[Congressional Record Volume 145, Number 132 (Monday, October 4, 1999)]
[House]
[Pages H9293-H9296]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            THE NORWOOD-DINGELL BILL OFFERS REAL HMO REFORM

  The SPEAKER pro tempore (Mr. Cooksey). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from New Jersey (Mr. Pallone) 
is recognized for 30 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from the Virgin 
Islands (Mrs. Christensen).


         The HIV-AIDS Crisis in the African-American Community

  Mrs. CHRISTENSEN. Mr. Speaker, I really appreciate the gentleman's 
generosity.
  Mr. Speaker, I yield to the gentlewoman from Texas, Ms. Eddie Bernice 
Johnson.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I thank the 
gentlewoman from the Virgin Islands (Mrs. Christensen) and the 
gentleman from New Jersey (Mr. Pallone) for yielding.
  Mr. Speaker, I join the Members here representing the Black Caucus, 
and I plead for more attention and funding to be given for prevention 
and treatment of the HIV virus and the AIDS disease.
  Mr. Speaker, somehow I think that back in 1980, 1981, and 1982, when 
many of the leaders from the gay community were speaking out against 
this virus, that much of the other parts of the community simply 
ignored it because they thought it was just a disease of the gay and 
lesbian population.
  Even at that time, I knew a virus did not know the sexual practices 
of people, and I felt it was a communicable disease that had the 
capacity of infecting almost anyone. That has proven to be true. Back 
in 1980 and 1981, when we were having meetings at home, I was getting 
warnings that it was dangerous to be talking about this kind of virus 
that is affecting just the gay community.
  We now find that is not the case. It is a communicable disease that 
will affect all persons that are subjected or exposed to this virus in 
the workplace, in the health facilities, anywhere that persons can be 
exposed to this virus.
  Mr. Speaker, we now plead for this money to follow where it is. We 
know that we have had reductions, and we are always pleased about 
having reductions in any kind of communicable disease. We have seen 
almost a wipe-out of diphtheria and all the various viruses and 
bacterial communicable diseases we have had in the past. Hopefully we 
will speak of this disease as one of the past, but we cannot ignore the 
education that must taken to prevent this devastating virus.
  With our young people and our youth groups, they must understand what 
causes the exposure and how to prevent that exposure. Far too many 
people are dying of AIDS. Even though it is much less than what it was 
some years ago, any death from this virus is too many, because it means 
that someone has ignored or not known what exposes them to this deadly 
virus.
  People are living longer, which is costing more for care, and we are 
always pleased to have good results, but nothing surpasses preventing 
diseases of this sort. For that reason, I hope we would give real 
attention to educating especially our younger people.
  We are finding that our older women in heterosexual relationships 
have an increase in the incidence of the HIV-AIDs virus because of 
loneliness, all kinds of other activities that would lead them to be 
exposed to this virus. That must be given attention. No matter what the 
profile of the individual might be or might seem to be, caution is 
advised.
  We have gone a long way in attempting to keep people alive with the 
various drugs that are very, very costly, and causing them to live 
longer lives. But nothing yet has come along for us to see the real end 
to this deadly virus. The best thing we can do is prevent it. We find 
that the persons who are the most sometimes uneducated are the ones who 
least believe that they can be exposed to this virus, and they are the 
ones who are becoming more exposed all the time. No one, absolutely no 
one, is safe when they take part in any activity that exposes them to 
this virus, no matter what.
  I am eternally grateful for the leaders in the gay community for 
continuing to talk about this virus, and not allowing the rest of us to 
forget it just because they had a larger incidence. That incidence has 
gone down tremendously in that community, but the leadership continues 
almost to come from the concentration of their community.
  I am grateful for them continuing to bring forth the leadership in 
educating the people, but there is an element

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missing. When people think it is only in the gay community, they simply 
think they are over and above this exposure. This is the myth we must 
break down. This is a virus that absolutely anyone can be exposed to. 
It only takes one exposure, so the education must go forth in all 
communities, young and old, heterosexual or not. We must not stop 
educating, because that is the only thing that is going to prevent this 
virus. It is costly, the treatment is very costly, the suffering is 
costly. We must really focus on prevention and not just paying for the 
illness.
  I want to thank the leadership of the gentlewoman from the Virgin 
Islands (Mrs. Christensen). As an M.D., she is fully aware of all of 
the factors involved, and I appreciate the leadership that she has 
brought forth.
  Mrs. CHRISTENSEN. I thank the gentlewoman from Texas (Ms. Eddie 
Bernice Johnson). I want to thank her for her leadership as a health 
care professional, as well as Vice-Chair of the caucus.
  Mr. Speaker, I yield to the gentleman from New Jersey (Mr. Payne).
  Mr. PAYNE. Mr. Speaker, first of all, let me thank the gentleman from 
New Jersey (Mr. Pallone) for yielding.
  I commend the gentlewoman from the Virgin Islands (Mrs. Christensen) 
for her perseverance, and the persistence and leadership she has shown 
by being a physician, and we are so happy to have her.
  But I also would like to add that we are in good company, because the 
Speaker pro tempore tonight is also a person who has done work on river 
blindness, and has donated his time and effort and resources to try to 
help people who are much worse off in another part of the world. I 
commend him for his work.
  Mr. Speaker, we are in a crisis. The issue of HIV and AIDS in this 
country is one of the most serious problems we must grapple with. Since 
the AIDS epidemic began in 1981, more than 640,000 Americans have been 
diagnosed with the disease, and more than 385,000 men, women, and 
children have lost their lives.
  I have been at the forefront of fighting against AIDS since the 
1980s, when it was not quite as acceptable to talk in public about this 
dread disease. In 1989, when I was first elected to Congress, I called 
a congressional hearing in my district of Newark, New Jersey, to sound 
the alarm on the epidemic that everyone was ignoring.
  In 1991, I introduced the abandoned infants bill, which was approved 
in the House. This was a bill to protect abandoned infants, some of 
whom were infected with HIV virus, and for other programs to assist 
them. I was outraged at the lack of attention being paid to this 
disease, a disease that was and still is killing people every day in 
every community.
  This past reluctance to address the problem that was staring us in 
the face is one reason why we have such a grave situation today. While 
we have advanced in that respect, we cannot rest on our laurels because 
the problem still exists and it is growing stronger with every passing 
day, especially with regard to people of color.
  For example, African-Americans make up only 12 percent of the 
population, but account for 45 percent of all reported HIV-AIDS cases. 
African-American women account for 56 percent of women living with HIV-
AIDS, and to me, the most sobering statistic, African-American children 
account for 58 percent of children living with the disease.
  The bottom line, Mr. Speaker, is that we are dying, and something 
must be done. The Clinton administration has worked with the 
Congressional Black Caucus to address the disproportionate burden of 
AIDS in racial minorities by funding money to those communities most 
affected. Together, we fought a hard battle with the majority party to 
secure an additional $156 million on targeted initiatives to address 
racial and ethnic minorities. A local Newark group fighting against 
AIDS with drama is Special Audiences, which recently received one of 
these grants.
  This increase in funding is a good start, but it is simply not 
enough. Right now AIDS is the leading cause of death of African-
American males between the ages of 25 and 44, the leading cause of 
death. This is unacceptable. Our young black men represent our future, 
and this terrible disease is killing them off.
  In order to address the AIDS issue effectively, we need to tackle the 
problem at all levels. First, we need to increase awareness of the 
disease. The difference in response from my first hearing on AIDS to 
this forum tonight is like the difference between night and day. The 
awareness of the disease has increased dramatically, and that is a good 
indication that people want to be helped.
  Secondly, we have to educate people on the dangers of this disease. 
This means everyone. AIDS is a killer that affects every segment of our 
population and every age group, from children to elderly adults. 
Without properly educating people, we will find ourselves in a much 
worse situation down the road than we are today.
  Finally, we must encourage better treatment and health care for those 
who have the disease. The disproportionate number of AIDS cases in the 
African-American population is not due to the lack of medical 
technology or advancements. Rather, it points to the limitations that 
African-Americans face in access to health care. The medicines and 
treatments are out there. They are effective, but we do not have access 
to them. That is wrong.
  Let me conclude by saying there is a common bond between all of these 
strategies. They are all contingent on increasing the Federal funding, 
and ensuring that these funds are targeted to the population that needs 
it the most.
  Our struggle against AIDS and the AIDS epidemic is far from over. Our 
efforts now are extremely important to the future of each and every 
citizen of the country. Every concerned individual needs to take an 
active role in the fight against AIDS. We must wake up, and we must 
make a concerted effort at both the Federal and grassroots level if we 
are truly determined to defeat the AIDS crisis.
  Mr. PALLONE. Mr. Speaker, I wanted to spend some time tonight, 
because this is the week when managed care reform, HMO reform, will 
come to the floor for the first time. I just wanted to spend about 15 
or 20 minutes talking about why the Patients' Bill of Rights, the 
bipartisan Norwood-Dingell bill, is the right measure, and why every 
effort that may be made by the Republican leadership over the next few 
days to try to stop the Norwood-Dingell bipartisan bill, either by 
substituting some other kind of HMO so-called reform or by attaching 
other amendments or poison pills that are unrelated and sort of mess 
up, if you will, the clean HMO reform that is necessary, why those 
things should not be passed, and why we should simply pass the Norwood-
Dingell bill by the end of this week.
  I do not want to take away from the fact that the Republican 
leadership has finally allowed this legislation to come to the floor, 
but I am very afraid that the Committee on Rules will report out a 
procedure that will make it very difficult for the bill to finally pass 
without having poison pill or other damaging amendments added that 
ultimately will make it difficult for the Patients' Bill of Rights to 
move to the Senate, to move to conference between the two Houses, and 
ultimately be signed by the President.
  A word of warning to the Republican leadership. This is a bill, the 
Norwood-Dingell bill, the Patients' Bill of Rights, that almost every 
American supports overwhelmingly. It is at the top of any priority list 
for what this Congress and this House of Representatives should be 
doing in this session. I think it would be a tragedy if the Republican 
leadership persists and continues to persist in its efforts to try to 
stall this bill, damage this bill, and make it so this bill does not 
ultimately become law.

                              {time}  2130

  I just want to say very briefly, Mr. Speaker, because I have 
mentioned it so many other times on the floor of the House of 
Representatives, the reason the Patients' Bill of Rights is a good bill 
and such an important bill basically can be summed up in two points; 
and that is that the American people are sick and tired of the fact 
that when they have an HMO, too many times decisions about what kind of 
medical care they will get is a decision that is made by the insurance 
company, by the HMO, and not the physician and not the patient. That is 
point number one.

[[Page H9295]]

  Point number two is that if an HMO denies a particular operation, a 
particular length of stay in the hospital, or some other care that a 
patient or physician feels is necessary, then that patient should be 
able to take an appeal to an independent outside review board that is 
not controlled by the HMO and, ultimately, to the courts if the patient 
does not have sufficient redress. Right now, under the current Federal 
law, that is not possible because most of the HMOs define what is 
medically necessary, what kind of care an individual will receive 
themselves. And if an individual wants to take an appeal, they limit 
that appeal to an internal review that is basically controlled by the 
HMO itself.
  So the individual cannot sue. If an individual is denied the proper 
care, they cannot take it to a higher court, to a court of law, because 
under the Federal law, ERISA preempts the State law and makes it 
impossible to go to court if an individual's employer is in a self-
insured plan, which covers about 50 percent of Americans, who get their 
health insurance through their employer, who is self-insured, and those 
people cannot sue in a court of law.
  We want to change that. The bipartisan Norwood-Dingell bill would 
change that. It would say that medical decisions, what kind of care an 
individual gets has to be made by the physician and the patient, not by 
the HMO. The definition of what is medically necessary is essentially 
decided by the physicians, the health care professionals.
  And, secondly, if an individual is denied care that that individual 
and their physician thinks they need, under the Patients' Bill of 
Rights, the bipartisan bill, what happens is that that patient has the 
right to an external review by an independent review board not 
controlled by the HMO. And, failing that, they can go to court and can 
sue in a court of law.
  Now, those are the basic reasons this is a good bill. There are a lot 
of other reasons. We provide for emergency services, we provide access 
to specialty care, we provide protection for women and children. There 
are a lot of other specific provisions that I could talk about, but I 
think there is an overwhelming consensus that this is a good bill. This 
is a bill that almost every Democrat will support and enough 
Republicans on the other side of the aisle will join us against their 
own Republican leadership in support of this bill.
  But there have been a lot of falsehoods being spread by the insurance 
industry over the last few days and the last few weeks and will 
continue until Wednesday and Thursday when this bill comes to the 
floor, and I wanted to address two of them because I think they are 
particularly damaging if people believe them. And they are simply not 
true.
  One is the suggestion that the patient protection legislation, the 
Norwood-Dingell bill, would cause health care premiums to skyrocket. 
That is simply not true. If we look at last week's Washington Post, 
September 28, there was an article that surveyed HMO members in Texas, 
where there is a very good patient protection law that has been in 
place for the last 2 years. That survey showed dramatically that in 
Texas they could not find one example where the Texas patient 
protection law forced Texas HMOs to raise their premiums or provide 
unneeded and expensive medical services. The Texas law, which has been 
on the books for 2 years, shows that costs do not go up because good 
patient protections are provided.
  In addition, we are told by the insurance companies that costs are 
going to go up because there will be a lot more suits and that will 
cost people more money and their premiums will have to go up. Well, the 
2-year Texas law that allows HMOs to be sued for their negligent 
medical decisions has prompted almost no litigation. Only five lawsuits 
out of the four million Texans in HMOs in the last 2 years, five 
lawsuits, which is really negligible.
  It is really interesting to see the arguments that the insurance 
companies use. The other one they are using, and they are trying to 
tell every Member of Congress not to vote for the Patients' Bill of 
Rights, not to vote for the Norwood-Dingell legislation, is this myth 
that employers would be subject to lawsuits simply because they offer 
health benefits to their employees under ERISA. What they are saying 
is, if we let the patient protection bill pass, employers will be sued 
and they will drop health insurance for their employees because they do 
not want to be sued.
  Well, that is simply not true. Senior attorneys in the employee 
benefits department in the health law department at some of the major 
law firms, and I will cite a particular one here from Gardener, Carton 
and Douglas, which basically did a legal analysis of the Norwood-
Dingell bill, claim that this is simply not correct. Section 302 of the 
Norwood-Dingell bill specifically precludes any cause of action against 
an employer or other plan sponsor unless the employer or plan sponsor 
exercises discretionary authority to make a decision on a claim for 
covered benefits that results in personal injury or wrongful death.
  So the other HMO myth is that an employer's decision to provide 
health insurance for employees would be considered an exercise of 
discretionary authority. Well, again, that is simply not true. The 
Norwood-Dingell bill explicitly excludes from being construed as the 
exercise of discretionary authority decisions to, one, include or 
exclude from the health plan any specific benefit; two, any decision to 
provide extra-contractual benefits; and, three, any decision not to 
consider the provisions of a benefit while internal or external review 
is being conducted.
  What this means is that we precluded all these employer suits. The 
employer basically cannot be sued under the Norwood-Dingell bill. And I 
would defy anyone to say that that is the case, that an employer can be 
sued effectively.
  I wanted to mention one last thing about the poison pills, and then I 
would like to yield to the gentlewoman from Texas, because she is 
representing the State of Texas. And she knows firsthand how this law 
has worked so effectively in her home State of Texas, and this is a law 
I use over and over again as an example of why we need the Federal 
laws. So I would like to hear her speak on the subject.
  Let me just say, though, that the other thing that we are going to 
see over the next few days here in the House is an effort by the 
Republican leadership to load down the Patients' Bill of Rights, the 
Norwood-Dingell bill, with what I call poison pills. I say they are 
poison because they do not really believe that these are good things. 
But they think if they pass them and add them to the Patients' Bill of 
Rights that, ultimately, that will defeat the bill. They cannot defeat 
the bill on its merits because they know that that will not work, so 
they try to add some poison pills.
  Basically, what they are trying to do, and this is the same stuff we 
have had in previous years, a few days ago the GOP leadership announced 
its intention to consider a number of provisions it claims will expand 
access to health insurance along with managed care. Again, this is a 
ruse. There is no effort here to really expand access for the 
uninsured. It is just that they have no other way to counter the 
growing momentum behind the Norwood-Dingell bill. But based on the 
statement released by the gentleman from Illinois (Mr. Hastert), the 
Speaker of the House, we can expect to see the following poison pills: 
The worst of them are: Medical Savings Accounts, Associated Health 
Plans, or MEWAs, and Health Marts.
  All three of these measures would fragment the health care market by 
dividing the healthy from the sick. This fragmentation will drive up 
costs in the traditional market, making it more difficult for those 
most in need of health insurance to get it. As a result, these measures 
would exacerbate the problem of making insurance accessible to more 
people.
  And that is not all they do. MSAs take money out of the treasury that 
could be used more effectively to increase access to health insurance 
through tax benefits. The Health Marts and the MEWAs would weaken 
patient protections by exempting even more people from State consumer 
protection and benefit laws.
  There is no doubt about what is going on here with the Republican 
leadership. The opponents of the Norwood-Dingell bill are cloaking 
their fear of the bill's strength in a transparent costume. They are 
trying to add these poison pills to kill the bill. We should not

[[Page H9296]]

allow it, and I do not think my colleagues will.
  Mr. Speaker, I yield to the gentlewoman from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I could not help but listen to 
the gentleman as he was making both an eloquent but very common-sense 
explanation of what we are finally getting a chance to do this week in 
the United States Congress. First, let me applaud the gentleman from 
New Jersey for years of constant persistence about the crumbling and, 
unfortunately, weakened health care system in America.
  I was just talking with my good friend the Speaker, and I think none 
of us have come to this Congress with any great adversarial posture 
with HMOs. I remember being a member of the Houston City Council and 
advocating getting rid of fraud and being more efficient with health 
care. So none of us have brought any unnecessary baggage of some 
predestined opposition to what HMOs stand for. I think what we are 
committed to in the United States Congress and what the gentleman's 
work has shown over the years, and what the Norwood-Dingell bill shows, 
is that we are committed to good health care for Americans, the kind of 
health care that Americans pay for.
  I would say to our insurance companies, and I will respond to the 
State of Texas because it is a model, but shame, shame, shame. The 
interesting thing about the State of Texas, and might I applaud my 
colleagues, both Republicans and Democrats alike in the House and 
Senate in Texas, it was a collaborative effort. It was a work in 
progress. It was all the entities regulated by the State of Texas who 
got together and sacrificed individual special interests for the 
greater good.
  I might add, and I do not think I am misspeaking, that all of the 
known physicians in the United States Congress, or at least in the 
House, let me not stretch myself to the other body, I believe, are on 
one of the bills. And I think most of them, if they are duly 
cosponsoring, are on the Norwood-Dingell bill. I think Americans need 
to know that. All of the trained medical professionals who are Members 
of the United States Congress are on the Norwood-Dingell bill, or at 
least cosponsoring it and maybe sponsoring another entity. That says 
something.

  What we should know about the Texas bill is, one, to all those who 
might be listening, our health system has not collapsed. Many of my 
colleagues may be aware of the Texas Medical Center, one of the most 
renowned medical centers in the whole Nation. Perhaps Members have 
heard of M.D. Anderson or of St. Luke's. Many of our trauma centers, 
the Hermann Hospital, developed life flight. We have seen no 
diminishment of health care for Texans because of the passage of 
legislation that would allow access to any emergency room or that would 
allow the suing of an HMO.
  I was just talking to a physician who stands in the Speaker's chair, 
if I might share, that if there is liability on a physician who makes a 
medical decision, the only thing we are saying about the HMOs is if 
they make a medical decision, if that medical decision does not bear 
the kind of fruit that it should, then that harmed or injured person 
should be allowed to sue. That has been going on in the State of Texas 
now for 2 years. There have been no representation that there has been 
abuse. I can assure my colleagues in a very active court system, as a 
former municipal court judge, there has not been any run on the 
courthouse, I tell the gentleman from New Jersey, because of that 
legislation.
  So I would just simply say, if I might share just another point that 
I think the gentleman mentioned in terms of a poison pill, that we 
tragically just heard that 44.3 percent of Americans do not have access 
to health insurance. We know that we have, as Henry Simmons has said, 
President of the National Coalition on Health Care, that this report of 
uninsured Americans is alarming and represents a national disgrace. We 
know we cannot fix everything with this. And I might say to the 
gentleman that Texas, alarmingly so and embarrassingly so, is number 
one in the number of uninsured individuals, but we do know that with 
this bipartisan effort of a Patients' Bill of Rights, I am supporting 
the Norwood-Dingell bill, we can address the crisis that many of our 
friends and our constituents are facing in terms of denied health care 
because HMOs are superceding the professional advice of physicians who 
have a one-on-one relationship with patients.
  I think we have to stop the hypocrisy in the patient's examination 
room. We must give back health care to the patient and the physician 
and the health professional. We must stop this intrusion. And I know 
the gentleman knows of this, because we have had hearings and heard 
many tragic stories.
  So I would say to the gentleman that I hope this is the week that is, 
and that is that we can successfully come together in a bipartisan 
manner to stand on the side of good health care for all Americans by 
passing the Norwood-Dingell bill, the Patients' Bill of Rights. And I 
thank the gentleman again for his leadership, and I continue to look 
forward to working with him. I believe at the end of the week, 
hopefully, when the cookies crumble, we will stand on the side of 
victory for that bill.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman. I wanted 
to say one more thing, because I know we are out of time. Even though 
Texas and my home State of New Jersey, and now we read California, have 
all passed good patient protection laws, I do not want any of our 
colleagues to think that we do not need the Federal law. These State 
laws still do not apply to 50 percent of the people that are under 
ERISA where the corporation, their employer, is self-insured.
  If we do not pass a Federal law, all of the things that Texas, 
California, and New Jersey and other States will do are still only 
going to apply to a minority of the people that have health insurance. 
So it is crucial, even though we know that States are making progress, 
and even though we have seen some of the courts now intervene, Illinois 
last week intervened and is allowing people to sue the HMO under 
certain circumstances, and the Supreme Court of the United States is 
taking up a case, even with all that, the bottom line is that most 
people still do not have sufficient patient protections because of that 
ERISA Federal preemption.
  It is important to pass Federal legislation. And we are going to be 
watching the Republican leadership to make sure when the rule comes out 
tomorrow or the next day, that they do not screw this up so that we 
cannot pass a clean Patients' Bill of Rights.
  I want to thank the gentlewoman again for so many times when she has 
been down on the floor with me and others in our health care task force 
making the case for the Patients' Bill of Rights. It is coming up, but 
we are going to have to keep out a watchful eye.

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