[Congressional Record Volume 146, Number 6 (Tuesday, February 1, 2000)]
[House]
[Pages H154-H158]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  THE INTERNATIONAL GLOBAL ECONOMY AND PATIENT PROTECTION LEGISLATION

  The SPEAKER pro tempore (Mr. Sherwood). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from Iowa (Mr. Ganske) is 
recognized for 60 minutes.
  Mr. GANSKE. Mr. Speaker, tonight I want to talk about two issues. 
First I want to talk about the international global economy, and then I 
want to say a few words about patient protection legislation, just so I 
will not disappoint any of my colleagues.
  While the international global economy is no longer a vision of the 
future, it is here, it is a reality, we are now establishing the rules 
that govern this economy; and the outcomes of these debates will have a 
direct impact upon my State of Iowa as well as on the country as a 
whole.
  Our country and my State have benefited greatly from the growing 
international marketplace and American efforts to reduce tariffs and 
trade barriers. For example, my home State of Iowa's exports increased 
nearly 75 percent over 5 years to $5 billion in 1998. Export sales from 
Des Moines alone totalled nearly half a billion dollars in 1998. This 
growth was a two-way street. My State has attracted more than $5 
billion in foreign investment. This level of international trade and 
investment supports thousands of jobs in Iowa and across the country, 
and it greatly benefits our economy in general.
  Over the past 30 years, we have made significant progress in breaking 
down barriers to trade. The General Agreement on Tariffs and Trade, or 
GATT; the World Trade Organization, or WTO; and the North American Free 
Trade Agreement have been effective in promoting the development of 
free trade. Yet we need to do much more. I have a book in my office 
published each year by the Office of the U.S. Trade Representative 
entitled ``National Trade Estimate Report on Foreign Trade Barriers,'' 
not exactly something that you want to read if you want to stay awake 
late at night. The 1999 edition is more than 400 pages long, but those 
400 pages detail the impediments that still exist to fully achieving a 
free international economy. America as the largest economic force in 
the world will benefit greatly if we eliminate those barriers.
  So tonight I want to talk about some of the trade issues Congress may 
be addressing this year and how they tie into the goal of expanding 
market access and promoting free trade.
  One of the first things Congress could do is to enact sanctions 
reform. The United States uses trade sanctions to apply economic 
pressure against countries to force them to modify their policies. Our 
trade sanctions against Cuba are an example. Often, these sanctions 
prohibit the export of food and medical products. These sanctioned 
markets currently buy $7 billion in agricultural commodities each year 
from the international community. That is $7 billion in agricultural 
commodities that they are not buying from us. The Department of 
Agriculture estimates that rural communities lose $1.2 billion in 
economic activity annually as a result of these unilateral sanctions. 
For this and other reasons, we need to end unilateral sanctions on food 
and medicine, except in cases of national security.
  First, they do not work. Our allies freely supply these products to 
the sanctioned states, undermining our efforts and taking away 
potential markets. Second, withholding food and medicine from civilians 
because we disagree with their governments' policies, in my opinion, is 
less than civilized. And, third, these unilateral sanctions punish 
America's farmers and further depress commodity prices by denying 
access to significant international markets. When our Nation's farmers 
are struggling for survival, that is not acceptable. By exempting 
agricultural and medical products from unilateral sanctions, we can 
provide our farmers with additional market opportunities and provide a 
humanitarian service to people living under those oppressive regimes.
  Another tool we can implement to promote free trade is fast-track 
negotiating authority. Fast track allows the

[[Page H155]]

President to negotiate international trade agreements and then bring 
those agreements to Congress for an up-or-down vote without amendments. 
This authority is authorized for limited periods of time. Beginning in 
1974, fast track was extended several times, until its most recent 
expiration in 1994. Armed with that fast-track authority, Presidents 
were able to assure our trading partners that they have the necessary 
authority to negotiate trade agreements and that Congress will not 
change the conditions of those agreements.
  It was under such authority that two multilateral trade agreements 
were reached under GATT, including the Uruguay Round which produced 
great dividends for U.S. farmers, U.S. interests and established the 
WTO, the World Trade Organization. Fast track also helped America reach 
free trade agreements with Israel in 1985 and Canada in 1988, as well 
as the North American Free Trade Agreement, or NAFTA, in 1993. But in 
1994, authorization for fast track expired; and it has not yet been 
reauthorized.
  Now, last year President Clinton announced in his State of the Union 
address that he would again seek renewed fast-track authority. 
Unfortunately, that was followed by a rather anemic and unsuccessful 
effort by President Clinton in 1998. So today, we still do not have 
fast-track authority.
  I believe that if we wish to continue making substantial improvements 
and advances in promoting free trade and if we want to shape or have 
input in the current negotiations of WTO, we need to reauthorize fast-
track authority. In this year's State of the Union address just last 
week, President Clinton spoke about nearly everything, except fast-
track authority.

                              {time}  1945

  I hope the President and Vice President put full White House support 
behind an effort to reauthorize fast track, and I hope we in Congress 
can pass it before we adjourn this fall.
  While sanctions reforming fast track will help America's efforts to 
enhance free trade and market opportunities for our industry and 
farmers, we must also engage other nations in multilateral agreements 
if we hope to get anything done. This can be done most effectively 
through international trade organizations.
  The system that has received the most attention lately is the World 
Trade Organization, the WTO. Everyone is aware of the events that took 
place in Seattle with the tear gas and the rioting in the streets. The 
Republican presidential primary candidates have been debating the 
merits of U.S. participation in WTO.
  Despite some of the concerns being expressed, I fully support U.S. 
membership in WTO and other international trade organizations. 
Opponents of trade organizations like to focus on the apparent negative 
effects of an international market. In the current international 
economic system, nations are looking for competitive advantages. The 
United States, for example, has great technology and we have an 
agricultural surplus, so we seek to promote these for our benefit. 
Others do for their particular industries.
  Many have argued that international agreements threaten to weaken 
other segments in our economy and should therefore be avoided. Some 
argue that we should not participate in these agreements because they 
threaten our national sovereignty.
  Well, I understand the concerns about opening our markets to other 
nations and the need to secure ourselves from threats against our 
sovereignty, and we must never relinquish control over our own destiny. 
However, these opponents fail to consider that these agreements in 
which we are involved were reached with our input. The rules of these 
organizations exist to ensure fair treatment from market to market and 
to reduce tariffs and restrictions, concepts that have greatly 
benefited America.
  One of the most effective agreements America has brokered is NAFTA. 
NAFTA has had a significant impact on Iowa's economy since it went into 
effect in January 1994. The agreement set a schedule for reduction and 
eventual limitation of tariffs between the United States and our 
neighbors, Canada and Mexico. This has resulted in a terrific growth 
for North American trade, greatly increasing our export market.
  For example, my home state of Iowa. Exports to Canada and Mexico 
nearly doubled in NAFTA's first 4 years. In 1998 alone, Canada and 
Mexico imported $2.3 billion in Iowa products, more than 44 percent of 
Iowa's export total. This growth supports thousands of jobs and has 
brought substantial economic benefits to our businesses and 
agricultural communities.
  NAFTA serves as a model for the international community. It reduces 
barriers, it promotes trade, and it capitalizes on America's 
advantages. The goal of the World Trade Organization is ``to help trade 
flow smoothly, freely, fairly, and predictably.'' I believe the WTO has 
significantly improved the international economy.
  The Uruguay Round which produced the WTO established a system of 
rules for member nations to ensure fair market treatment. In addition, 
it established a process by which member nations could seek redress for 
their grievances without resorting to immediate trade retaliation. That 
action helps prevent disruptions in international markets, and the 
result has been a global lowering of tariffs, an easing and elimination 
of import quotas and an overall more free system of trade. These are 
essential components to future prosperity for America and our trading 
partners.
  Of significant importance to our Nation's agricultural trade was the 
implementation of the Sanitary and Phytosanitary Agreement, or SPS. 
This states that a nation or trading block cannot impose restrictions 
on the import of agricultural or food products based on a health 
concern unless that concern can be backed by scientific evidence.
  This strikes at the heart of many of the barriers that other nations 
have erected to keep out our American agricultural products. It helps 
open markets that have traditionally been closed to our farmers.
  But I want to talk for a minute about the role of WTO in resolving 
trade disputes, because it is this function that is at the heart of 
many of the criticisms of WTO. The set of rules by which members must 
abide were agreed to by all of the members. However, nations sometimes 
violate those rules, despite their commitments. When this happens, the 
WTO dispute settlement process offers a forum through which nations can 
seek solutions to their differences without immediately imposing trade 
barriers.
  When a member files a complaint, a WTO-appointed commission reviews 
the case and issues an opinion. Countries have the ability to appeal 
those findings. After the appeals process is exhausted, the loser of 
the case must modify their policies to comply with the rules to which 
they themselves agreed.

  Now, the WTO does not have enforcement authority, but it does have 
international opinion and the collective will of the members of the 
organization in an enlightened way and enlightened self-interest to 
encourage nations to comply with World Trade Organization rules. Thus, 
the WTO is only as strong as the commitment of its member nations. But 
the collective will of the international market is a significant factor 
in reducing barriers to trade.
  The current round of WTO trade negotiations must address the issue of 
compliance while seeking to further reduce barriers to trade. If the 
European Union, one of the largest members of WTO, continues to violate 
the rules of the agreement, the future of WTO is in jeopardy.
  The future of WTO will be determined in the next couple of years, 
determined by the new round of negotiations and determined by the 
potential accession of China to the World Trade Organization.
  I was very disappointed with events in Seattle at the end of last 
year. I believe this new round is a terrific opportunity for us to 
expand our role in the international economy by improving market access 
for Iowa's products. For the opening session to be disrupted in the way 
it was was very unfortunate, to say the least. This round will 
determine the future effectiveness of the World Trade Organization, and 
the United States should use the WTO to make significant advances in 
the reduction of barriers to America's goods.
  An issue that may change the international market significantly is 
the

[[Page H156]]

prospect of China joining the WTO. The United States and China a few 
months ago reached a bilateral agreement on China's accession to the 
World Trade Organization. This agreement looks very promising, and I 
would like to point out a few details that may interest you.
  Overall, China agreed to cut tariffs from an average of 24.6 percent 
in 1997 to an average of 9.4 percent by the year 2005. For U.S. 
priority products, tariffs will be cut to 7.1 percent. That is a 62 to 
71 percent drop in tariff rates on most imported goods. In addition, 
China agreed to phase out most import quotas by the year 2005, making 
these new tariff rates applicable to most products, regardless of 
quantity.
  China also agreed to give American companies more control of the 
distribution of their products at both the wholesale and the retail 
levels. American suppliers will no longer have to go through state 
trading enterprises or Chinese middlemen. American companies will be 
allowed to provide maintenance and services for their products, 
something particularly important, for instance, with automobiles.
  In agriculture, China agreed to lower the average tariff on American 
agricultural products from nearly 40 percent to 17 percent. In 
addition, it will set tariffs on U.S. priority products, such as pork, 
beef and cheese, at 14.5 percent. That is a significant concession.
  The agreement also establishes tariff rate quotas which represent the 
maximum level of imported product for which lower tariffs are applied. 
The goal of trade negotiations are to increase those quotas and 
eventually eliminate them, thus producing the greatest possible 
benefits for the exporting nation.
  For example, China agreed to eliminate oil seed quotas by the year 
2006 and to increase the quota for corn to 7.2 million metric tons by 
the year 2004. By comparison, China currently imports only 250,000 
metric tons of American corn.
  China also agreed to abide by the Phytosanitary Safety Agreement and 
to accept the U.S. Department of Agriculture certification that 
American meat and poultry is safe. What this means is that China will 
now open its market to U.S. pork, beef, and poultry, access which has 
been denied because of China's claim that American meat is not safe 
enough for consumption.
  I can guarantee you, America's meat is safe for export. I go overseas 
to Third World countries. Let me tell you, on most any given day, I 
would rather have an American piece of meat.
  In addition, China pledged not to provide export subsidies for its 
agricultural products. Let me repeat that. China pledged not to provide 
export subsidies for its agricultural products. So they are opening up 
their market, they are reducing their quotas, they are reducing their 
tariffs, and they are also agreeing not to subsidize their own 
producers, giving them an unfair or uncompetitive advantage. These 
agricultural concessions are very attractive and they hold forth the 
promise of significant growth for our nation's farmers.
  We passed the Freedom to Farm Bill here a few years ago. I think 
overall moving away from restrictions on planting and giving farmers 
freedom to plant the crops that they want is a good move, but part of 
the bargain of that bill is also that we work hard to remove export 
barriers and import barriers in other countries. This is part of what 
we are doing with the accession agreement with China.
  Another component of the agreement of interest to our nation is in 
the area of financial services. Currently foreign insurance companies 
are allowed to operate in only two cities in China. This bilateral 
agreement will remove all geographic limitations for insurance 
companies within 3 years. Within 5 years, foreign insurers will be able 
to offer group, health and pension insurance, which represents 85 
percent of all premiums sold.
  Foreign firms will be allowed under this agreement 50 percent 
ownership for life insurance and will be allowed to choose their own 
joint venture partners. Non-life insurance companies will be allowed to 
establish local branches, hold 51 percent ownership upon accession, and 
form wholly-owned subsidiaries within 2 years.
  In addition, China agreed to lower tariffs on American automobiles to 
25 percent from the current rate of 80 to 100 percent, and American 
financing programs for these cars would also be available. Tariffs on 
information technology like computers and Internet-related equipment 
would be eliminated by the year 2005 and banks and financial 
institutions would have unprecedented access to the Chinese population. 
China promised to conduct business in a fair, non-discriminatory 
manner, and in accordance with WTO rules.
  The United States also ensured that its existing anti-dumping 
protection provisions and product safeguard programs will remain in 
place for the next 12 to 15 years.
  Well, despite the apparent benefits of this agreement, I still think 
we need to be careful. China does not have a great track record in 
complying with trade agreements. Currently our trade relationships with 
China continue to be tilted in favor of China. Despite continued 
engagement and extension annually of normal trade relations or most-
favored-nation status, the U.S. trade deficit with Beijing has 
increased from $6.2 billion in 1989 to $56.9 billion in 1998.
  In 1992, we signed a memorandum of understanding to improve market 
access between the United States and China.

                              {time}  2000

  The Chinese Government has failed to reduce significant trade 
barriers to U.S. products. In addition, our bilateral agreement is not 
the final document concerning China's membership in the World Trade 
Organization.
  China must now complete bilateral agreements with the European Union, 
with Canada and with other trading partners. These agreements will then 
be combined into a comprehensive, multilateral package, that would be 
presented to Congress. Congress must then decide whether to grant China 
permanent Most Favored Nation status, or normal trade relations.
  A year ago, I opposed a 1-year extension of NTR to China. I did so 
for several reasons, the unfair balance of our trade relationship; the 
40 percent import tariffs that China puts on our agricultural products, 
I do not think that is fair; China's violations of our national 
security; their disregard for human rights and their threatening 
posture towards their neighbors.
  Additionally, I did not feel that past extensions of NTR had greatly 
benefited America's interests. Rather, despite NTR, China's actions 
jeopardized our national and economic security. However, this bilateral 
accession agreement could open a tremendous market for American and 
Iowan products, if, and this is the big if, China actually complies 
with the provisions of the treaty.
  The unprecedented access for international businesses would expose 
Chinese society to outside influences like never before. While the jury 
is still out, the fine print has not yet been made available for 
review, I expect the President will request Congress to waive the 
Jackson-Vanick amendment which requires annual extension of NTR for 
China and ask us to improve permanent NTR status.
  This is going to lead to a vigorous and energetic debate on this 
floor of the House of Representatives. The stakes are very high. This 
may sound like an arcane subject. Maybe it is not as personal as the 
patient protection legislation that I am going to be talking about in a 
few minutes, but I can say what we decide on the floor of this Congress 
on this treaty could have significant impact on each and every one of 
us in this country in terms of how our economy is going to do.
  If Congress approves permanent normal trade relations for China and 
abandons the annual review requirement, do we risk losing valuable 
leverage in future negotiations? If we grant permanent NTR, will we 
actually experience significant reform in the Chinese markets, or will 
China renege on its promises as it has in the past?
  If we do not grant permanent normal trade relations, will we be 
watching from the sidelines as other nations take advantage of new 
market opportunities to 1 billion people? These are some of the 
questions that Congress will have to ask this session. I look forward 
to the debate, and I am learning more about the fine print of this 
agreement.

[[Page H157]]

  In summary, I think the United States must pursue free trade whenever 
possible. This includes reforming our sanctions policies to provide 
American food and medicine to needy civilians. It involves granting the 
President fast track negotiating authority to ensure our place in 
global trade negotiations. It involves participating in international 
trade organizations to open new and expanding markets. It involves 
reducing trade barriers in order to spur further economic growth for 
our economy, but we must remain aware of the implications such action 
may have on our security, and we must make those decisions 
appropriately.
  At this time, I am leaning towards a yes vote on permanent normal 
trade relations with China, and I am looking forward to the debate.


                     Patient Protection Legislation

  Mr. GANSKE. Mr. Speaker, I want to say a few words about patient 
protection legislation, particularly in response to what I consider to 
be a rather inaccurate publication that has been sent to Congress, all 
Members of Congress recently, by the HMO industry.
  Before I go any further, I want to be crystal clear what my position 
has been throughout this long debate. As we have developed patient 
protection legislation, I have always believed that any entity, whether 
a doctor, a health plan or a business, that makes decisions on medical 
necessity must be held responsible for those decisions. Moreover, I 
find it reprehensible that there are those who would promote the 
argument that an entity should be able to wrongfully cause the death of 
a patient and be shielded from legal responsibility.
  Currently, doctors are held responsible for the medical decisions 
they make, but health plans and even employers can dodge such 
responsibility through the ERISA preemption clause. Recognizing that 
plan sponsors and some employers do make these decisions, the Norwood-
Dingell-Ganske bill, the Bipartisan Consensus Managed Care Improvement 
Act of 1999, erases this unintended shield by making those plans 
responsible for any decision they make regarding medical necessity.
  Of those lawsuits that are brought, most would not be against 
employers or plan sponsors because they are generally not involved in 
the medical necessity decisions that could lead to a personal injury or 
death. Therefore, our bill protects health plans and employers by 
ensuring that they can only be sued if they decide to do more than 
offer health insurance. In a recent communication entitled Health Plan 
Liability, What You Need to Know, the American Association of Health 
Plans makes a number of dubious assertions about the Norwood-Dingell-
Ganske Bipartisan Consensus Managed Care Improvement Act of 1999. I 
would advise my colleagues to take this with a grain of salt. In fact, 
my colleagues may want to take it with a whole truckload of salt that 
is currently cruising the streets here in Washington.
  To begin with, the AAHP implies that supporters of the Norwood-
Dingell-Ganske bill are promoting lawsuits, but the supporters of the 
Norwood-Dingell-Ganske bill believe that patients should have an 
opportunity to pursue internal and external review in a timely fashion 
before they are harmed. It is the appeals process with an independent 
review panel that will improve quality of care and ensure that patients 
receive necessary health care, but as Governor Bush says, ``at the end 
of the day, HMOs must be responsible for their actions.''
  Then AAHP claims that HMOs already can be sued under ERISA. Well, 
again, take that characterization with a huge grain of salt, because it 
is true that under ERISA HMOs can be sued but only for the costs of 
treatment denied. Now, how is that a just outcome for a child that has 
already lost his hands and his feet or somebody else who has lost their 
life? It is a travesty that many of these people and their families 
find that their legal remedy, under ERISA, through their employer plan, 
for their loss, is only the cost of treatment denied.
  That is an unfair burden on patients. It was never the congressional 
intent and the Norwood-Dingell-Ganske bill provides appropriate 
liability and external appeals process protections for patients and 
their families.
  Next, the American Association of Health Plan little manual says, 
``The current medical malpractice system demonstrates that making 
correct decisions does not preclude lawsuits,'' but under the Norwood-
Dingell-Ganske bill the external appeals panel makes a determination on 
the appeals that are brought before it. If the health plan does not 
abide by the panel's decision, then the patient and his family have the 
ability to pursue liability action. However, if the plan abides by the 
independent panel's decision, then it is protected under our bill, the 
bill that passed this House by a vote of 275 to 151, it is protected 
from the punitive damages that the health plans are so concerned about.
  On this point, an additional claim that our bill, ``requires external 
review to be completed in all cases before an individual can sue the 
plan. Therefore, few claims will ever reach court,'' AAHP then states 
that the Norwood-Dingell-Ganske bill would, ``allow enrollees to bypass 
external review when an enrollee claims that he or she had been harmed 
before an external review is initiated.''
  AAHP fails to point out that the Norwood-Dingell-Ganske bill allows 
them to go directly to State court only, I repeat only, if they have 
suffered personal injury or wrongful death. After a patient has already 
been killed, seeking any further treatment or an appeal is absurd. On 
external review AAHP says that we say, ``expanded health plan liability 
is necessary because plans may not adhere to the decisions of the 
external review even at this time.''
  AAHP states that, ``There is no evidence demonstrating that in States 
that have a binding external review system, health plans do not adhere 
to the decision of external review entities.''

  However, in the House Committee on Commerce, we heard testimony from 
Texas that refutes this statement by the HMO industry. That lawsuit, 
Plocica versus NYLCare is a case in which the managed care plan in 
Texas did not obey the law, and a man died. This case exemplifies why 
we need accountability at the end of the review process.
  Mr. Plocica was discharged from a hospital suffering from severe 
clinical depression. His treating psychiatrist informed the plan that 
he was suicidal and required continued hospitalization until he could 
be stabilized. Texas law requires an expedited review by an independent 
review organization, one of those IROs that Governor Bush speaks about. 
Prior to discharge, such a review was not offered to the family by the 
plan, by the HMO.
  Mr. Plocica's wife took him home. During the night he went to his 
garage. He drank half a gallon of antifreeze and he died a horrible, 
painful death.
  This case shows that external review and liability go hand in hand. 
Without the threat of legal accountability, HMO abuses like those that 
happened to Mr. Plocica will go unchecked.
  The lesson from Texas also is that there will not be an avalanche of 
lawsuits. In fact, when HMOs know that they will be held accountable, 
there will be fewer tragedies like those that happened to Mr. Plocica.
  A couple of Sundays ago, just before the Iowa caucuses, AARP, the 
American Association of Retired Persons, ran a one-hour infomercial on 
TV. They interviewed all of the Presidential candidates on their 
positions on a number of issues interesting and of importance to senior 
citizens. One of the questions that they asked was, what is your 
opinion on patient protection legislation? And they had quotes from all 
of the candidates, both Republicans and Democrats.
  I want to read a transcript of what Texas Governor George W. Bush had 
to say about this issue. These are Governor Bush's words. ``As governor 
of Texas, I have led the way in providing for patient protection laws 
when it comes to managed care programs. I am proud to report that our 
State is on the leading edge of reform. People who are in managed care 
programs in the State of Texas have the right to choose their own 
doctor so long as it does not run up someone else's premium. People in 
my State are able to take advantage of emergency room needs and yet be 
covered by managed care. Women have direct access to OBGYNs. Doctors 
are not subject to gag rules.''
  Governor Bush continued. ``We have information systems now that are 
made available for consumers who are in managed care programs. We have

[[Page H158]]

done a good job of making the managed care systems in our Texas 
consumer friendly, as well as provider friendly.''
  Governor Bush continued. ``I have also allowed a piece of legislation 
to become law that allows for people to take disputes with managed care 
companies to an objective arbitration panel called an independent 
review organization.''

                              {time}  2015

  ``It is a chance for the insurance provider and for consumers to 
resolve any disputes that may arise.''
  Here is the important part of this statement. These are in Governor 
Bush's words. This is from the Texas experience.
  ``If after the arbitration panel makes a decision, and if the HMO 
ignores that decision, i.e., in this gentleman's case where he drank 
half a gallon of antifreeze case and died because of that HMO's medical 
necessity decision, then consumers in the State of Texas will be able 
to take the HMO to a court of law to be able to adjudicate their 
dispute.''
  George Bush finished his statement by saying, ``I believe this brings 
accountability to HMOs, and I know it gives consumers the opportunity 
to take their case to an objective panel. This law is good for Texas. I 
believe this law will be good law for America, as well.''
  Mr. Speaker, the bill that we passed here a few months ago, the 
Bipartisan Managed Care Consensus Reform Act of 1999, the Norwood-
Dingell-Ganske Act, was modeled after the Texas laws. Let me give some 
examples.
  The Norwood-Dingell proposal on utilization review, when a plan is 
reviewing the medical decisions of its practitioners, it should do so 
in a fair and rational manner. The bipartisan consensus bill lays out 
basic criteria for good utilization review: physician participation in 
development of review criteria, administration by appropriately 
qualified professionals, timely decisions. All of these things, and the 
ability to appeal those decisions, are in the Norwood-Dingell bill.
  Guess what, this became law in Texas in 1991. These provisions that 
were in the Norwood-Dingell bill were enhanced in Texas law in 1995.
  How about internal appeals? The bill that passed the House says, 
``Patients must be able to appeal plan decisions to deny, delay, or 
otherwise overrule doctor-prescribed care and have those concerns 
addressed in a timely manner. Such an appeal system must be expedient, 
particularly in situations that threaten the life and health of the 
patient, and conducted by appropriately credentialed individuals.''
  What is the situation in Texas? In 1995, these internal appeals were 
promulgated by regulations by the Texas Department of Insurance.
  How about external appeals? In the Norwood-Dingell-Ganske bill, 
individuals must have access to an external independent body with the 
capability and authority to resolve disputes for cases involving 
medical judgment. The plan must pay the costs of the process. Any 
decision is binding on the plan. If a plan refuses to comply with the 
external reviewer's determination, the patient may go to court to 
enforce the decision. The court may award reasonable attorneys' fees in 
addition to ordering the provision of the benefit.
  What is the Texas law? The same thing. It became law in 1997. Since 
it has been enacted, 700 patients plus have appealed their health 
plan's decisions, with 50 percent of the decisions falling in favor of 
the patients and 50 percent of the decisions in favor of the health 
plan. The Texas external appeals process is being challenged in court. 
It could be overturned unless we act here in Congress.
  How about insurer accountability? In the Norwood-Dingell-Ganske bill, 
health plans are currently not held accountable for decisions about 
patient treatment that result in injury or death under ERISA.
  Currently, the Employee Retirement Income Security Act preempts State 
laws and provides essentially no remedy for injured individuals whose 
health plan decisions to limit care ultimately cause harm. If the plan 
was at fault, the maximum remedy is the denied benefit. The bipartisan 
consensus bill would remove ERISA's preemption and allow patients to 
hold health plans accountable according to State law.
  However, plans that comply with the external reviewer's decision may 
not be held liable for punitive damages. That is those $50 million or 
$100 million awards. Additionally, any State law limits on damages or 
legal proceedings would apply. What is the situation in Texas? The same 
thing. It became law in 1997. Since that time, only three lawsuits are 
known to have been filed as a result of the Texas managed care 
accountability statute.
  Mr. Speaker, this missive that we need to take with a truckload of 
salt put out by AHP says, oh, yes, but there are a bunch of cases out 
there in Texas that have not been filed, so we do not really know. I 
would point out that Texas is tracking suits filed, not decided. In 
Texas, there is a 2-year statute of limitations on bringing suits. If 
those suits were out there, we would know about them because they would 
have to be filed. It simply is not happening.
  Before Texas passed this law in 1997, the insurance industry, the 
HMOs, said the sky would fall, the sky would fall. There would be a 
plethora of lawsuits. Instead, we have seen three filed. However, we 
have seen probably over 1,000 of those disputes resolved before an 
injury occurred. That is what we want to do.

  Choice of plans, the provision that is in the Norwood-Dingell-Ganske 
bill, the same thing in Texas, became law in 1999.
  Provider selection provisions, those regulations have already been 
promulgated by the Texas Department of Insurance in 1995. Women's 
protections that are in the bipartisan consensus bill became law in 
Texas in 1997. Access to specialists in the Norwood-Dingell-Ganske 
bill, the bipartisan bill, were promulgated by regulation in Texas by 
the Texas Department of Insurance in 1995.
  Drug formulary, prescriptions. The provisions that are in our bill 
that passed this House with a vote of 275 became law in Texas in 1999.
  Mr. Speaker, maybe Governor Bush and for that matter Senators McCain 
and Hatch, Senator Lott, the majority leader, the gentleman from Texas 
(Mr. Armey), and presidential candidate Gary Bauer are also aware of 
the December poll by the Harvard School of Public Health and the Kaiser 
Family Foundation which found that nearly 70 percent, let me repeat 
that, 68 percent, to be precise, of Republican respondents, that is two 
out of three, more than two out of three Republicans, said that they 
would favor patients' rights legislation that included the right to sue 
their health plans.
  It is awfully hard for somebody to argue that an industry which is 
making life and death decisions should have a shield from liability 
that no other industry in this country has. Do automobile makers have a 
shield from liability if they make a car that explodes? Do medical 
manufacturers have a shield from liability if their product causes a 
patient to die? No. I do not know of too many Americans that think they 
should.
  When each and every one of us is not only a purchaser but a 
participant in this health system, when we know that a member of our 
family or a friend or a colleague at work has been mistreated by their 
HMO and denied medically necessary care, that is why about 85 percent 
of the people in this country think that this Congress ought to pass 
strong bipartisan patient protection legislation.
  I sincerely hope that we move in that direction before the end of 
this session. I look forward to working with my colleagues on both 
sides of the aisle to try to effect a bill that we can get on the 
President's desk, get it signed into law, that handles the medical 
necessity issue and that provides an effective enforcement mechanism.

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