[Congressional Record Volume 146, Number 10 (Tuesday, February 8, 2000)]
[House]
[Pages H248-H252]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  2015
           HEALTH CARE REFORM STILL MAJOR ISSUE FOR AMERICANS

  The SPEAKER pro tempore (Mr. Ryan of Wisconsin). Under the Speaker's 
announced policy of January 6, 1999, the gentleman from Iowa (Mr. 
Ganske) is recognized for 60 minutes as the designee of the majority 
leader.
  Mr. GANSKE. Mr. Speaker, I am going to probably not take all of my 
allotted hour tonight, probably about half an hour or so. Any 
colleagues that may be following should have notice of that.
  This weekend in Parade Magazine, February 6, 2000, on page 15, there 
is a cartoon. I do not have it blown up like I have made charts of many 
cartoons in the past as I have spoken here on patient protection 
legislation, so let me describe what this cartoon shows. It shows a 
doctor sitting at his desk holding a sheet of paper. There is a 
patient, a man, sitting in the chair in front of the desk. The doctor 
is saying, ``Your HMO won't cover any illness contracted in the 20th 
century.''
  Well, Mr. Speaker, it is a truism that in order for something to be 
funny, in order for there to be a joke to be effective or a cartoon to 
be effective, the public has to understand what the punch line is and 
what the issue is. And the issue, of course, is that HMOs have not 
treated many people around this country fairly. They have come up with 
rules and regulations in byzantine and bizarre ways to deny necessary, 
medically necessary care for their patients. So of course when we see a 
cartoon like this where a physician is telling a patient sitting in 
front of him, ``Your HMO won't cover any illness contracted in the 20th 
century,'' it fits right in with what we think of as an unfairness of 
treatment by HMOs, along with the turn of the century, the new 
millennium.
  I think that this cartoon and the jokes that we will frequently hear 
about HMOs indicate where the public is in their opinion on health 
maintenance organizations and whether they get treated fairly and 
whether, in fact, they think Congress ought to finally get something 
done to pass patient protection legislation.
  I have been coming to the well of this House of Representatives for 5 
years now. I started out with a bill that I had called the Patient 
Right to Know Act that would have banned gag clauses in HMO contracts 
that prevent physicians from telling patients all of their treatment 
options. I mean, the situation is such that some HMOs have tried to 
prevent physicians from telling a patient all of their treatment 
options because one of them might be an expensive one; and they have 
required physicians, for instance, to phone the HMO to get an 
authorization before they can even tell a patient what the treatment 
options are.
  Before I came to Congress, I was a physician. It would be like me 
examining a lady with a lump in her breast knowing that there are three 
treatment options, and then because this HMO has this gag clause in a 
contract, having to excuse myself, go out into the hallway, get on the 
telephone and ask some bureaucrat at some HMO whether I can tell the 
patient about all three of her treatment options. I mean this issue has 
been here in Congress for too long, and the public feels that way.
  I have here a survey done by Kaiser Family Foundation, the Harvard 
School of Public Health called National Survey on Health Care and the 
2000 Elections, January 19, 2000. They were surveying a number of 
issues, but they said on patient rights, more consensus emerged on the 
issue of patient rights, even though, after nearly 2 years of debate, 
voters have decided that a Patients' Bill of Rights could increase the 
cost of their premiums. We will talk about that later, because the 
costs have been greatly overestimated by the managed  care industry, 
and there are several studies that show that a cost increase in a 
person's premiums would be very modest, probably in the range of 
several dollars per month. That would then mean that one's insurance 
would actually mean something if one got sick.

  Mr. Speaker, to go on of what the findings in the survey showed, 
about two-thirds of registered voters, of health care voters, because 
they divided this up into voters that were concerned about different 
issues, and education and health care, by the way, were way at the top 
of this survey, two-thirds of registered voters think health insurance 
premiums for people like them would go up if patient protections were 
enacted, but very few think their premiums would go up very much. And I 
say to my colleagues, they are right.
  Now, 72 percent of registered voters favor patients' rights 
legislation versus only 17 percent that oppose it. In contrast to other 
health issues, there is more consensus between Democratic and 
Republican registered voters on patients' rights with 75 percent of 
Democratic registered voters and 68 percent, more than two-thirds, more 
than two out of three of Republican registered voters favoring patient 
protection legislation.
  It goes on to say, one reason there may be greater consensus on 
patient rights is that many registered voters view patient protection 
legislation as a plus for them personally. Mr. Speaker, 45 percent say 
that it would make them better off, and only 7 percent say it would 
make them worse off. Mr. Speaker, 37 percent say they would not be much 
affected, but among health care voters, 52 percent say it would make 
them better off. As in past Kaiser-Harvard surveys, support for 
patients' rights does not fall when people believe health insurance 
premiums will go up.
  Well, Mr. Speaker, maybe it is because the presidential candidates 
have looked at this issue; they are being asked about it constantly. 
Maybe it is because some of them have been told by all of the people 
that they are talking to around the country right now about what they 
feel about this. Maybe it is because they have looked at the polls. I 
do not know exactly why. But, Mr. Speaker, all of our major 
presidential candidates, whether we are talking about Democrats or 
Republicans, believe that we ought to pass patient protection 
legislation.
  Let me just read to my colleagues a few of the statements from both 
Democrats and Republicans on this issue. One of these people will be 
our next President. Here is what Bill Bradley says: ``Health care 
decisions should be made by doctors and their patients, not an 
insurance company bureaucrat. A patient who feels that an HMO has 
denied needed care should have the right to an independent appeals 
process and should have the right to sue if harmed by an HMO decision. 
I support the Patients' Bill of Rights and I would push for a consumer 
right to know which would ensure that HMOs reveal important details of 
a plan that affect the care you receive.'' Democrat running for 
President.
  How about a Republican running for President. Here is what the 
Republican who won the New Hampshire primary, Senator John McCain, has 
said on HMO reform. When asked whether patients should have the right 
to sue, the most contentious issue, Senator McCain says yes. ``Once a 
patient has exhausted all options to obtain appropriate medical care 
that has been denied by an HMO, including going through a free and fair 
internal and external appeals process, that patient should have the 
right to seek redress in the courts. The right to sue should be limited 
to actual economic damages and capped noneconomic damages under terms 
that do not foster frivolous lawsuits.''
  What does Al Gore, Vice President Gore, say about  this? He says, ``I 
believe that we must pass a strong enforceable Patients' Bill of Rights 
to ensure that people insured by HMOs get the health care they need 
when they need it. For many people, the decisions HMOs make can be the 
difference between life and death, and no one should

[[Page H249]]

have to worry about an HMO at a time when they are worried about their 
immediate survival. That is why I am calling for improved patient care 
by granting patients the right to an independent appeal when they are 
denied treatment, access to specialists, guaranteed coverage of 
emergency room treatment and the right to hold health maintenance 
organizations accountable for their actions.''

  What does Governor George Bush say on the issue of patient 
protections? By the way, I believe all of these statements are in an 
AARP infomercial that has been broadcast around the country. Here is 
what Governor Bush says about this. Governor Bush has a lot of 
experience on this, because several years ago Texas passed a strong 
patient protection piece of legislation, several pieces of legislation, 
and here is what he says: ``I believe patients need access to a speedy 
and impartial forum to resolve disputes over health care coverage. 
Texas has a law that gives patients the right to seek legal action if 
they have been harmed. I allowed it to become law because we have a 
strong independent review process and other protections designed to 
encourage quick out-of-court resolutions instead of costly litigation. 
The process is working in Texas,'' Governor Bush says. He goes on and 
says, ``I would support similar protections at the Federal level, 
provided they do not supercede the patient protection laws Texas and 
many other States already have on the books.''
  Well, Mr. Speaker, the bill that was passed here in the House last 
year, the bipartisan consensus Managed Care Reform Act of 1999 written 
by the gentleman from Georgia (Mr. Norwood), the gentleman from 
Michigan (Mr. Dingell), and myself, passing this House by a wide vote 
margin of 275 to 151, was modeled after the Texas law. Last week I gave 
a similar Special Order on this and I pointed out the many, many 
similarities between the bill that passed the House and what is 
currently in place in Texas.
  As Governor Bush has told me personally and spoken on this 
vigorously, that bill is working. The HMO industry did not fall apart 
when it was passed. There were 30 HMOs in Texas; today there are over 
50. There has not been a plethora of lawsuits; in fact, there have only 
been about four filed. We know that the filings are an accurate index 
of how well that law is working, because Texas has a 2-year state of 
limitation on filings.
  So if there were any cases out there, we would know about it. But 
there have not been because they have a dispute resolution mechanism, 
an independent review panel, and because the HMOs know that if they do 
not follow the law, they are going to be liable; and of those cases, 
those few cases that have been filed in Texas, most of them have been 
because the HMOs did not follow the law. So they should be liable, 
especially if a patient goes out and commits suicide, as is one of 
those cases, because the HMO made an incorrect determination on medical 
necessity. They did not follow the Texas law.
  I could go on and talk about others who have endorsed this, but I 
think for a minute we ought to talk about what is going on here in 
Congress now. Because a bill passed the Senate a year or so ago and as 
I mentioned, we passed a strong bipartisan bill here in the House of 
Representatives a couple of months ago. So once we have a bill that 
passes the Senate and a bill that passes the House, if they are not the 
same, then they go to what is called a conference committee.
  Unfortunately, it looks as if the conference committee has been 
stacked against coming up with a strong, good piece of legislation that 
could have the support of the House of Representatives that was already 
voted on for strong legislation, and a bill that could get the 
President's signature. Why do I say that? Well, let me read from the 
Daily Monitor, Congressional Quarterly from Friday, February 4. It 
says, ``Although the House in October passed the patients' right 
portion of the overall managed care bill by 275 to 151 with 68 
Republicans voting yes, House Speaker Dennis Hastert stacked the 
conference committee with foes of that measure. Only one Republican on 
that conference committee from the House voted for the bill that passed 
the House with 275 votes, and that one person voted for all of the 
alternatives.''
  Well, I think that we are seeing here a foot-dragging, at least an 
appearance from naming of the conferees that there really is not a 
commitment to take the clear message that the House gave in that vote, 
but also in several motions to instruct for our conferees to stand up 
for the bill that passed this House of Representatives with a strong 
bipartisan vote.

                              {time}  2030

  I mean, that vote only came after we had to jump over many hurdles 
during that debate that were put up by the opponents to passing patient 
protection legislation.
  I think that House Republicans in particular fear that Democrats 
could leverage voter anger over this perceived foot-dragging in an 
election year. So we are seeing statements now coming out about, well, 
we should get a bill out, bring it back to the House, bring it back to 
the Senate from the conference.
  But I just have a bit of recommendation for my Republican colleagues. 
If they bring back a bill that is not a strong bill, that plays games 
with the fine details, that does not address the issue of medical 
necessity, which continues to allow for Federal employee plans, the 
ability for HMOs to define ``medical necessity'' in any way that they 
want to, a bill that does not have a strong enforcement provision to 
make sure that HMOs follow the rules, then it cannot pass. That 
conference report cannot pass the House. We cannot get it to the 
President, and we are at a stalemate.
  The gentleman from Georgia (Mr. Norwood) who wrote that bill, along 
with me on the Republican side, we stand ready and available to our 
leadership to help in terms of getting a strong piece of legislation 
that is a real piece of patient protection legislation to the House. I 
have made that offer to the Speaker on several occasions. We will 
continue to work to try to make sure that a bill that comes out of 
conference, that comes to the floor of the House, is worthy of the name 
``patient protection legislation.''
  Let me just point out a couple of areas where we could see some real 
problems. The patient protection bill was married to a bill on patient 
access to deal with the uninsured. I certainly think that we ought to 
deal with trying to decrease the number of uninsured. I think there are 
components in that access bill which could gain bipartisan support. I 
mean, moving to 100 percent deductibility for health insurance for 
individuals and making that effective January 1, 2000, would be one of 
those things that would get broad bipartisan support. I am certainly in 
favor of that.
  Currently this year individuals who purchase their health insurance 
only have a 60 percent deduction, as versus a business getting a 100 
percent deduction for health insurance for their employees. I do not 
think that is fair. We ought to fix that now. That is one of the items 
that could be the basis for a bipartisan agreement on access.
  But there are some provisions in that other bill that got married to 
the patient protection bill which are really big problems. Let me give 
an example. The Congressional Budget Office just did a study on what 
are called association health plans, or are otherwise known as multiple 
employer welfare association plans, MEWAs; AHAs, MEWAs, all these 
acronyms.
  What these are, an association health plan is where an organization, 
for instance, could offer a health plan to its members and be included 
under Federal law but be absolved from State insurance regulation for 
the health plan.
  Multiple employer welfare associations are basically the same thing. 
Years ago when Congress first passed the Employee Retirement Income 
Security Act, ERISA, the piece of legislation which pulled insurance 
oversight away from the States and basically left nothing in its place 
for quality control, which is why we have this problem with HMOs as 
offered by employers today, years ago when that bill passed there was a 
loose definition of ``associations.''
  We saw a number of bogus associations offer health plans. They were 
undercapitalized. In some cases they were simply fraudulent. They went 
bankrupt. People ran away with the profits, and a whole bunch of 
people,

[[Page H250]]

 hundreds of thousands of people, were left without insurance.

  So Congress came back in the early 1980s and they tightened up the 
definition. They said, you can only offer an employer plan if you are a 
labor union or if you are an employer; an employer, not a grouping of 
employers or associations. Congress had to learn the hard way. A lot of 
people had to learn the hard way what the problem was. But some people 
now want to expand that definition again. I think the Clinton 
administration is correct on this, that it is not a good idea.
  Let me give some reasons why. There was a study of association health 
plans just done by the Congressional Budget Office. This analysis by 
the CBO found that most small employers and workers would actually pay 
higher premiums if a preemption from State law for association health 
plans is brought back in this conference report, if it were enacted.
  The report reveals that association health plans would save costs by 
skimming the healthy from the existing State-regulated small group 
market, thus making coverage more expensive for those who are left in 
that State coverage; i.e., the sick.
  Specifically, this Congressional Budget Office report said that 
association health plans would not significantly reduce the number of 
uninsured. This is why a lot of people have said, well, we need to do 
association health plans that would decrease the number of uninsured.
  But the Congressional Budget Office has looked at this and said, not 
so. Contrary to opponents' claims that AHPs would cover up to 8.5 
million uninsured, the Congressional Budget Office estimated that 
coverage would only increase by 330,000 individuals, but also noted 
that the overall number of individuals insured would be lower, 
``Because some of those who gained coverage through association health 
plans would have otherwise obtained coverage in the individual 
market.''
  Then the CBO goes on to say, ``Four in five workers would be worse 
off under association health plans and health marts.'' According to the 
CBO report, 20 million employees and dependents of small employers 
would experience a rate increase under association health plans, while 
only 4.6 million would see a rate reduction.
  Those do not sound like particularly great numbers to me. We are 
going to reduce the rate for about 4.5 million, but we are going to 
increase the premiums for 20 million. Does that make sense? Is that 
something we should be putting into a bill where we are trying to 
reduce the number of uninsured?
  The CBO says, ``In addition, 10,000 of the sickest individuals would 
lose coverage if association health plans were enacted. Association 
health plans would save money primarily by cherry-picking.'' What does 
that mean? The CBO estimated that nearly two-thirds of the cost savings 
for association health plans would result from attracting healthier 
members from the existing insurance pool.
  I come from one of the largest insurance centers in the United 
States, Des Moines, Iowa. I think it has more insurance companies than 
Hartford, Connecticut. I can say something about how insurance works. 
It works by making sure there is a large enough pool of the insured so 
we can spread out the risk, the cost of the risk.
  But what association health plans would do is they would pull the 
healthy out of that larger market. Sure, the premiums might be lower 
for that group, but it would leave a sicker group behind. As the CBO 
said, we could see many, many people lose their insurance, because with 
that sicker pool, now the cost of premiums would go up dramatically. We 
would have a smaller pool but a sicker pool. Therefore, in order to not 
go bankrupt, the insurers who are covering that group that is left 
behind would have to raise their premiums a lot.

  The CBO report goes on, ``Association health plans would eliminate 
benefits to cut costs.'' Think about that, association health plans 
would eliminate benefits to cut costs. Contrary to proponents claims 
that association health plans could offer generous benefits while 
lowering insurance costs, the Congressional Budget Office found that 
dropping State-mandated benefits would be the second major method the 
AHPs would use to reduce costs; i.e., cherry-picking. But they 
estimated that ``One-third of cost savings would come from eliminating 
benefits.''
  Then the CBO went on to say, ``Association health plans would not 
reduce overhead costs. Contrary to claims that association health plans 
could reduce overhead by 30 percent, CBO assumed that cost savings 
arising from the group purchasing feature of association health plans 
and health marts would be negligible.'' They found no substantial 
evidence that joining a purchasing coop produced lower insurance costs 
for firms.
  The CBO correctly points out that States with aggressive insurance 
reforms would see the most damage. The CBO report indicates that States 
with strict insurance reforms like Massachusetts, New Jersey, New York, 
would be most attractive to the association health plans.
  The report concludes that ``In States with more tightly compressed 
premiums, where the most cross-subsidization occurs, low-cost firms 
would face the greatest potential difference in price between 
traditional and association health mart plans.''
  I mean, Mr. Speaker, if my colleagues want a full report, the report 
called ``Increasing Small Firm Health Insurance Coverage Through 
Association Health Plans and Health Marts,'' the study that I am 
talking about, it is available on the CBO web site www.cbo.gov, g-o-v.
  I would recommend to my colleagues that they look this up, because it 
is very possible that we could see a conference report come back that 
has this provision in it that could actually increase the number of 
uninsured, rather than decrease it, and could undermine State efforts 
at providing insurance coverage.
  I have here a letter from my Governor. I just got this. This is from 
Governor Vilsack of the State of Iowa. It is addressed to all of the 
Iowa Congressmen and Senators.
  ``Gentlemen, it has come to my attention that conferees from the U.S. 
House of Representatives and the U.S. Senate will soon meet to consider 
the patient protection bills passed by each Chamber last year. I have 
been advised that the House version of this legislation contains 
provisions that would exempt multiple employer welfare arrangements and 
association health plans from a variety of State laws.''
  Okay, that is the provision that was in the access bill that was 
married to the patient protection bill. So it does not deal as 
expressly with patient protection, but it is being folded into the 
patient protection legislation.
  The Governor goes on to say, ``I would like to express my concern 
about these proposals for the following reasons.'' And I happen to 
believe, Mr. Speaker, that just about every Governor in this country 
will write a similar letter to us, whether they are Republican or 
Democrat, on this issue.
  My Governor says, ``It is my view that the MEWA AHP provisions would 
render State small employer health insurance reforms unworkable by 
allowing groups to opt in and out of State regulation based on their 
medical needs. Furthermore, these provisions would lead to a siphoning 
of healthy workers from the State-regulated health insurance market, 
which would then become a dumping ground for high-cost groups. As 
premiums rise for those remaining in the State-regulated market, more 
small firms would drop out of health insurance coverage, and the number 
of uninsured in our State and across the Nation would increase. This 
seems contrary to efforts in our State to try to reduce the number of 
uninsured individuals.''
  Governor Vilsack goes on: ``The legislation could also mean a Federal 
takeover of health insurance regulation by preempting traditional State 
regulatory authority.'' Let me just repeat this: ``The legislation 
could also mean a Federal takeover of health insurance regulation by 
preempting traditional State regulatory authority.''
  I am a Republican. How many times have I heard my colleagues from my 
side of the aisle say, ``Hey, we need to devolve power back to the 
States.'' The States are the places where we ought to be doing 
insurance.

                              {time}  2045

  There is a bill that passed a long time ago called the McCarran-
Ferguson Act, which basically says that insurance regulation should be 
done at the State level.

[[Page H251]]

  I would like to know how many of my Republican colleagues want to 
repeal the McCarran-Ferguson Act and take it over by the Federal 
Government. I am one of those Republicans who believe that the role of 
the Federal Government should be limited; that we should not be taking 
this over.
  This was part of the original problem with the ERISA bill. We 
exempted oversight by the States and so we have had a lot of abuses.
  The governor goes on to say, States would be powerless to enforce 
their insurance rules with regard to these federally-licensed health 
plans or to resolve problems for their residents quickly. Moreover, 
States could no longer move quickly to prevent the insolvency of a 
failing association health plan, or seize assets to assure payment of 
enrollees and local health care providers.
  We are getting right back to what I was talking about before. Past 
experience has shown that some of these plans have gone insolvent.
  Traditionally the State takes over to make sure that people are not 
left uninsured, but if they are under the Federal purview, what happens 
to those people whose plans then go bankrupt?
  Governor Vilsack then goes on, ``For all those reasons,'' listen to 
this my colleagues, ``for all those reasons, the National Governors' 
Association, the Republican Governors' Association, the National 
Conference of State Legislatures, the National Association of Insurance 
Commissioners have opposed those provisions.''
  My governor finishes by saying, ``I add my voice to theirs in asking 
you to reconsider such provisions so that we do not run the risk of 
increasing the number of uninsured in Iowa and in the country.
  ``Furthermore, I think it is important and necessary for States to be 
able to continue to regulate this important industry as we have 
successfully done for a number of years.
  ``Iowa has a reputation for a balanced regulation and it would be 
difficult to maintain that balance with these federally-imposed 
requirements. Sincerely, Tom Vilsack, governor of Iowa.''
  I would again reiterate that I think that most of the Members are 
going to receive a similarly worded letter from their governors, 
whether they be Democrat or Republican, on this issue. So if the 
conference bill comes back to us with these association health plans or 
these multiple employer welfare associations, people need to think 
very, very seriously, if they are really serious about decreasing the 
number of uninsured, whether they can support a bill that would have 
this type of provision in it.
  Now, another issue that is going to be very important is on the issue 
of medical necessity and who at the end gets to determine medical 
necessity. The bill that we passed here in the House basically says 
that that independent peer panel, if there is a dispute and a patient 
has gone through the internal appeals process through their HMO and is 
unhappy with the decision by the HMO, that the patient can take that 
denial to an independent peer panel, a group of doctors not paid for by 
the HMO or a part of the HMO, and get an independent review.
  The House version says that unless you have a specific exclusion of 
coverage in the contract, for instance the HMO contract that you have 
specifically says we will not provide a bone marrow transplant, that 
unless there is a specific exclusion then that independent panel 
determines the medical necessity of the treatment, not the health plan.

  Unfortunately, we have a situation with the bill from the other side 
of the capitol that does not address this issue. In fact, it is worse 
than the status quo. It would basically say that HMOs can define 
medical care in any way they want to.
  What does that mean? Well, under Federal law now you have some HMOs 
that are saying we define medical necessity as the cheapest, least 
expensive care, quote/unquote.
  For all of us who are concerned about health care costs, you might 
initially think, well, what would be wrong with that? Well, I can say 
what is wrong with that. As a plastic and reconstructive surgeon, I 
took care of a lot of kids who had cleft lips and palates. They were 
born with a deformity in the roof of their mouth, a big hole in the 
roof of their mouth, and they cannot eat without food coming out of 
their nose and they cannot speak properly.
  The commonly accepted, standard treatment for that is a surgical 
repair to bring those tissues together and to recreate a roof of the 
mouth so that, A, they do not have food going up into their nose and 
coming out and, B, so that they can learn to speak properly or have the 
best chance to do that.
  Under this definition that some HMOs have come up with, i.e., the 
cheapest, least expensive care, they could justify the treatment for a 
child with that birth defect as a piece of plastic, like an upper 
denture; we are just going to give him an upper denture to put in the 
roof of his mouth. That is a travesty, but that could exactly happen 
and people have lost their lives on the basis of decisions that HMOs 
have made on medical necessity where they have ignored their 
physician's advice and denied needed treatment.
  Many times I have stood up here and told the story about a little boy 
from Atlanta, Georgia, who when he was 6 months old, in the middle of 
the night, had a temperature of 104, and his mother thought he needed 
to go to the emergency room and she phoned a 1-800 number for an HMO 
and was told, well, you can only take him to one emergency room. That 
is all we are going to authorize.
  It was 60-some miles away. After they had passed several hospitals 
where the little boy could have been treated, he had an arrest, a 
cardiac arrest, before he got to the hospital. Partly as a result of 
that loss of circulation to his hands and his feet, he developed 
gangrene in both hands and both feet and they both had to be amputated.
  That HMO made a medical decision and said we will let you go to the 
emergency room but only this one a long way away. If you go to any 
other ones, you have to pay for it yourself, and mom and dad were not 
medical professionals; they did not know how sick little Jimmy was 
until his eyes rolled back in his head and he stopped breathing en 
route to the hospital.
  In my opinion, when an HMO makes a medical decision like that they 
ought to be legally responsible for that. Under current Federal law, if 
it is a health plan that you get through your employer, in that type of 
situation the health plan would be liable only for the costs of the 
amputations. I do not think that is justice.
  Furthermore, none of the leading contenders for President, whether 
they be Republican or Democrat, think that that is justice. How can one 
defend a health maintenance organization that is making life and death 
decisions and say they should have a legal shield from their medical 
malpractice?
  As a physician, I have never argued that physicians should be free of 
liability from their malpractice and I do not know of any physicians 
who do that, who make that argument. That is why we carry malpractice 
insurance. I do not know of any auto maker that has a legal liability 
shield like that. I do not know of any of our airplane manufacturers or 
airlines. I do not know of any business in this country that has that 
kind of legal immunity and, yet, because of a 25-year-old Federal law, 
HMOs that deny medically necessary care and provide that insurance 
through an employer they are not liable. They are only liable for the 
cost of care denied, and if the patient has died then they are liable 
for nothing.

  I just don't think that that is fair. I do not think that one can 
justify that. I think one would be laughed out of any room in this 
country. That is why I find it very hard to understand how some 
colleagues of mine can oppose restoring responsibility.
  I am a Republican. I have argued on this floor many times that people 
ought to be responsible for their actions. Many of my Republican 
colleagues have made the same comments. If somebody is a cocaine or a 
drug dealer, they ought to be liable for that. They ought to spend time 
in jail. If somebody commits murder, I bet an awful lot of my 
Republican colleagues would say if they are guilty of first degree 
murder they should get the death penalty. I know that when we passed 
the welfare reform bill, our thoughts were that if one is an able- 
bodied person and they get help and they have a period of time to get 
some training,

[[Page H252]]

then it is their responsibility to get a job.
  Responsibility has been a big word on this Republican side. But where 
do I see that type of responsibility being applied to HMOs? If it is 
not addressed by the conference committee, then that bill will not pass 
this House and we will end up with a big goose egg, a big zero, for 
addressing this major problem.
  I started out this talk by saying I have been working on this for 4 
years, 5 years. So has the gentleman from Georgia (Mr. Norwood), and 
many others on both the Republican and the Democratic sides. In the 
meantime, a lot of patients have been denied necessary care; a lot of 
patients who have ended up like that little boy from Atlanta, Georgia, 
with some significant deficits, if not loss of their life, as has been 
outlined by major magazines such as Time Magazine on feature cover 
stories.
  It really is time, Mr. Speaker, that we addressed this issue; that we 
do not load up a conference report with bad ideas; that we take the 
bill that passed this House, a bill that could be signed into law 
tomorrow by President Clinton, a bill that tomorrow could be giving 
people around this country a fair shake by their HMOs. We ought to do 
it soon, and I sincerely hope that the motives of the members of the 
conference committee are to actually accomplish a piece of legislation 
and are not simply a face-saving measure because they know that this is 
an election year and the public is demanding that Congress take action.

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