[Congressional Record Volume 145, Number 123 (Tuesday, September 21, 1999)]
[House]
[Pages H8454-H8459]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, I must say that I am so pleased to be 
following the special order of my colleague, the gentleman from Iowa 
(Mr. Ganske), because he addressed the same issue that I would like to 
address this evening and that is the need for HMO reform and the need 
to bring legislation to the floor of this House which we refer to as 
the Patients' Bill of Rights because it provides protection for 
Americans who are patients who happen to be members of HMOs or managed 
care organizations; and those protections are needed right now.
  They were needed a long time ago, but it is really time that the 
Republican leadership of the House of Representatives allow this bill 
to come to the floor to be debated, and I believe it will pass 
overwhelmingly.
  I must say, I have been on this floor many times over the last year, 
or even beyond, asking that the Republican leadership allow the 
opportunity for the Patients' Bill of Rights to come to the floor, and 
we were told last Friday for the first time that the Speaker has set 
the week of October 4, approximately 2 weeks from now, for that 
opportunity.
  Although I have to say that I am suspicious of the way that this will 
be brought to the floor and the procedure and the rules that will be 
followed; and I know that my colleague, the gentleman from Iowa (Mr. 
Ganske), mentioned that as well. I must say that I am pleased that we 
will be debating HMO reform and that one of the bills that we have been 
promised by the Speaker that will be brought to the floor is the 
Patients' Bill of Rights.
  I really need to emphasize this evening, as I have so many other 
times on the floor and this well, that there are differences between 
the various managed care reform proposals that have been proposed here 
and that even though it is true that the Republican leadership now says 
that they will allow debate on the Patients' Bill of Rights, they have 
also made it quite clear that they are going to favor bills other than 
the Patients' Bill of Rights and that there may and certainly will be 
an effort to pass alternative legislation to the Patients' Bill of 
Rights.
  I need to urge my colleagues not to fall into the trap of thinking 
that anything other than the new bipartisan Patients' Bill of Rights is 
acceptable, not only to us but to the American people.
  I wanted to point out that it has been very interesting. Really, just 
last Wednesday, I guess, September 13, in the New York Times, there was 
an article that talked about how the GOP leadership was very cool on 
our patients' rights plan and how they were

[[Page H8455]]

sort of scouring and looking at all kinds of ways of avoiding passage 
of the Patients' Bill of Rights. And I just wanted to, if I could, 
either summarize or read through some of the interesting aspects of 
this article because, as we know back in August, just before the summer 
break, in the first part of August, this was on August 6, just before 
we left for the summer recess, at that point the Speaker indicated that 
he was going to allow a Republican group, a group of Republicans, to 
put together a bill that he and the Republican leadership would find 
acceptable in terms of HMO reform.
  There was no question in my mind that this was a bill, this was an 
effort by the Republican leadership, to essentially bypass or kill the 
bipartisan Patients' Bill of Rights that had been drafted by my 
colleague, the gentleman from Georgia (Mr. Norwood); the gentleman from 
Michigan (Mr. Dingell), who has long been an advocate and who 
formulated the original Patients' Bill of Rights; the gentleman from 
Iowa (Mr. Ganske); myself; and others, who had basically come up with a 
bipartisan Patients' Bill of Rights that would have achieved real HMO 
reform. At the time on August 6, the Speaker said, well, I am not in 
favor of that bill, the Patients' Bill of Rights, but I will let the 
gentleman from Oklahoma (Mr. Coburn) and a few other Members of 
Congress on the Republican side see what they can come up with for us 
to consider in September that perhaps the Republican leadership would 
support.
  As we know, and I am again referring to this article in the New York 
Times, when the gentleman from Oklahoma (Mr. Coburn), who is a 
physician from Oklahoma, and the gentleman from Arizona (Mr. Shadegg), 
who is a Republican Member, disclosed the text of their bill last week 
when we came back after the August break, Speaker Hastert had no 
comment. Senior House Republicans, including the chairmen of several 
committees and subcommittees, expressed grave reservation about the 
bill that theoretically they had asked the gentleman from Oklahoma (Mr. 
Coburn) and others to put together as their alternative to the 
Patients' Bill of Rights.
  The gentleman from Texas (Mr. Armey), who is the House majority 
leader, described the Coburn-Shadegg bill as the least worst way to do 
the wrong thing, and he said the provisions of the bill authorizing 
patients to sue HMOs for injuries caused by the negligence of a health 
plan still bothered him.

  The gentleman from Virginia (Mr. Bliley), the chairman of our House 
Committee on Commerce, said he too was reluctant to create a new right 
to sue.
  Basically, what we see here is the Republican leadership once again 
backing off a bill which theoretically they had asked their own Members 
to put together, and the reason clearly was because they saw the 
Coburn-Shadegg bill as too much like the Patients' Bill of Rights, the 
bipartisan Patients' Bill of Rights, particularly with regard to the 
liability provisions.
  Now we read, or we find out, that even though the Speaker has said 
that he is going to allow managed care reform to come to the floor on 
the week of October 4, that not only will the Patients' Bill of Rights 
be an option, not only will the Coburn-Shadegg bill be an option, but 
it is very possible that another bill, which I think really expresses 
what the leadership wants, and this is the bill that came out of the 
House Committee on Education and the Workforce, and it was sponsored by 
the gentleman from Ohio (Mr. Boehner), basically what his bill does is, 
I think, take a piecemeal approach to HMO reform that is totally 
unacceptable and shows very dramatically where the Republican 
leadership is going on the important issue of HMO reform.
  I think what is going to happen, and we are basically seeing 
indications of that, is that the House Republican leadership will 
endorse the Boehner bill and try to get that through the rules that 
they will use to bring this legislation to the floor as the bill that 
we finally vote on as opposed to the Patients' Bill of Rights or even 
the bill that the gentleman from Oklahoma (Mr. Coburn) and the 
gentleman from Arizona (Mr. Shadegg) have come up with.
  I want to stress this evening that if that is what happens, if in 
fact the procedures that come out of the Committee on Rules that are 
set forth and the procedures by which we debate HMO reform on this 
floor the week of October 4 basically allow the Boehner bill to be the 
order of the day and that is the bill that the leadership supports, 
then we will have achieved nothing effectively in terms of HMO reform 
and this whole effort to try to come up with something that will help 
and protect the average American will have actually done the opposite, 
and HMO reform will be killed.
  I just want to explain, if I could briefly, where the Boehner bill is 
such a bad bill by comparison to the Patients' Bill of Rights that my 
colleague, the gentleman from Iowa (Mr. Ganske), the gentleman from 
Georgia (Mr. Norwood), the gentleman from Michigan (Mr. Dingell), and 
so many others of us who care about HMO reform have put forward on a 
bipartisan basis.
  The Boehner bills leave out most Americans. The bills cover only 
people who obtain health insurance through their employer. The bills 
fail to extend needed patient protections to the millions of people 
that purchase health insurance individually; and what we are basically 
saying, and the Boehner bills do not do, is that the protections that 
we are seeking through the Patients' Bill of Rights, those protections 
should apply to all health plans, regardless of whether it is employer 
sponsored, whether it is individually purchased, whether it is ERISA, 
whether it is Medicare, whatever it happens to be, all health plans 
should have these same basic protections from HMOs or managed care.
  The other thing and this is most important, if we look at the Boehner 
bills, they pretend to secure patients' rights but they contain no way 
to enforce those rights other than the weak penalties currently 
available under ERISA, and enforcement is so important. It is not that 
those of us who support the Patients' Bill of Rights want everybody to 
sue. In fact, the example in Texas, which is one State that has passed, 
as the gentleman from Iowa (Mr. Ganske) has mentioned, a very 
progressive Patients' Bill of Rights in Texas, where there is the 
ability to sue now and there has been for 2 years, only one or two 
lawsuits have actually been filed. Because once those patient 
protections are in place, there is no reason to file a lawsuit because 
there are basic protections under the law.
  So what we are saying is, even though we would provide for a right to 
sue, even though we would have an external review and a procedure for 
that, it is only because we want the practical enforcement to be there, 
to guard against the abuses of HMOs.
  What the Boehner bills do is it is basically a very narrow, piecemeal 
approach. For example, H.R. 2043, which is supposed to protect against 
the so-called gag clauses, does not prohibit plans from retaliating 
against doctors who discuss the plan's financial incentives. One of the 
worst offenses right now with HMOs is the fact if the plan does not 
cover a particular procedure, the doctor is gagged and cannot say 
anything about that procedure. A lot of HMOs right now have that kind 
of rule, gagging, not allowing a doctor to say what procedure a person 
needs because they will not cover it. What a terrible thing, and there 
is no protection against that in the Boehner bills.

  Let me just give a few other indications of the inadequacies in the 
Boehner bills and why I dread the fact that the House leadership, the 
Republican leadership, may try to have this be the final product of 
this debate the week of October 4.
  The Boehner bills require direct access to physicians only for 
routine OB-GYN care. They do not allow persons with chronic or serious 
medical conditions to have direct access to specialists. Nor do the 
Boehner bills permit persons with conditions requiring ongoing care to 
obtain standing referrals to a needed specialist. The bills do not 
include a requirement that a plan have a provider network with a 
sufficient number and variety of providers who are available and 
accessible in a timely manner. In addition, there is no requirement 
that a plan cover the services of a specialist who is not in the plan's 
network if the network lacks the provider expertise or capacity to 
treat the enrollee's condition.

[[Page H8456]]

  One of the biggest concerns that I hear from my constituents with 
HMOs is inadequate access to specialists. We need to provide for that 
and that is what the Patients' Bill of Rights does. That is what the 
Boehner bills do not do.

                              {time}  2030

  Continuity of care. The Boehner bills do not protect patients from 
abrupt changes in ongoing treatment when their provider is dropped from 
the plan's network or their employer changes health plans. They have no 
provision to limit excessive provider financial incentives 
arrangements. This is another big complaint. Right now, there are 
incentives in a lot of HMOs for one's doctor not to provide health care 
in many cases, or not to provide treatment in certain instances, 
because there is a financial incentive if he provides less care. Now, 
this is not always true, but it is one of the abuses that we find from 
time to time, and we do not want it to be there; we want to make sure 
it does not happen, that there is no such financial incentive.
  Another thing in the Boehner bills: emergency care. One of the 
biggest complaints I hear about HMOs is that if I have to go to an 
emergency room because I feel the necessity, I have chest pain, I feel 
I have to go to a hospital, oftentimes I need prior authorization, or I 
can only go to an emergency room for a hospital that is maybe 50 miles 
away instead of the one that is down the street. Well, that has to be 
changed. But H.R. 2045, one of the Boehner bills, fails to insure that 
people can obtain emergency care when and where the need arises without 
fear of excessive charges.
  Under this bill, if a plan and the emergency room physician disagree 
on what emergency care is necessary, the patient can be stuck holding 
the bill. I use the example of severe pain. Severe pain does not count 
as an emergency if an individual with severe chest pains risks having 
to pay for services out of pocket, or if he or she goes to an emergency 
room without getting prior authorization. So again, one does not have 
protection that one can make sure that if one has severe pain and 
thinks they are having a heart attack, they can go to an emergency room 
down the street and they do not have to worry about prior 
authorization.
  I just want to mention one more thing about the Boehner bills because 
I think the enforcement aspect is so important. What we are saying 
about the patients' bill of rights and really the two things that are 
the hallmark of the patients' bill of rights, the bill that should pass 
this House, and I hope that it does, one is the definition of ``medical 
necessity,'' what is necessary, what kind of operation is necessary, 
how long one has to stay in the hospital, whether one has a particular 
procedure or a particular operation. That definition of what is 
``medically necessary'' is made by the physician and the patient, not 
by the insurance company.
  The second hallmark of the patients' bill of rights is that if one 
has been denied care, one can go to an outside panel or an outside 
review board that is not influenced by one's HMO and ultimately, if 
that fails, that one can bring suit in court.
  Well, under the Boehner bills, H.R. 2089, they purport to create an 
independent external appeals system, but it is biased against the 
patients and allows the health plans to control virtually all aspects 
of the external review process. The bill requires external reviewers to 
uphold plans as long as the plans follow their own definitions, no 
matter how arbitrary the definitions. A plan could define ``medical 
necessity'' to be nothing more than care defined under whatever 
treatment guidelines and utilization protocols the plan adopts, even if 
the guidelines and protocols are not backed by any clinical evidence or 
good professional practice.
  What we say in our patients' bill of rights is the decision about 
what is medically necessary is made by the doctor and the patients. How 
we effectuate that is that we use the standards of care that are 
applicable for that particular specialty. So if the Board of Cardiology 
has certain procedures which they consider the norm in the practice of 
cardiology, those are the procedures that apply in terms of determining 
what is medically necessary. But under the Boehner bills, it is up to 
the HMO to decide that. They do not have to make reference to the local 
Board of Cardiology; they do not have to make reference to any studies 
at all. They just define what is ``medically necessary'' on their own 
based, on whatever cost containment is beneficial to them, in many 
cases.
  That is what we do not want. We do not want the external review 
process to be limited to what the HMO defines as medically necessary. 
Of course, we want to make sure that there is an outside external 
review, unbiased, not under the influence of the HMO, and that 
ultimately one has the right to sue.
  Mr. Speaker, I could talk more this evening about what is important 
in our patients' bill of rights and why it is so much preferable to the 
Boehner bills and other bills that might come to the floor; but I think 
the most important thing is that if the Republican leadership is really 
serious about allowing the opportunity for a full and fair debate 
during the week of October 4 on patient protections, they have to craft 
the rule in such a way that there is a clear opportunity for us and for 
the majority of this House to support the patients' bill of rights. I 
am fearful that that is not going to happen.
  I will be watching, as my colleague from Iowa mentioned, over the 
next few weeks to see what kind of rule comes out of the Committee on 
Rules, but we are going to be very careful to monitor that, because if 
there is going to be a promise that we have an opportunity to bring 
real protections to this floor, then it has to be a promise that is 
fulfilled pursuant to the rules of this House. I hope that that is the 
case, and I will continue to look at it over the next 2 weeks.


            Issues of Importance in the Republic of Armenia

  Mr. PALLONE. Mr. Speaker, I wanted to turn briefly, if I could 
tonight, to a couple of international issues unrelated to the issue of 
HMO reform. As many of my colleagues know, I am very much involved in 
both the Armenia caucus as well as the India caucus that we have here 
in the House of Representatives, and I wanted to take a few moments 
initially to talk about the anniversary, if you will, of Armenia's 
independence, and then I would like to talk a little bit about some 
issues relative to India that will be coming up in the next few weeks 
in the context, most likely, of some of the appropriations bills and 
conference reports that we will be considering here on the floor of the 
House.
  Mr. Speaker, if I could turn initially to the Republic of Armenia. 
Today, Tuesday, September 21, is actually the eighth anniversary of the 
independence of the Armenian Republic, and it is celebrated by the 
citizens of Armenia, as well as people of Armenian dissent here in the 
United States and around the world.
  The United States, as the leader of the free world, has welcomed the 
arrival of Armenia into the family of democratic nations, and I am 
proud that this Congress has consistently voted to provide humanitarian 
and economic development assistance to help Armenia preserve democracy 
and the institutions of civil society and to continue the transition to 
a free market economy. I am proud that our administration has made a 
priority of achieving a negotiated settlement to the Nagorno Karabagh 
conflict, which is vital to bringing stability and economic integration 
to the southern Caucasus region.
  However, I believe there is a lot more that America can do to help 
Armenia achieve its rightful place as a free nation with a secure 
future, and to do so is not only in Armenia's interests. The United 
States has a fundamental national interest in bringing about stability 
in the strategically located Caucasus region and in supporting those 
emerging nations like Armenia that share our values.
  Mr. Speaker, I had the opportunity to visit the Republic of Armenia 
as well as Nagorno Karabagh and Azerbaijan with a bipartisan group of 
Members of Congress last month, in August. We saw firsthand the 
outstanding progress Armenia has made in fostering democracy and in 
promoting economic growth.
  Mr. Speaker, the Republic of Armenia may be a very young country, but 
the Armenian nation is one of the

[[Page H8457]]

 world's most ancient and enduring. The story of the Armenian people, a 
nation whose history is measured not in centuries, but in millennia, 
the first to adopt Christianity as its national religion, is an 
inspiring saga of courage and devotion to family and nation. It is also 
an epic story of a triumph of a people over adversity and tragedy.
  Early in this century in one of history's most horrible crimes 
against humanity, 1.5 million Armenian men, women, and children were 
massacred by the Ottoman Turkish Empire. Every April, Members of this 
House join in commemoration of the Armenian genocide, and we can never 
relent, and will never relent, in our efforts to remind the world that 
this tragedy is a historic fact and to make sure that our Nation and 
the whole world community and, especially the Turkish nation, come to 
terms with and appropriately commemorate this historic fact.
  After the collapse of the Ottoman Empire, the people of Armenia 
established an independent state on May 28, 1918. But unfortunately, 
the fledgling nation was not able to overcome the simultaneous 
pressures of the forces of Ataturk's Turkey and the Russian Communists. 
Ultimately, the lands of eastern Armenia were occupied by the Soviet 
Red Army, and Armenia became one of the Soviet Union's constituent 
republics in 1936.
  During 5\1/2\ decades under Soviet rule, at least some Armenian 
cultural presence was maintained, even if the political shots were 
called in Moscow. However, the predominantly Armenian region of Nagorno 
Karabagh was placed under the jurisdiction of Azerbaijan under an 
arbitrary decision by the dictator Stalin.
  Mr. Speaker, in the late 1980s, the tumultuous changes rocking the 
Soviet Union were strongly felt in Armenia. In 1988, a movement of 
support began for the Karabagh Armenians to exercise their right to 
self-determination. The movement for the freedom of Karabagh helped to 
rekindle the struggle for freedom for all the Armenian people.
  That same year, a devastating earthquake struck northern Armenia and 
its destruction continues to be in evidence. In 1990, the Armenian 
National Movement won a majority of seats in the parliament and formed 
a government; and on September 21, this day, in 1991, 8 years ago, the 
Armenian people voted overwhelmingly in favor of independence in a 
national referendum.
  Since then, Mr. Speaker, the Armenian people have worked to 
reestablish a state and a nation to create a society where their 
language, culture, religion, and other institutions are able to 
prosper. The progress made in 8 short years by the Republic of Armenia 
has been an inspiration, not only for the sons and daughters of the 
Armenian Diaspora, but for Armenians and freedom-loving people 
everywhere. Having survived the genocide and having endured decades 
under the domination of the Soviet Union, the brave people of Armenia 
have endeavored to build a nation based on the principles of democracy 
and opportunities for all.
  Mr. Speaker, as they have for so much of their history, the Armenian 
people have accomplished all of this against daunting odds. The tiny, 
landlocked Republic of Armenia is surrounded by hostile neighbors, 
Turkey and Azerbaijan, who have imposed blockades that have halted the 
delivery of basic necessities. Yet independent Armenia continues to 
persevere. While democracy has proven to be an illusive force in much 
of the Soviet bloc, Armenia held multiparty presidential elections last 
year; and on May 30 of this year, parliamentary elections were held 
once again.
  As the founder and chairman, with the gentleman from Illinois (Mr. 
Porter) of the Congressional Caucus on Armenian Issues, I consider 
U.S.-Armenia relations to be one of our key foreign policy objectives. 
Support for Armenia is in our practical interests. Helping to support 
stabilization is strategically important in an often unstable part of 
the world. Standing by Armenia is also consistent with Armenia's 
calling to support democracy and human rights and to defend free 
peoples throughout the world.

  Mr. Speaker, I want to emphasize that the people of Armenia want good 
relations with their neighbors and the entire world community; and I 
believe the moral, political, and economic power of the U.S. could go a 
long way towards helping Armenia achieve that goal.
  Finally, Mr. Speaker, I would like to say that the reality of daily 
life for the people of the Republic of Armenia continues to be 
difficult. I saw that, once again, with my colleagues when we visited 
Armenia in August. But the commitment to working for a better future is 
remarkably strong in all the men, women, and young people of Armenia, 
especially.
  I just want to take this occasion to wish the Armenian people well on 
the occasion of their independence day and, more important, in their 
ongoing effort to establish a free republic so that their children may 
prosper in the homeland of their ancestors.


                          India-U.S. Relations

  Mr. PALLONE. Mr. Speaker, I would like now to turn lastly to the 
issue, some of the issues relative to India-U.S. relations, and there 
are basically three topics that I would like to mention which I think 
are relevant, particularly in light of some of the appropriations bills 
that are now going to conference and which will be coming to the floor 
within the next week or two.
  First, I did want to start out by saying with regard to India-U.S. 
relations that there has been, I noticed in the last week or two, since 
we came back from the August break, an effort by Pakistan once again to 
internationalize the Kashmir conflict by trying to bring in the United 
States as a mediator. I think many of us know, my colleagues know, that 
India maintains that the Kashmir conflict should be addressed on a 
bilateral basis with Pakistan under established frameworks agreed to by 
both countries.
  Now, thus far, the Clinton administration has widely resisted 
Pakistani attempts to internationalize the Kashmir conflict; and 
certainly that was the case after the last conflict where President 
Clinton specifically said that he was not going to act as a mediator 
and that the two nations basically had to sit down together and work 
out their differences. However, I understand that some of my 
colleagues, Democrats and Republicans, in the House are now circulating 
once again letters urging that the administration break with this long-
standing precedent and intervene in this bilateral dispute in Pakistan.

                              {time}  2045

  I think such a development would not contribute to peace and 
stability in South Asia. Rather than seeking this what I consider 
reckless change of policy, it is important for Members of Congress to 
encourage the administration to maintain its current prudent approach.
  I believe President Clinton's July 4 meeting with Prime Minister 
Sharif of Pakistan succeeded in bringing about a Pakistani withdrawal 
of troops from India's side of the line of control. I welcome that. 
There is absolutely no question that President Clinton played a major 
role in the ultimate withdrawal, if you will, of Pakistan back to the 
line of control, so now we have relative peace in Kashmir.
  But, unfortunately, Pakistan is still trying to drag the United 
States into this conflict as an international mediator. This is really 
nothing more than a strategic ploy to enhance Pakistan's position in 
the conflict.
  India has made it clear that it does not favor third party mediation. 
Pakistan has earned its recent international isolation, given its 
destabilizing actions in Kashmir. Pakistan must not be rewarded with 
gains at the negotiating table in light of its costly gambit in 
Kashmir, a policy that has militarily failed and has strategically 
failed. They should not be given some propaganda advantage by having 
this Congress suggest that the United States should intervene.
  Mr. Speaker, as part of this special order I include for the Record 
the text of a letter I sent to President Clinton back in July before 
the break, where I urged him to resist Pakistan's efforts to bring the 
United States into its bilateral conflict with India.
  I think this letter was appropriate in July, and it is still 
appropriate today.
  The letter referred to is as follows:

[[Page H8458]]

                                                     July 7, 1999.
     Hon. William Jefferson Clinton,
     The White House,
     Washington, DC.
       Dear Mr. President: I am writing to express my support for 
     your efforts to effectuate a withdrawal of Pakistani forces 
     from India's side of the Line Of Control in Kashmir, and to 
     respectfully urge that the Administration continue to resist 
     Pakistan's efforts to internationalize its bilateral dispute 
     with India by drawing in the United States as a mediator.
       In the aftermath of your Independence Day meeting with 
     Prime Minister Nawaz Sharif, I was very encouraged by the 
     published reports indicating that Administration officials 
     believe that yielding to Pakistan's desire to bring the U.S. 
     in as an international mediator would be to side with 
     Pakistan, given India's long-standing position that the issue 
     should be resolved bilaterally.
       I welcome your meeting with Prime Minister Sharif with the 
     goal of getting Pakistan to withdraw its forces from India's 
     side of the Line of Control (LOC). I was somewhat concerned 
     by Mr. Sharif's characterization, in the Pakistani media, of 
     the talks at the White House, suggesting that you will play a 
     more active mediating role in Kashmir. I hope this was merely 
     an exercise in spin control by Mr. Sharif. But I would urge 
     that you and the Administration maintain the current, limited 
     approach of achieving a Pakistani withdrawal, while allowing 
     India and Pakistan to resolve the Kashmir issue on a 
     bilateral basis, pursuant to the framework set forth in the 
     Simla Accords and, more recently, in the Lahore Declaration. 
     The bottom line is that India is fighting to defend its 
     territory against an armed infiltration. Under those 
     circumstances, the U.S. must maintain a clear policy of 
     opposing armed aggression and not rewarding Pakistan with 
     gains at the negotiating table.
       I am also encouraged by indications that you will travel to 
     South Asia later this year. For the reasons that I've stated 
     above, it is important that the trip not be a vehicle for the 
     U.S. to play a mediator role in Kashmir.
       I have written to you previously urging that you visit 
     India, the world's largest democracy. I cannot emphasize 
     enough how valuable it would be in bringing the U.S. and 
     India closer together.
       Thank you for your attention to this matter and for your 
     continued leadership on this and other urgent foreign policy 
     priorities.
           Sincerely,
     Frank Pallone, Jr.
                                  ____



                                                  U.S. Senate,

                                    Washington, DC, July 21, 1999.
     Hon. William Jefferson Clinton,
     The White House, Washington, DC.
       Dear Mr. President: We commend your timely intervention to 
     help defuse the immediate crisis in Kashmir. Particularly 
     important is your commitment to take a personal interest in 
     encouraging the Prime Ministers of India and Pakistan to 
     resume and intensify their dialogue, begun in Lahore in 
     February, to resolve all issues between them, particularly 
     Kashmir.
       Kashmir is the most dangerous nuclear flashpoint in the 
     world today. As President Richard Nixon noted 25 years ago, 
     nuclear powers have never fought each other, but the clash 
     between Muslim Pakistan and Hindu India over disputed Kashmir 
     territory could erupt into the world's first war between 
     nuclear powers. To avert this possibility, the dispute over 
     Kashmir's unresolved status must be settled promptly and 
     peacefully.
       The United States should help break the stalemate over 
     Kashmir to reduce the chance of nuclear war in the Asian 
     subcontinent. Therefore, we urge you to: (1) consider 
     appointment of a Special Envoy who could recommend to you 
     ways of ascertaining the wishes of the Kashmiri people and 
     reaching a just and lasting settlement of the Kashmir issue; 
     and (2) propose strengthening the UN Military Observers Group 
     to monitor the situation along the Line of Control.
       We await your prompt response and stand ready to support 
     these diplomatic initiatives.
           Sincerely,
     Jim Johnson.
     ------ ------.
     ------ ------.
     Robert G. Torricelli.

  The second issue I want to mention relative to India relates to the 
foreign operations appropriations bill, on which I believe tomorrow the 
House and Senate conferees will meet to hammer out the differences 
between the two bills in the two Houses with regard to the Foreign 
Operations Appropriations Act.
  What I am asking is that the conferees not adopt a Senate provision 
which could affect India. Section 521 of the Senate fiscal year 2000 
foreign operations bill reads or talks about special notification 
requirements.
  It says in section 521 that, ``None of the funds appropriated in this 
Act shall be obligated or intended for Colombia, India, Haiti, Liberia, 
Pakistan, Serbia, Sudan, or the Democratic Republic of Congo, except as 
provided through the regular notification procedures of the Committee 
on Appropriations.''
  What this section does, what this Senate provision will do, is to 
require the administration to notify the House and Senate 
appropriations committees whenever the fiscal year 2000 foreign aid is 
allocated to India. The Committee on Appropriations, as required by 
law, would have 15 days to approve or disapprove the allocation.
  But I would point out to my colleagues, Mr. Speaker, that this 
procedure is not imposed on all countries that receive U.S. foreign 
aid. It is used to closely monitor countries that receive U.S. foreign 
aid only if there is concern on the part of the Committee on 
Appropriations.
  The House bill, the House Foreign Operations Act, contains a similar 
provision, but it does not include India as one of the countries that 
come under this provision. I want to commend the House appropriators 
for recognizing that there is no reason to include India along with 
these other countries that are mentioned.
  I say that and I urge the conferees not to adopt the Senate language 
and to adhere to the House language because India is a democracy. India 
is a market economy. India has become increasingly close to the United 
States. It has a huge market for U.S. goods and trade.
  I think it would be a mistake to label India as a pariah in this 
fashion for any limited U.S. assistance that the State Department or 
the USAID may try to provide to India through humanitarian or 
development assistance. We provide very little aid to India. It is 
relatively insignificant. But the point is that India should not be 
painted as the sort of pariah these other countries that require this 
notification are.
  I know some of my colleagues will say, well, Pakistan is included as 
one of these nations. But the fact that Pakistan is included on this 
list for prior notification does not mean that India should be 
included. If the recent conflict in Kashmir that I just pointed out 
showed anything, it was that India acted responsibly, whereas Pakistan 
instigated a military incursion that could have led to a wider war. Let 
us not reward, if you will, Pakistan by saying that India should be 
included on this notification list when there is absolutely no reason 
to do that.
  In a similar vein, and lastly, with regard to U.S.-India relations 
this evening, Mr. Speaker, I wanted to mention the fiscal year 2000 
defense appropriations bill, which is also in conference at this time.
  There is a provision in the Senate bill that would suspend for 5 
years certain sanctions against India and Pakistan. I support this 
provision wholeheartedly. There is no reason for us to continue these 
sanctions against both nations because the only country that is 
suffering for it is the United States, because of limitations on our 
exports and our trade and our business opportunities in India and 
Pakistan.
  I want to say that while I strongly support the end of the sanctions 
and the suspension of the Glenn amendment sanctions against these two 
South Asian nations, there is another critical provision in the Senate 
language that would, in my opinion, be a grave mistake. That is the 
Senate language to repeal the Pressler amendment, which bans U.S. 
assistance to Pakistan.
  I have already spoken out on the floor previously and explained the 
reasons why we should not repeal the Pressler amendment. Again, a lot 
of this goes back to what has been happening the last few months, the 
Kashmir conflict; the fact that Pakistan continues a policy of nuclear 
proliferation, which is not what India is doing.
  We were reminded about why the Pressler amendment was needed because 
of the way that Pakistan carried out this war in Kashmir over the 
summer and instigated the war, many times with regular Pakistan army 
troops.
  Pakistan has also repeatedly been implicated, along with China, Iran, 
and North Korea, in the proliferation of nuclear weapons and missile 
technology. India's nuclear program, by contrast, is an indigenous 
program, and India has not been involved in sharing in technology with 
unstable regimes.
  I want to mention one more thing tonight that is new in this regard. 
That is that this month, in September, the CIA issued its annual 
national intelligence estimate on missile threats reported. In this 
annual report, they reported that Pakistan has obtained M-

[[Page H8459]]

11 short-range missiles from China and medium-range missiles from North 
Korea. The CIA's assessment is that both missiles may have a nuclear 
role, and there have been calls in Congress for new sanctions to be 
imposed on China in light of these latest revelations, a step that I 
would certainly be prepared to support.
  But besides imposing sanctions on countries that transfer this type 
of technology, like China, I believe we should also hold the countries 
who receive these weapons systems accountable. We certainly should not 
reward countries like Pakistan by lifting the existing sanctions on 
military transfers in light of the information that has recently come 
to light in this CIA report.
  So I would once again say, Mr. Speaker, that this is yet another 
reason why we should not support repeal of the Pressler amendment. I 
would say again that I hope that the conferees, and I would urge the 
conferees to not repeal the Pressler amendment, even as I support the 
idea of eliminating the Glenn amendment sanctions against both India 
and Pakistan.

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