[Congressional Record Volume 145, Number 137 (Tuesday, October 12, 1999)]
[Extensions of Remarks]
[Page E2072]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       BIPARTISAN CONSENSUS MANAGED CARE IMPROVEMENT ACT OF 1999

                                 ______
                                 

                               speech of

                        HON. BENJAMIN A. GILMAN

                              of new york

                    in the house of representatives

                       Wednesday, October 6, 1999

  Mr. GILMAN. Mr. Speaker, I rise today in support of H.R. 2723, the 
bipartisan consensus Managed Care Improvement Act. This important piece 
of legislation is long overdue and I am pleased to be a cosponsor of 
this bipartisan bill that will reform the managed care industry. I 
commend Mr. Norwood and Mr. Dingell for their diligent work and 
determination in bringing this bill to the floor today and the House 
leadership for scheduling debate on this bill.
  H.R. 2723, will bring about necessary changes to the managed care 
industry by bringing the attention of HMOs back to the needs of the 
American public. For too long, these insurance companies have been 
driven by profits and have lost sight of their true responsibility, to 
provide a quality service to those Americans who pay for insurance each 
month. All too often we hear stories from our constituents who have had 
numerous conflicts with their insurance companies, ranging from denial 
of coverage for preventative procedures and medically necessary 
treatments to denial of reimbursement for trips to emergency rooms and 
specialists. Americans pay their monthly premiums and expect that if 
the time comes when they need to seek out medical assistance, they 
should not have to worry about whether or not their HMO is going to 
oppose the necessity of their visit to a doctor.
  Americans should be able to see specialists such as a cardiologist or 
oncologist without obtaining a referral from their primary physician, a 
chore which merely takes up time, time that may be better served by 
immediately seeing a specialist. Moreover, women should have direct 
access to their obstetrician-gynecologist and parents should have the 
option to select a pediatrician as their child's primary physician. 
Under current guidelines, this is not an option. However, these issues 
would be addressed by the passage of H.R. 2723.
  The major concern that has been brought to my attention by my 
constituents has been the issue of employer liability. I am gratified 
that this bill contains a self-executing managers amendment that will 
directly address this concern. With the passage of H.R. 2723, language 
will be implemented which clearly states that an employer can not be 
held liable unless they are making medical decisions. An employer can 
provide health care coverage for their employees and set the parameters 
of that coverage with the knowledge that they will not be sued by an 
employee should the HMO make a negligible medical decision that results 
in injury or death.
  The intent of this legislation is to make managed care coverage more 
user friendly. To provide the necessary information to policyholders up 
front so that the frequency of injuries and deaths due to negligent 
decisions by the HMO decreases. However, there will be times when an 
HMO fails to provide coverage for services that a policy holder is 
entitled to. It is for these cases, that the individual has the ability 
to hold the HMO accountable for its negligent decisions. In cases of 
personal injury or death, the individual deserves the right to sue the 
insurance company and hold them financially responsible for their 
irresponsible decisions. It is for this reason that I strongly support 
the liability portion of this bill.
  I am confident that by requiring health plans to disclose information 
to policyholders regarding coverage of benefits, doctors, facilities, 
and claim procedures, the need to proceed to a judicial solution should 
not occur as often as opponents of this bill insist.
  Accordingly, I urge my colleagues to stand up and fight for the 
rights of the American public and to support passage of this 
legislation.

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