[Congressional Record Volume 145, Number 157 (Tuesday, November 9, 1999)]
[House]
[Pages H11844-H11845]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       HMO'S NEED ACCOUNTABILITY

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Texas (Mr. Green) is recognized for 5 minutes.
  Mr. GREEN of Texas. Mr. Speaker, I appreciate the comments of my 
colleague from Wisconsin. I agree that, hopefully, we will all be out 
tomorrow evening so we can go home and celebrate our Veterans Day 
programs in our districts and honor our veterans because of their 
commitment to our country and our freedoms.
  I am here tonight to talk about an amazing announcement today that 
literally made the headlines on newspapers all over the country.
  What do the American people mostly Democrats and also a significant 
amount of Republican Members know that the Republican leadership does 
not seem to know? Well, that is an open-ended question and it may take 
more than my 5 minutes to answer, but I will do it as best I can.
  We want doctors and patients, and not HMO bureaucrats, to make the 
medical decisions. Today one of the Nation's largest HMOs, United 
Health Group, took the first step in recognizing the error of their 
ways. They decided they would no longer review each treatment 
recommendation made by a physician.
  With the active support of the American people and the HMO reform 
conference committee, hopefully this will just be the first company 
that will do that and will proceed to have some real true HMO reform.
  One company in the insurance business recognized what Democrats and 
the American people have known for years is that the most qualified 
people to make medical treatment decisions are the patients and doctors 
who know the details of that specific case.
  Before we claim victory, we have to recognize that this is only a 
first step and in some ways a very small step.
  Instead of reviewing the cases as they come in, the United Health 
Care has decided to review their physicians once a year. This is much 
better, but it still raises some concerns. One of the problems can be, 
that in reviewing a doctor's treatment decisions in this manner, it may 
be nearly impossible to determine the case each doctor has and whether 
there is specific reason such as

[[Page H11845]]

 treating a high-risk patient or children that led the doctor to 
prescribe more tests than another doctor.
  Again, this is a first step and a good step, but we still have got a 
long way to go. Other HMOs need to follow United's lead and every HMO, 
including United, needs to commit to leaving medical treatment 
decisions to the doctors and the patients without interference.
  This recent decision by United raises the broader question of HMO 
reform and whether it is still necessary if other HMOs follow United's 
lead. The short answer is yes. The truth is that most HMOs are good. 
Managed care is created to take the ever increasing cost out of health 
care. But what we have seen is that not only have they taken the cost 
out up until this year, but they have also taken the quality out.
  According to United, they approved 99 percent of the claims that 
their doctors had recommended. So what they found out is that they 
created a bureaucracy that they were paying for, that they approved 
those claims.
  What is so important is that the patients' bill of rights that this 
House passed on a very bipartisan vote is still needed to protect the 
population who find themselves in an HMO that may not be as responsive 
as United is or as realistic as United that actually looked at it and 
said, hey, it is not cost effective to continue to do this.

                              {time}  2200

  As long as the industry continues to operate in their unregulated 
vacuum, these nonresponsive HMOs will continue to pop up and take 
advantage of the unsuspecting consumers. The scariest part of this 
scenario is that these unsuspecting consumers will not know that they 
are in such an HMO until it is too late. There are a lot of laws in 
this country that are designed to protect the majority from a small 
percentage of offenders. Most of us would not think of taking money 
from a person in return for a service but then when they come to 
collect what they paid for, deny, or worse in some cases, even delay 
that service. But the HMOs accept the premiums from consumers, but then 
deny or delay benefits in the hope that the consumer, who is really now 
the patient, will just give up and go away. They need to be held 
accountable for these deplorable actions.
  I have an example of a constituent in my district. If you are 
familiar with Houston, she lives in the north part of Harris County. 
She had an appointment with a specialist in her neighborhood near 
Intercontinental Airport in the Humble area twice and it was canceled 
by her HMO. Finally they assigned her to a specialist across town. She 
said it was just difficult for her to be able to have family take her 
across town when literally there was a hospital complex that was so 
close she could get to. Again, it was delayed twice and ultimately 
could be denied because of transferring her to a specialist across 
town.
  No other industry enjoys the protection that the HMO industry does 
from Federal law under the ERISA act. With this shield they are able to 
ignore the needs of their patients and they are held accountable to 
nobody. What I hope we would do as a Congress would be to respond and 
hopefully the HMO conference committee that we have will be responsive, 
Mr. Speaker.

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