients enrolled in any phase of high-
     quality, peer-reviewed clinical trials affords people with 
     cancer and other serious or life threatening disease the 
     opportunity to seek the best and most appropriate care while 
     helping to advance scientific knowledge. This access is 
     integral to possibly extending life, reducing morbidity, and

[[Page H7978]]

     increasing medical knowledge. As you may know, in many cases, 
     coverage for routine patient services for patients who 
     wish to participate in a clinical trial are often denied, 
     thereby creating a major barrier for patients who would 
     like, or need, access to these treatments. For these 
     patients, the clinical trial offers a critical opportunity 
     to receive state of the art cancer treatment--therapies 
     that may be their best and most appropriate treatment 
     option and their only chance at survival and an improved 
     quality of life. In addition, without sufficient 
     enrollment in clinical trials, we as a nation lose an 
     opportunity to collect data about the safety and efficacy 
     of a new therapy or technology that could potentially 
     benefit future generations of patients and save the health 
     care system money. We firmly believe it is essential that 
     cancer patients have access to these often-times 
     lifesaving therapies that can reduce suffering and prolong 
     life and are very supportive of the provision in H.R. 
     2723.
       The Society commends you for sponsoring this legislation 
     that provides access to clinical trials for all patients with 
     serious and life threatening diseases. Due to the nature of 
     research, life-saving treatments for one disease are often 
     found in clinical trials of a drug aimed at treating another 
     disease. Recently, clinical trials of Rezulin, a diabetes 
     drug, showed that the drug may slow rapid cell growth in some 
     cancers. Similarly, research has shown that the cancer drug, 
     endostatin, may help heart disease. By providing broad access 
     to clinical trials, your legislation will help advance the 
     state of research for many diseases by allowing for the 
     cross-pollination of research--cancer patients will benefit 
     from clinical trials in AIDS, diabetes, etc., and vice versa.
       While we are very pleased with your leadership on this 
     issue, we are concerned that H.R. 2723 will not help patients 
     who want to enroll in privately sponsored pharmaceutical 
     trials--the type that is most frequently provided through the 
     Food and Drug Administration. We would greatly appreciate 
     your consideration of increasing access to these types of 
     clinical trials for managed care patients.
       The diagnosis of cancer is devastating--not only must 
     patients confront an array of medical decisions, they must 
     deal with financial and emotional burdens as well. We thank 
     you for sponsoring legislation ensuring that cancer patients, 
     irrespective of type of health insurance, will face fewer 
     financial worries as they consider their treatment options. 
     Please call Megan Gordon, Legislative Representative, for any 
     additional information you or your staff may need.
           Sincerely,
                                                    Kerrie Wilson,
     National Vice President, Policy Advocacy.
                                  ____

                                               American Academy of


                                                Ophthalmology,

                                  Washington, DC, August 30, 1999.
     Hon. Charles Norwood,
     Longworth House Office Building,
     Washington, DC.
       Dear Representative Norwood: The American Academy of 
     Ophthalmology (AAO) would like to thank you for your 
     introduction of H.R. 2723, the Bipartisan Consensus Managed 
     Care Improvement Act of 1999. Your bill contains the core 
     patient protections the AAO supports and believes should be a 
     part of all managed care plans.
       AAO is the world's largest educational and scientific 
     organization of eye physicians and surgeons (Eye M.D.s), 
     representing over 26,000 members, dedicated to the treatment 
     and diagnosis of disorders of the eye.
       AAO supports H.R. 2723 on the basis that it would guarantee 
     the following six protections to the millions of Americans 
     enrolled in managed care plans:
       1. An out-of-network (point-of-service) option at the time 
     of enrollment;
       2. Timely access to specialty care;
       3. A fair and expedited independent appeals process;
       4. A consumer information checklist;
       5. A ban on financial incentives that result in the 
     withholding of care or a denial of a referral; and
       6. A ban on ``gag clauses'' which prohibit a provider from 
     giving patients certain information, including treatment 
     options.
       We look forward to working with you to ensure passage of a 
     strong, comprehensive and meaningful patient protections bill 
     this Congress. Again, thank you for introducing your bill and 
     for championing this issue in the House of Representatives.
           Sincerely,
                                         William L. Rich, III, MD,
     Secretary for Federal Affairs.
                                  ____

                        Friends Committee on National Legislation,
                                  Washington, DC, August 26, 1999.
     Re Managed Care Improvement Act.

     Representative Charles Norwood,
     U.S. House of Representatives,
     Washington, DC.
       Dear Representative Norwood: I am writing on behalf of the 
     Friends Committee on National Legislation (FCNL, a Quaker 
     lobby in the public interest) to express our strong support 
     for the Bipartisan Consensus Managed Care Improvement Act of 
     1999 (H.R. 2723).
       FCNL supports a health care system whose primary goal is 
     maintaining and improving the health of the population. In 
     recent years, managed care has taken over as the dominant 
     health care delivery system. The shift to managed care has 
     reflected the belief, particularly within the business 
     community, that managed care does a substantially better job 
     of controlling health care costs than does traditional fee-
     for-service insurance. Thus, managed care organizations are 
     under strong pressure to keep costs down. In addition, many 
     managed care organizations operate on a for-profit basis 
     which exerts pressures to reduce outlays. These changes in 
     the structure of health care insurance have created an 
     environment in which patients' interests can (and sometimes 
     do) take a back seat. While we are sensitive to the economic 
     issues in health care, we also believe that reform and 
     regulation are necessary in order to ensure that managed care 
     organizations hold the interests of patients as a prime 
     focus.
       Following are some of the provisions of H.R. 2723 that are 
     of particular importance to FCNL.
       Scope of coverage: We support extending managed care 
     protections to all 161 million people in the U.S. with 
     private insurance. This would complement the protection 
     already afforded to those in Medicaid and Medicare managed 
     care.
       Access to care: We strongly favor efforts to reduce and 
     eliminate bureaucratic obstacles that some patients have 
     faced as they seek access to physicians and needed health 
     care services. For example, we support access to closest 
     emergency room, without prior authorization and without 
     higher costs; guaranteed access to needed health care 
     specialists, outside the network, if needed; access to 
     pediatric specialists; the right of women to directly access 
     ob/gyn care and services; and access to quality clinical 
     trials for those with no other effective option.
       Protection of Doctor/Patient Relationship: We oppose 
     limitations placed on physicians by HMOs or insurance 
     companies that reduce their ability to treat or communicate 
     with patients. For example, we believe that legislation 
     should prohibit gag clauses that restrict the freedom of 
     health care providers to discuss all treatment options with 
     patients; limit financial incentives to withhold care; ensure 
     continuity of care so that patients in the middle of long-
     term treatment plans do not suffer an abrupt transition of 
     care if their physician or other provider is dropped from the 
     plan; and assure that health care professionals who report 
     deficiencies in the quality of health care services will not 
     experience retaliation by the plan.
       Accountability: We support the right of patients to timely 
     appeals of health plan decisions and to be able to hold 
     health plans accountable for decisions. Examples of such 
     rights include access to internal and independent external 
     appeals processes that are fair, unbiased, and timely; and a 
     mechanism that holds health plans legally accountable when 
     their decisions harm patients.
       FCNL applauds your efforts and the efforts of your 
     colleagues to pass legislation that would provide these and 
     other related protections to patients in managed care plans.
           Sincerely,
                                              Florence C. Kimball,
     Legislative Education Secretary.
                                  ____



                              American Federation of Teachers,

                                  Washington, DC, August 20, 1999.
     U.S. House of Representatives,
     Washington, DC.
       Dear Representative: I am writing on behalf of the over one 
     million members of the AFT to urge your support for 
     bipartisan patients rights legislation, H.R. 2723, the 
     Bipartisan Consensus Managed Care Empowerment Act of 1999. 
     Hopefully, when Congress returns from its August recess, the 
     House of Representatives will have the opportunity to vote on 
     this important bill.
       This bipartisan measure, introduced by Representatives 
     Charles Norwood (R-GA) and John Dingell (D-MI), is compromise 
     patients' rights legislation that retains essential features 
     of the Patients Bill of Rights, H.R. 358, that AFT has also 
     supported.
       The bipartisan bill (H.R. 2723), which applies to all 161 
     million Americans with health insurance coverage, has these 
     essential features;
       Ensures access to emergency care without prior 
     authorization, following a ``prudent lay person'' standard;
       Authorizes direct access to OB/GYNs and pediatricians to be 
     primary care physicians;
       Provides access to pediatric specialties;
       Provides for continuity of care when there is a change of 
     plan or change in the provider network;
       Provides for an independent external appeals process;
       Authorizes patients to sue health plans in state courts, 
     but disallows punitive damages if a plan complies with an 
     independent external appeals decision;
       Provides that doctors and nurses can report quality 
     problems without fear of retaliation from Health Maintenance 
     Organizations (HMOs), insurance companies and hospitals.
       AFT is particularly pleased that H.R. 2723 contains 
     protection against retaliation for health care workers acting 
     as patient advocates. The AFT is proud to represent over 
     53,000 health care professionals who know such protections 
     for patient advocacy are an essential component of quality 
     health care.
       H.R. 2723 offers the House a very real opportunity to enact 
     legislation on a bipartisan basis that will improve the 
     quality of managed care. The American Federation of Teachers 
     urges you to co-sponsor and support this vital legislation.
           Sincerely,

                                           Charlotte J. Fraas,

                                  Director of Federal Legislation,
                                   Office of Government Relations.

[[Page H7979]]

     
                                  ____
         AFSCME, American Federation of State, County and 
           Municipal Employees, AFL-CIO,
                                  Washington, DC, August 18, 1999.
     Honorable Charles Norwood,
     U.S. House of Representatives,
     Washington, DC.
       Dear Representative Norwood: On behalf of the 1.3 million 
     members of the American Federation of State, County and 
     Municipal Employees (AFSCME), I am writing to thank you for 
     your leadership in introducing the Bipartisan Consensus 
     Managed Care Improvement Act of 1999 (H.R. 2723). This 
     compromise legislation provides meaningful reform of managed 
     care with significant and enforceable protections for 
     consumers.
       In particular, we are pleased that the bill extends patient 
     protections to all of those who are covered by managed care 
     plans rather than just limited segments of the insured 
     population. Importantly, the bill holds all, rather than just 
     some, plans accountable for treatment denials which result in 
     the injury or death of patients. But the liability shield now 
     enjoyed by self-funded plans is removed in a balanced way, 
     providing that there will be no punitive damages where the 
     plan has followed the recommendation of an external review 
     panel. Further, the bill makes clear that employees cannot be 
     sued unless they intervene in treatment decisions.
       Of particular interest to AFSCME members who work in health 
     care, H.R. 2723 includes important protections for physicians 
     and nurses who raise concerns or warnings about the care of 
     patients. Although limited, these protections will allow 
     health care professionals to speak, without fear of reprisal, 
     to appropriate public regulatory agencies, appropriate 
     private accrediting bodies, plan administrators or their 
     employers. The provision protecting patient advocacy will 
     help accomplish the bill's overall goal of improving the 
     quality of care for patients.
       In sum, H.R. 2723 would accomplish reform in a meaningful, 
     yet balanced way. We thank you for co-sponsoring this 
     important legislation.
           Sincerely,
                                                Gerald W. McEntee,
     International President.
                                  ____

                                         American Thoracic Society


                            and the American Lung Association,

                                  Washington, DC, August 24, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives,
     Washington, DC.
       Dear Representative Norwood: On behalf of the American Lung 
     Association and its medical section, the American Thoracic 
     Society, I want to congratulate you for introducing the Bi-
     Partisan Patient Protection legislation (H.R. 2723). The ALA/
     ATS strongly support this important legislation.
       American consumers deserve quality health insurance. Far 
     too often we hear of cases where health insurers have either 
     obstructed or completely denied insured patients access to 
     the care they need. Insurers, by design or default, are 
     preventing patients from getting the care they need.
       Your legislation will help end many of the abuses in our 
     nation's health insurance system. Your legislation will give 
     all of our nation's insured individuals access to 
     specialists, a swift appeals process and legal recourse for 
     denied care, and will ensure physicians--not insurers--
     determine medical necessity. These important patient 
     protections are needed to restore confidence to our nation's 
     health care system.
       The American Lung Association and the American Thoracic 
     Society are ready to work with you and other Members of 
     Congress to quickly enact this important legislation. Again, 
     thank you for your leadership on this important issue.
           Sincerely,
                                                     Fran DuMelle,
     Deputy, Managing Director.
                                  ____



                             National Breast Cancer Coalition,

                                  Washington, DC, August 24, 1999.
     Representative John Dingell,
     Representative Charles Norwood,
     U.S. House of Representatives,
     Washington, DC.
       Dear Representatives: On behalf of the National Breast 
     Cancer Coalition (NBCC) and the 2.6 million women living with 
     breast cancer, I am writing to thank you for your leadership 
     in offering H.R. 2723, The Bipartisan Consensus Managed Care 
     Improvement Act of 1999. Passage of this legislation would 
     ensure that patients in private health plans have access to 
     legitimate patient protections.
       The National Breast Cancer Coalition is a grassroots 
     advocacy organization made up of more than 500 member 
     organizations and 60,000 individual members dedicated to the 
     eradication of breast cancer through advocacy and action. We 
     have long been committed to working with Members of Congress 
     to enact meaningful healthcare reform. While many versions of 
     ``patient protection'' legislation have been discussed in the 
     past, we appreciate your leadership on introducing strong and 
     comprehensive bipartisan legislation that brings us one step 
     closer to achieving our goal.
       One of NBCC's top concerns is breast cancer patients' 
     access to clinical trials. Women with breast cancer often 
     seek participation in clinical research studies as their best 
     treatment option. It is unconscionable that their health 
     plans would deny payment for even routine patient care cost 
     like physician and hospital charges merely because patients 
     are receiving treatment in the context of a clinical trial 
     versus standard therapy. H.R. 2723, which would require 
     health plans to cover routine patient care costs for cancer 
     patients enrolled in approved clinical trials, is a critical 
     step in including greater participation in clinical trials.
       We also want to thank you for including access to specialty 
     care in the Bipartisan Consensus legislation. This provision 
     is extremely important to ensure that individuals in private 
     health plans have access to the specialty care they need--an 
     essential component of a meaningful patients' bill of rights. 
     We are pleased that this legislation would allow breast 
     cancer patients to go straight to their oncologists should 
     that be medically appropriate.
       Finally, NBCC appreciates your recognition that a right 
     without strong enforcement is no right at all. By holding 
     plans accountable when their decisions to withhold or limit 
     care injures patients, H.R. 2723 ensures that insurers are 
     subject to the same rules and legal penalties for injuries as 
     any other industry. Strong enforcement is absolutely 
     essential to any meaningful managed care reform, and we are 
     pleased that the Bipartisan Consensus bill incorporates this 
     provision.
       Thank you again for your outstanding leadership. We look 
     forward to working with you to get H.R. 2723, The Bipartisan 
     Consensus Managed Care Improvement Act, enacted into law this 
     year. Please do not hesitate to call me or NBCC's Government 
     Relations Manager, Jenifer Katz if you have any questions.
           Sincerely,
                                                       Fran Visco,
     President.
                                  ____

                                           American Association of


                                             University Women,

                                  Washington, DC, August 24, 1999.


             protect women's health in managed care reform

       Dear Representative: On behalf of the 150,000 members of 
     the American Association of University Women (AAUW), I urge 
     you to support the Bipartisan Consensus Managed Care 
     Improvement Act of 1999 (H.R. 2723), introduced by Reps. 
     Charlie Norwood (R-GA) and John Dingell (D-MI), when the 
     House considers managed care reform legislation. AAUW 
     believes that H.R. 2723 will ensure accountability of managed 
     care plans and a health care delivery system that fully meets 
     the needs of women and families.
       AAUW believes that only H.R. 2723 will significantly 
     improve managed health care for all consumers, and especially 
     for women. H.R. 2723 covers all 148 million privately insured 
     Americans and addresses a broad range of issues that will 
     provide quality, timely, and appropriate health care to all 
     consumers; ensure patients' rights; and meet the needs of 
     women and their families. H.R. 2723 guarantees that patients 
     can have a health plan's decision to deny care reviewed by an 
     independent medical expert, and holds managed care plans 
     accountable when their decisions to withhold or limit care 
     cause injury or death. H.R. 2723 is particularly important to 
     women because it: Ensures that women have direct access to 
     ob-gyn services from the participating health care 
     professional of their choice; Ensures that pregnant women can 
     continue to see the same health care provider throughout 
     pregnancy if their provider leaves the plan or their employer 
     changes plans; Ensures access to specialists, including, when 
     appropriate, specialists outside a plan's network; and 
     Ensures access to clinical trials for new treatment options 
     and that may save people's lives.
       Once again, I urge you to support H.R. 2723 to ensure 
     accountability of managed care plans and a health care 
     delivery system that fully meets the needs of women and 
     families. If you have any questions, please call Nancy 
     Zirkin, Director of Government Relations, at 202/785-7720, or 
     Lisa Levine, Government Relations Manager, at 202/785-7730.
           Sincerely,
     Sandy Bernard, President.
                                  ____

                                            National Black Women's


                                               Health Project,

                                  Washington, DC, August 24, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives,
     Washington, D.C.
       Dear Congressman Norwood: The National Black Women's Health 
     Project (NBWHP) is writing in support of the Bipartisan 
     Consensus Managed Care Improvement Act (H.R. 2723). NBWHP is 
     the only national organization solely dedicated to improving 
     the health and well-being of America's 17.8 million Black 
     women through wellness programs and services, information, 
     and advocacy. We have been and continue to be a strong 
     supporter of managed care reform. The proposed legislation 
     offers significant protections for all Americans, and the 
     specific implications for women and women of color are 
     vitally important. Of great importance is the inclusion of 
     patient access to medical treatments and therapies including 
     clinical trials. This is highly significant as women of color 
     are often under-represented in clinical trials. In addition, 
     the inclusion of access to all prescription drugs is crucial 
     as women would have assured access to coverage for 
     contraceptives.
       There is an urgent need for consumer protections in the 
     health care and insurance system, and we feel that this 
     legislation is a

[[Page H7980]]

     progressive action in this regard. We appreciate any 
     opportunities to work with you. If you have any further 
     questions, please feel free to telephone our office. Shelia 
     Clark, our Public Policy Associate, is our contact person. We 
     look forward to the passage of this legislation.
           Sincerely,
                                                      Julia Scott,
     President and CEO.
                                  ____

                                             National Alliance for


                                             the Mentally Ill,

                                   Arlington, VA, August 24, 1999.
     Hon. John Dingell,
     Hon. Charles Norwood,
     U.S. House of Representatives.
     Washington, DC
       Dear Representatives Dingell and Norwood: On behalf of the 
     208,000 members and 1,200 affiliates of the National Alliance 
     for the Mentally Ill (NAMI), I am writing to express our 
     support for your legislation, the Bipartisan Consensus 
     Managed Care Improvement Act of 1999 (H.R. 2723). As the 
     nation's largest organization representing people with severe 
     mental illnesses and their families, NAMI believes that 
     federal standards are necessary to ensure that access to the 
     most advanced treatment is not compromised in the name of 
     cost savings. We support your efforts as an important step 
     forward in protecting the interests of consumers and their 
     families in the health care system.
       In particular, NAMI is especially pleased that your 
     legislation will address critical issues that are of great 
     concern to people with severe mental illnesses and their 
     families including use of restrictive prescription drug 
     formularies and meaningful external appeals. NAMI is grateful 
     that your legislation will protect the ability of patients 
     and their doctors to go beyond a health plan's limited drug 
     formulary when it is necessary to find the most effective 
     medication. this protection is critically important for 
     people with serious brain disorders such as schizophrenia and 
     manic-depressive illness who depend on newer medications as 
     their best hope for recovery.
       NAMI also strongly supports your proposal for external 
     grievance procedures that would require that decisions of 
     independent review panels be legally binding upon health 
     plans and prevent health plans from being able to select the 
     independent third-party review panel. Patients and their 
     families should be able to take their claim of an unfair 
     denial of treatment coverage to an unbiased process for an 
     adjudication of their rights.
       NAMI also supports key provisions in H.R. 2723 regarding 
     access to medical specialists. Health plans should be 
     required to provide access to covered specialty care within a 
     plan's network and allow consumers unobstructed access to a 
     specialist, such as a psychiatrist, over a longer period, 
     without repeated and unnecessary pre-authorizations from 
     their plan. Finally, NAMI would like to thank you for 
     including in your bill strong protections for consumer access 
     to medical treatment costs associated with clinical trials. 
     For many people with severe mental illnesses, clinical trials 
     on new medications are the best hope for successful 
     treatment. Health plans should not be allowed to deny 
     patients access to these trials by refusing to pay for 
     routine medical care.
       NAMI is grateful for your efforts on behalf of people with 
     severe mental illnesses and their families. Your bipartisan 
     approach to this difficult issue is an important step forward 
     in placing the interests of consumers and families ahead of 
     politics. NAMI looks forward to working with you to ensure 
     passage of meaningful managed care consumer protection 
     legislation in the 106th Congress.
           Sincerely,
                                                     Laurie Flynn,
     Executive Director.
                                  ____



                                      Families USA Foundation,

                                  Washington, DC, August 11, 1999.
     Hon. Charlie Norwood,
     Longwood HOB, Washington, DC.
       Dear Congressman Norwood: Congratulations on the 
     introduction of the ``Bipartisan Consensus Managed Care 
     Improvement Act of 1999,'' H.R. 2723. We are well aware of 
     the efforts you and others made to make this bill a reality.
       As you know, the American public is losing faith in our 
     health care delivery system. Managed care companies that 
     began with the promise of providing high quality care at an 
     affordable price are not always delivering on that promise. 
     Unfortunately, this has resulted in consumers being worried 
     that they will not get the care they need even though they 
     are covered with health insurance. Your bill is a reasonable 
     compromise proposal that can bring back balance to our health 
     care system.
       We look forward to working with you to make the 
     ``Bipartisan Consensus'' bill the law of the land.
           Sincerely,
                                                Ronald F. Pollack,
     Executive Director.
                                  ____

                                          National Organization of


                                          Physicians Who Care,

                                 San Antonio, TX, August 24, 1999.
     Hon. Charlie Norwood,
     Longworth HOB, Washington DC.
       Dear Congressman Norwood: I am president of Physicians Who 
     Care, Inc. (``PWC''). It is a not-for-profit organization 
     which is devoted to protecting the doctor-patient 
     relationship and ensuring quality health care. Formed in 1985 
     in San Antonio, Texas the organization has approximately 
     4,000 members, most of them doctors in private practice. PWC 
     believes the responsibility for medical care belongs first 
     and foremost to physicians and patients. We affirm the right 
     of the physician, as the provider of care, to diagnose, 
     prescribe, test and treat patients without undue outside 
     interference. We affirm the right of the patient, as the 
     person most affected by care, to choose his or her own 
     physician and help determine the type of treatment received.
       On behalf of PWC and its board of directors, I am writing 
     to you now. As you know, one of the major issues facing our 
     country today is our health care delivery system--quality, 
     access, delivery, accountability and fairness. We are 
     apprised that this issue will come before the House of 
     Representatives next month after Congress reconvenes from its 
     summer recess.
       We have reviewed H.R. 2723, the bill introduced into the 
     House by Representatives Norwood and Dingell. It is known as 
     the ``Bipartisan Consensus Managed Care Improvement Act of 
     1999''. We strongly support it as it insures fairness and 
     accountability in our health care delivery system that has 
     been lacking in what the Senate has passed and other 
     legislation that has gone before (H.R. 2723). We ask that you 
     vote in favor of it.
       Now is the opportunity to vote on legislation that will 
     support the ability of patients to receive proper care from 
     their providers and provide providers with measures of 
     confidence and comfort not known by them since managed care 
     and managed care plans were foisted upon patients and 
     physicians.
       We are particularly impressed by the wording in H.R. 2723 
     relating to external appeals, the ability of patients to sue 
     their health plans and managed care organizations like HMOs 
     (just like they can physicians, hospitals and others who make 
     medical decisions in patient care), excluding employers from 
     liability unless they are involved in the same medical 
     decision-making that presently exposes physicians, hospitals, 
     nurses and the like.
       Moreover, we are mindful that opponents of this type 
     legislation raise costs as an issue or that employers will 
     not be able to provide health insurance to their employees if 
     the ERISA preemption is lifted or even that lifting this 
     preemptive effect will cause more lawsuits. To these points, 
     we respectfully and firmly disagree! Opponents are using 
     emotion and ``scare tactics'' to avoid fact and the ability 
     of all patients to receive proper and quality health care.
       We are not against managed care; it does have a place. 
     However, we are strongly against managed care plans not 
     ``toeing the line'', i.e. not wanting to be held accountable 
     for their medical decisions that adversely affect patient 
     care (all over the country managed care plans are failing, 
     200 in California alone).
       Now may be the last time that you have to provide effective 
     relief to patients and their providers alike. If you do not, 
     our court system may do it for you (as recent decisions in 
     the last few years seem to strongly indicate.)
       Please vote what is right, fair and just for all patients; 
     we sincerely ask that you support H.R. 2723.
       Thank you.
           Sincerely,
                                              Ronald Bronow, M.D.,
     President.
                                  ____



                                            Patients Who Care,

                                 San Antonio, TX, August 24, 1999.
     Hon. Charlie Norwood,
     Longworth HOB, Washington, DC.
       Dear Congressman Norwood: I am president of Patients Who 
     Care (PtWC). It is a non-profit 501(c)3 organization of 
     approximately 20,000 members and is dedicated to promoting 
     through education an understanding of issues affecting access 
     by patients to the highest quality health care possible. We 
     believe in preserving quality medical care, affordability of 
     care and care reimbursement plans, and preserving the doctor/
     patient relationship. We also feel it is the right of 
     patients to choose their own physician and determine the type 
     of treatment received. Finally, we try to help patients 
     understand their rights in the health care decision-making 
     process.
       On behalf of PtWC and its board of directors, I am writing 
     to you now. As you know, one of the major issues facing our 
     country today is our health care delivery system--quality, 
     access, delivery, accountability and fairness. We are 
     apprised that this issue will come before the House of 
     Representatives next month after Congress reconvenes from its 
     summer recess.
       We have received H.R. 2723, the bill introduced in the 
     House of Representatives Norwood and Dingell. It is known as 
     the ``Bipartisan Consensus Managed Care Improvement Act of 
     1999''. We strongly support it as we feel it insures fairness 
     and accountability in our health care delivery system. These 
     qualities have been lacking in what the House and Senate have 
     passed in previous health care legislation. We ask that you 
     vote in favor of H.R. 2723, and do all you can to help this 
     bill move quickly to passage.
       Now is the opportunity to vote on legislation which will 
     support the ability of patients to receive proper care from 
     their providers. It will also give providers a greater 
     measure of confidence and comfort in treating their patients 
     since managed care and the managed care plans were foisted 
     upon patients and physicians many years ago.

[[Page H7981]]

       We are particularly impressed by the wording in H.R. 2723 
     relating to external appeals, the ability of patients to sue 
     their health plans and managed care organizations like HMOs 
     (just like they can physicians, hospitals and others who make 
     medical decisions in patient care), excluding employers from 
     liability unless they are involved in the same medical 
     decision-making that presently exposes physicians, hospitals, 
     nurses and the life. We are also mindful that opponents of 
     this type legislation raise ``costs'' as the issue, saying 
     `employers will not be able to provide health insurance to 
     their employees if the ERISA preemption is lifted or even 
     that lifting this preemptive effect will cause more 
     lawsuits'. We feel this is a lesser concern than decisions 
     that adversely affect patient care (all over the country 
     managed care plans are failing--200 in California alone).
       Now may be the last time you have to provide effective 
     relief to patients and their providers. If you do not, our 
     court system may do it for you (as recent decisions in the 
     last few years seem to strongly indicate.)
       Please vote what is right, fair and just for all patients; 
     we sincerely ask that you support H.R. 2723.
       Thank you.
           Sincerely,
                                      Steven C. Johnson, CLU, RHU,
                                                        President.

       P.S. It is also our understanding that most ``individual'' 
     health care plans, not currently under ERISA, will not be 
     affected by this legislation, or be required to conform to 
     H.R. 2723. please be vigilant of this issue which our members 
     have raised.
                                  ____



                           Alliance for Children and Families,

                                                  August 24, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives, Washington, DC.
       Dear Representative Norwood: We at the Alliance for 
     Children and Families are writing to express our support for 
     the Bipartisan Consensus Managed Care Improvement Act (H.R. 
     2723), which you have introduced with Representative Dingell. 
     The Alliance, an international nonprofit association 
     representing over 350 child- and family-serving 
     organizations, supports this important legislation to protect 
     patients' rights. Alliance members serve more than 5 million 
     individuals each year in more than 2,000 communities.
       Broad bipartisan support for this new legislation 
     represents a major breakthrough on behalf of patients' 
     rights. This bill provides essential protections for all 
     consumers in the private health insurance marketplace. H.R. 
     2723 ensures that medical decisions will be in the hands of 
     medical experts. It permits people to hold their managed care 
     plans accountable when plan decisions to withhold or limit 
     care result in injury or death. We believe that holding 
     health plans accountable will be a strong incentive for them 
     to deliver clinically necessary care, minimizing the need for 
     lawsuits.
       We support your bill because it includes much needed 
     patient protections, strong reforms of the managed care 
     industry and due process protections for providers. It 
     ensures that patients have access to a fair and independent 
     external review for cases in which care is denied. H.R. 2723 
     also ensures that patients have access to specialists, 
     including, when appropriate, specialists outside a plan's 
     network.
       Thank you for your leadership in protecting patients' 
     rights through the Bipartisan Consensus Managed Care 
     Improvement Act of 1999.
           Yours sincerely,
                                             Carmen Delgado Votaw,
     Senior Vice President, Public Policy.
                                  ____



                                 Paralysis Society of America,

                                                  August 23, 1999.
     Hon. Charlie Norwood,
     U.S. House of Representatives, Longworth Building, 
         Washington, DC.
       Dear Representative Norwood: On behalf of the Paralysis 
     Society of America (PSA), I am writing to voice support for 
     H.R. 2723, the Bipartisan Consensus Managed Care Improvement 
     Act of 1999.
       We are pleased to see that the consensus bill combines the 
     patient protections found in the major managed care reform 
     bills introduced in the House this year, including H.R. 216, 
     the Quality Care Act, and H.R. 358, the Patients' Bill of 
     Rights. We also note the importance of H.R. 2723 as a 
     bipartisan bill. Legislators who support this bipartisan bill 
     recognize the importance of a health care system that 
     balances the cost of service delivery without sacrificing 
     individual patient needs.
       PSA's membership of more than 19,800 people consists of 
     individuals with spinal cord injury or disease, their family 
     members and caregivers, health care professionals, and others 
     with an interest in the disciplines of spinal cord medicine 
     and paralysis. As you can imagine, the outcome of patient 
     protection legislation speaks directly to the vested interest 
     in our membership.
       Particular attention is given to those portions of the 
     legislation covering freedom of choice, specialists, and 
     external appeals, clinical trials and privacy. Also of 
     interest to our membership are the sections covering 
     continued care, freedom of communication, clinical trials 
     reform, incentives to deny care, and privacy:
       PSA members want the right to freely choose and/or change 
     their doctor and hospital;
       PSA members want the right to see a specialist if they and 
     their doctor determine the need is paramount to managing the 
     complex health care needs of people with spinal cord 
     dysfunction;
       PSA members want the right to a second and third opinion 
     following denial of coverage by a health plan, at no cost to 
     the patient;
       PSA members should not be forced to change doctors and 
     hospitals while in the midst of a course of treatment for a 
     health care problem;
       Doctors must be able to talk freely with patients without 
     fearing repercussions from health plans. Every doctor should 
     be free to discuss anything relative to a patient's health 
     with the patient, even if the information may be negative 
     towards the health plan. Health plans must not be permitted 
     to use tactics that discriminate against doctors for 
     cooperation in patient advocacy, such as threats of firing, 
     disciplinary action and by providing incentives to deny care;
       PSA members should be able to participate in clinical 
     trials that may maximize their independence and quality of 
     life without undue interference from their health plan; and
       PSA members are concerned about their right to privacy. No 
     medical information on a patient should be released without 
     the patient's approval.
       The right to quality health care and patient protection is 
     of primary importance to the members of the Paralysis Society 
     of America. PSA offers its support, and will gladly assist 
     you in any way we can to ensure that H.R. 2723 is enacted 
     into law.
           Sincerely,
                                                    Nancy Starnes,
     Director.
                                  ____

                                          Natioanal Association of


                                         School Psychologists,

                                    Bethesda, MD, August 24, 1999.
     Hon. Charlie Norwood,
     Longworth House Office Building,
     Washington, DC.
       Dear Representative Norwood: On behalf of the National 
     Association of School Psychologists, (NASP) I am writing to 
     express our strong endorsement of H.R. 2723, the Bipartisan 
     Consensus Managed Care Improvement Act of 1999.
       NASP is an organization that represents 21,500 school 
     psychologists and related professionals throughout the world. 
     NASP works to actively promote educationally and 
     psychologically healthy environments for all children and 
     youth. We work together with national coalitions to increase 
     support and funding for primary prevention services and 
     mental health programs that deter youth from delinquent 
     activity, assist them with improved learning and provide them 
     with experiences and role models to become successful in 
     life. In health care, our goal is to increase access and 
     affordability of health and mental health services for which 
     coverage is often extremely limited or denied.
       Developing a balanced compromise on the most controversial 
     of managed care reform provisions, the Bipartisan Bill would 
     provide essential protections for consumers in the private 
     health insurance marketplace. The Bipartisan Consensus Bill 
     maintains a strong utilization review process to require the 
     oversight of trained personnel, assures fair appeals, 
     guarantees access to emergency and urgent care services and 
     holds health plans accountable for their decisions. 
     Furthermore, this bill requires the development of quality 
     criteria along with performance and clinical outcome measures 
     for at-risk individuals and people with chronic and severe 
     illness. If H.R. 2723 is passed, this provision will have an 
     important positive impact on the health care provided to 
     adults with severe mental health illnesses, children with 
     serious emotional disturbances and other people with 
     significant mental disorders who are increasingly being 
     served in managed care settings.
       Our efforts to improve mental health service delivery must 
     include the elimination of insurance discrimination against 
     people with mental disorders and the serious problems 
     associated with the delivery of mental health care by HMOs. 
     It is time to move beyond the impasse in this effort. The 
     Bipartisan Bill creates a new ``Patients' Bill of rights'' 
     which should pass the House with minimal dissension. Thank 
     you for your commitment to reaching a workable compromise to 
     finally provide consumers with the opportunity to appeal 
     instances of discrimination or denial of care.
           Sincerely,
                                                 Susan Gorin, CAE,
     Executive Director.
                                  ____

                                     American Association of Oral,


                                   and Maxillofacial Surgeons,

                                     Rosemont, IL, August 26, 1999
     Hon. Charlie Norwood,
     U.S. House of Representatives, Washington, DC
       Dear Representative Norwood: On behalf of the American 
     Association of Oral and maxillofacial surgeons (AAOMS), which 
     represents the nation's approximately 6,000 oral and 
     maxillofacial surgeons, I thank you for supporting provider 
     nondiscrimination language as stated in Section 133(a) of the 
     bi-partisan ``Consensus on Managed Care Improvement Act of 
     1999''.
       We fell that this bill has the strongest chance of being 
     enacted, as it is a bi-partisan effort and is endorsed by 
     President Clinton. AAOMS lends its strong support for the 
     Consensus on Managed Care Improvement Act of 1999, and hopes 
     that it is enacted into law.

[[Page H7982]]

       Oral and maxillofacial surgeons in your district and across 
     the nation believe that provider nondiscrimination is a key 
     component of managed care reform. It is the top legislative 
     priority of the AAOMS.
       Thank you again for all your help in making sure that 
     provider nondiscrimination language was included in this 
     important piece of legislation.
           Sincerely,
                                        David A. Bussard, DDS, MS,
     President.
                                  ____

                                                American Podiatric


                                    Medical Association, Inc.,

                                     Bethesda, MD, August 31, 1999
     Hon. Charlie Norwood,
     U.S. House of Representatives, Washington, DC.
       Dear Mr. Norwood: With regard to HR 2723, the Bipartisan 
     Consensus Managed Care Improvement Act of 1999, I am pleased 
     to announce our unqualified support of the proposal. 
     Embodying every principle the association has embraced as 
     essential for meaningful managed care reform, we are 
     convinced its enactment is in the best interest of all 
     Americans.
       The strong bipartisan support your measure has heretofore 
     generated is compelling evidence that, given a fair hearing 
     by the full House, a comprehensive patient oriented reform 
     package can prevail. To this end we offer our understanding 
     and enthusiastic support.
       Best regards!
           Sincerely Yours,
                                             Ronald S. Lepow, DPM,
                                                        President.


                             Opticians Association of America,

                                     Fairfax, VA, August 24, 1999.
     Hon. Charlie Norwood,
     Washington, DC.
       Dear Representative Norwood: On behalf of the Board of 
     Directors and the members of the Opticians Association of 
     America, I am writing to thank you for sponsoring H.R. 2723, 
     the bipartisan managed care improvement bill.
       This bill would give basic, common-sense protections to 
     millions of Americans in managed care plans, and it is 
     certainly refreshing to see the bipartisan way in which it 
     was approached!
       In addition, we are pleased to see that the bill contains a 
     point-of-service option and anti-discrimination language 
     which guarantee consumers the widest possible choice of 
     providers.
       We look forward to continued collaboration in the interest 
     of America's health care consumers.
           Sincerely,
                                          Jacqueline E. Fairbarns,
     Assistant Executive Director for Government Relations.
                                  ____



                             American Osteopathic Association,

                                  Washington, DC, August 27, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives,
     Washington, DC.
       Dear Congressman Norwood: The American Osteopathic 
     Association (AOA) represents the nation's 43,500 osteopathic 
     physicians. As President, I am pleased to let you know that 
     the AOA endorses your bill, the ``Bipartisan Consensus 
     Managed Care Improvement Act of 1999'' (H.R. 2723).
       The AOA advocates, on behalf of patients, for Congress to 
     enact strong, meaningful, and comprehensive protections. 
     After six years of debate and delay, we believe that H.R. 
     2723 is the bipartisan legislation that will ensure the AOA's 
     long sought principles. These include: physicians allowed to 
     determine medical necessity; health plans held accountable 
     for their actions; a fair and independent appeals process 
     available to patients, and protections which apply to all 
     Americans.
       Over the last two decades, managed care has become less 
     interested in delivering quality healthcare to patients. 
     Instead, the focus seems entirely on the bottom line. It is 
     time to bring the focus back to our patients and away from 
     HMO profits. Employers and patients are tired of not 
     receiving the care they are promised, pay for, and deserve. 
     H.R. 2723 will help bring the quality back into healthcare 
     and allow osteopathic physicians to care for our patients in 
     accordance with the high principles guiding our profession.
       Again, thank you for your leadership on this critical 
     issue. We are encouraged by the broad bipartisan support your 
     legislation has received. The AOA pledges to work with you 
     and all Members of Congress to ensure swift enactment of H.R. 
     2723. Please feel free to contact Michael Mayers, AOA 
     Assistant Director of Congressional Affairs, in our 
     Washington office at 202-414-0148 with any further comments 
     or questions.
           Sincerely,
                                          Eugene A. Oliveri, D.O.,
     President, American Osteopathic Association.
                                  ____



                              American Counseling Association,

                                  Alexandria, VA, August 27, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives,
     Washington, DC.
       Dear Representative Norwood: I am writing on behalf of the 
     more than 51,000 members of the American Counseling 
     Association to express our strong support for your 
     legislation H.R. 2723, the Bipartisan Consensus Managed Care 
     Improvement Act of 1999. This bipartisan patient protection 
     legislation will afford health care consumers the essential 
     protections necessary to ensure the delivery of quality 
     health care services.
       H.R. 2723 provides a wide array of consumer protections 
     including several key components for mental health providers 
     and their clients, such as putting medical decisions in the 
     hands of medical experts, not the insurance company 
     bureaucrats; the ability to hold health plans liable when 
     their decisions to withhold or deny care result in injury or 
     death; adequate access to specialists; a continuity of care 
     clause, and a provision to prohibit nondiscrimination against 
     providers based on their type of license. In addition these 
     protections would apply to all privately insured individuals, 
     unlike other managed care legislation considered in Congress.
       Representatives Norwood, we thank you for your continued 
     advocacy on behalf of health care consumers. This legislation 
     will make a difference to the millions of Americans with 
     private health insurance. Please let us know if we can be of 
     any assistance in your work.
           Sincerely,
                                              Donna Ford, MS, NCC,
     President, American Counseling Association.
                                  ____

                                                   American Public


                                           Health Association,

                                  Washington, DC, August 10, 1999.
     Hon. Charles Norwood,
     Washington, DC.
       Dear Representative Norwood: On behalf of the American 
     Public Health Association, which represents more than 50,000 
     public health professionals around the country, I am writing 
     to express our support for your new bi-partisan managed care 
     reform bill, H.R. 2723.
       This bill will provide patients with real, enforceable 
     assurances that they will receive the care they need and have 
     purchased from managed care companies. If passed by Congress, 
     this bill will: improve access to emergency services; allow 
     more people to enter clinical trials; provide patients with a 
     fair appeals process for denied claims; lift barriers to 
     specialists; and hold plans responsible for the medical 
     decisions they make.
       Furthermore, the bill's broad bi-partisan cosponsorship--
     and announced support from President Clinton--makes it 
     Congress' best chance to complete action on this important 
     issue this year.
       We understand that some within the managed care industry 
     oppose any government regulation, but this issue is a very 
     important one for consumers, health care providers, and the 
     public health community. Your steadfast commitment to reform 
     and your strong leadership throughout this debate are 
     commendable. H.R. 2723 is a significant and welcome step 
     toward achieving new protections for managed care patients. 
     We look forward to continuing work with you toward 
     achievement of that mutual goal.
           Sincerely,

                                 Richard A. Levinson, MD, DPA,

                                     Associate Executive Director,
     Programs and Policy.
                                  ____

                                              National Partnership


                                         for Women & Families,

                                  Washington, DC, August 13, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives,
     Washington, DC.
       Dear Representative Norwood: The National Partnership is 
     pleased to endorse the Bipartisan Consensus Managed Care 
     Improvement Act of 1999 (H.R. 2723). This is strong, 
     bipartisan patient protection legislation, and thanks to your 
     hard work, we believe it can--and will--pass the House of 
     Representatives.
       For women and families, few issues resonate as profoundly 
     and pervasively as the need for quality health care. Survey 
     after survey reveals Americans' growing dissatisfaction with 
     the current health care system, and many feel the system is 
     in crisis. We need common-sense patient protections that will 
     restore consumer confidence and tip the balance back in favor 
     of patients and the health care providers they rely on.
       There are many features of this bill that are especially 
     important. First and foremost, this bill ensures that medical 
     judgments will be in the hands of medical experts, not 
     insurance bureaucrats looking at the bottom line. This bill:
       Ensures that patients have recourse to a genuinely 
     independent external review when care is denied.
       Allows patients to hold their managed care plan accountable 
     when plan decisions to withhold or limit care result in 
     injury or death.
       Ensures that women have direct access to ob-gyn services 
     from the participating health care professional of their 
     choice.
       Ensures that doctors and nurses can report quality problems 
     without retaliation from HMOs, insurance companies, and 
     hospitals.
       Ensures access to specialists, including, when appropriate, 
     specialists outside a plan's network.
       Ensures access to clinical trials that may save people's 
     lives.
       The House of Representatives faces an historic opportunity 
     to provide patients the protections they need. We look 
     forward to working with you to ensure passage of this 
     important legislation.
           Sincerely,
     Judith L. Lichtman,
       President.
     Debra L. Ness,
       Executive Vice President.
     Joanne L. Hustead,
       Director of Legal and Public Policy.

[[Page H7983]]

     
                                  ____
                                        The American Occuapational


                                     Therapy Association, Inc.

                                  Bethesda, MD, September 1, 1999.
     Hon. Charles Norwood,
     U.S. House of Representatives,
     Washington, DC
       Dear Representative Norwood: On behalf of the 60,000 
     members of the American Occupational Therapy Association, 
     Inc. (AOTA), I would like to express our endorsement for the 
     Bipartisan Consensus Managed Care Improvement Act of 1999, 
     H.R. 2723. We appreciate your leadership, along with 
     Representative John Dingell, in continuing to puruse strong 
     managed care legislation with real patient protections 
     through bipartisan efforts.
       H.R. 2723 contains many critical patient protections that 
     the members of AOTA believe are necessary to ensure patients 
     receive the care that they need. Federal legislation should: 
     guarantee patients' access to all medically necessary 
     specialty care using appropriate utilization review 
     standards; protect patients' right to choose a health care 
     plan allowing out-of-network care; prohibit the restriction 
     of importance medical communications and require information 
     disclosure standards; prohibit discriminatory practices 
     against health care professionals; require timely, 
     independent due process procedures; and hold health plans 
     accountable for their medical decisions.
  H.R. 2723 is considerably more comprehensive than legislation passed 
by he Senate in July. It is important that these protections are 
available to all Americans enrolled in private health care plans.
       Over the August recess we have notified our members, asking 
     them to talk to their legislators. Please let us know how we 
     can continue to assist you in your efforts to have 
     comprehensive managed care legislation addressed on the House 
     floor.
       Again, we thank you for your leadership and hard work on 
     this issue. We look forward to continuing to work with you to 
     pursue passage of comprehensive managed care legislation.
           Sincerely,

                                           Kathryn M. Pontzer,

                                       Senior Legislative Counsel,
     Federal Affairs Department.
                                  ____

                                          American Association for


                                  Marriage and Family Therapy,

                                  Washington, DC, August 23, 1999.
     Hon. Charles Norwood,
     House of Representatives,
     Washington, DC
     RE: Bipartisan Consensus Managed Care Improvement Act of 1999 
         (H.R. 2823)
       Dear Dr. Norwood: The American Association for Marriage and 
     Family Therapy is writing to express our strong support for 
     the Bipartisan Consensus Managed Care Improvement Act of 1999 
     (H.R. 2723). On behalf of the 46,000 marriage and family 
     therapists throughout the United States, we want to applaud 
     you and Rep. Dingell for your effort to provide Americans 
     with comprehensive patient protections.
       Your bill offers several safeguards that are integral to 
     our members, as well as the public at large. One provision, 
     the prohibition on discrimination against providers, has 
     particular significance. It expands consumer access to 
     qualified practitioners who are regulated by the states. 
     Without this protection, insurers and plans can continue to 
     discriminate against many licensed health care professionals. 
     Additionally, the provision will foster competition among 
     providers and expand the pool of trained practitioners.
       The ability to access speciality care is also a positive 
     component of this legislation. Patients with ongoing 
     healthcare conditions will greatly benefit from the 
     opportunity to access specialists who are trained in the 
     treatment of their special conditions. Moreover, removing the 
     requirement of a primary care referral will reduce costs and 
     delays that burden health care delivery.
       Other provisions of significance to our organization 
     include: an independent review process for determination of 
     medical necessity decisions; the ability of people with 
     special health care needs and chronic conditions to continue 
     to access their health care professionals after employers 
     change plans; the ability to hold managed care plans 
     accountable for decisions to deny care; and guaranteed access 
     to emergency care services.
       These protections are a superb example of how Members from 
     both sides of the aisle can work together to improve the 
     quality of medical care for all employees. Your leadership in 
     this effort is truly outstanding and appreciated. If there is 
     any role our organization can play in passage of this 
     legislation, please contact our Government Affairs Manager, 
     David Bergman, at (202) 467-5015. Its time to ensure that all 
     American are provided with the security of a comprehensive 
     health care system.
           Sincerely,

                                               Michael Bowers,

                          Executive Director, American Association
     for Marriage and Family Therapy.

                          ____________________