[Congressional Record Volume 146, Number 42 (Thursday, April 6, 2000)]
[Senate]
[Pages S2339-S2340]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   HONORING THE GOOD WORKS OF THE SOCIETY FOR MATERNAL-FETAL MEDICINE

  Mr. THURMOND. Mr. President, I rise to recognize the vital work 
performed by a group of tireless and dedicated professionals: The 
members of the Society for Maternal-Fetal Medicine (SMFM). I 
congratulate the Society for its outstanding achievements, and note 
this year they celebrated their 20th annual meeting.
  It is often said that the United States is home to the finest pool of 
health care professionals in the world. I could not agree more. Each 
and every day, these professionals provide cutting edge care for 
millions across the country. Treatments that did not exist just ten 
years ago are now saving lives on a routine basis. I am hopeful that we 
never take this high level of care for granted.
  The Society for Maternal-Fetal Medicine is one group that 
demonstrates the tremendous talent we have in our country. For many of 
us, ``maternal-fetal medicine'' may not be an everyday term. However, 
we all acknowledge that mothers experiencing complicated pregnancies 
require and deserve the best care possible. Maternal-fetal specialists 
provide care or consultation during complicated pregnancies. In 
addition, they provide education and research concerning the most 
recent approaches to the diagnosis and treatment of obstetrical 
problems. As a result, these specialists promote awareness of the 
diagnostic and therapeutic techniques for optimal management of these 
complicated pregnancies. In addition, it should be noted that maternal-
fetal medicine specialists are complementary to obstetricians in 
providing consultations, co-management or direct care before and during 
pregnancy.
  Mr. President, I urge my colleagues to join me in congratulating the 
members of the Society of Maternal-Fetal Medicine for their outstanding 
work. I also want to acknowledge the fine work of Dr. Peter Van 
Dorsten, President of the SMFM, who resides in my home state of South 
Carolina. There is no doubt that Americans across the country join me 
in thanking these unique individuals.
  Mr. KENNEDY. Mr. President, seven months have elapsed since the House 
of Representatives passed the bi-partisan Norwood-Dingell bill to end 
insurance company and HMO abuses, and more than six months have passed 
since House and Senate conferees were appointed to prepare the final 
version of this important measure.
  Today, I am releasing a new study by the Minority Staff of the 
Health, Education, Labor and Pensions Committee that documents how 
devastating this long delay has been for millions of Americans and 
their families, and how urgent it is for the House-Senate conference to 
complete its work as soon as possible.
  Drawing on data gathered by the University of California School of 
Public Health and the Harvard School of Public Health, the report 
documents unacceptably high numbers of patients who are denied needed 
care, who suffer increased pain, or whose health has seriously declined 
because too many HMOs and insurance companies put profits ahead of 
patients.
  According to the study, 59,000 patients each day--22 million patients 
a year--report added pain and suffering as the result of the actions of 
their health plans. Large numbers of patients have specialty referrals 
delayed or denied. Others are forced to change doctors. Still others 
are forced to take prescription drugs that are different from the drugs 
their doctor prescribed.
  In addition to patients' reports of significant problems as the 
result of actions of their health plans, thousands of physicians report 
seeing patients every day whose health has seriously declined as the 
result of abuses

[[Page S2340]]

such as the failure to cover recommended prescription drugs, denial of 
needed diagnostic tests and procedures, and unwillingness to allow 
referrals for specialty care.
  This study provides powerful new evidence of the need for Congress to 
move promptly to pass a strong Patient's Bill of Rights. Millions of 
families are suffering because of the failure of Congress to act. 
Families across America deserve protection, and it is time for Congress 
to fulfill its responsibility and see that they get it.
  I ask unanimous consent the study be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

The Impact on Patients of Delays in Passing a Patients' Bill of Rights: 
A Senate Health, Education, Labor and Pensions Committee Minority Staff 
                                 Study

       Delays in passing legislation to curb insurance company 
     abuse result in injury to thousands of patients daily and 
     millions of patients annually. Drawing on two prior studies 
     on the incidence of abusive health plan practices, this 
     report looks at the number of patients affected daily, 
     weekly, monthly and yearly.
       The estimates are based on patient self-reports of 
     experiences with health plans and on physicians' reports of 
     the frequency of various abuses and the seriousness of 
     injuries sustained by the patients they see in their own 
     practices.
     Highlights
       According to patient reports, every day, as the result of 
     actions of their health plan: 59,000 patients experience 
     added pain and suffering; 41,000 patients experience a 
     worsening of their condition; 35,000 patients have needed 
     care delayed; 35,000 patients have a specialty referral 
     delayed or denied; 31,000 patients are forced to change 
     doctors; and 18,000 patients are forced to change 
     medications.
       According to physician reports, every day: 14,000 
     physicians see patients whose health has seriously declined 
     because an insurance plan refused to provide coverage for a 
     prescription drug; 10,000 physicians see patients whose 
     health has seriously declined because an insurance plan did 
     not approve a diagnostic test or procedure; 7,000 physicians 
     see patients whose health has seriously declined because 
     an insurance plan did not approve referral to a medical 
     specialist; 6,000 physicians see patients whose health has 
     seriously declined because an insurance plan did not 
     approve an overnight hospital stay; and 6,000 physicians 
     see patients whose health has seriously declined because 
     an insurance plan did not approve a referral for mental 
     health or substance abuse treatment.
       Table 1 shows the incidence of plan restrictions on care 
     and patient injuries resulting from plan actions by day, 
     week, month, and annually, as reported in the survey of 
     patients. Table 2 shows the number of physicians seeing plan 
     abuses that result in serious declines in patient health each 
     day, month, week, and year.

                                            TABLE 1.--PATIENT SURVEY
----------------------------------------------------------------------------------------------------------------
                                                 Number of        Number of        Number of        Number of
                                                  patients         patients         patients         patients
              Health plan abuse                 affected per     affected per     affected per     affected per
                                                    year            month             week             day
----------------------------------------------------------------------------------------------------------------
Delay in Needed Care........................       12,880,000        1,073,000          247,000           35,000
Delay or Deny Specialty Referral............       12,880,000        1,073,000          247,000           35,000
Forced to Change Doctors....................       11,270,000          939,000          216,000           31,000
Forced to Change Medications................        6,440,000          537,000          124,000           18,000
Results of Health Plan Abuse:
    Added Pain and Suffering................       21,638,000        1,803,000          415,000           59,000
    Worsening of Condition..................       14,876,000        1,240,000          285,000           41,000
----------------------------------------------------------------------------------------------------------------
Source: Committee Analysis Based on Helen H. Schauffler's ``California Managed Health Care Improvement Task
  Force Survey of Public Perceptions and Experiences with Health Insurance Coverage.'' U.C. Berkeley School of
  Public Health and Field Research Corporation, September, 1997, reported in Improving Managed Health Care in
  California, Findings and Recommendations, Volume Two, January 1998, tables 4 and 19, projected to the national
  level.


                                           TABLE 2.--PHYSICIAN SURVEY
----------------------------------------------------------------------------------------------------------------
                                                 Number of        Number of        Number of        Number of
                                                doctors each     doctors each     doctors each     doctors each
                                                year seeing      month seeing     week seeing       day seeing
              Health plan abuse                patients with    patients with    patients with    patients with
                                              serious decline  serious decline  serious decline  serious decline
                                               in health plan   in health from   in health from   in health from
                                                   abuse          plan abuse       plan abuse       plan abuse
----------------------------------------------------------------------------------------------------------------
Denied coverage of recommended prescription           137,000          111,000           71,000           14,000
 drug.......................................
Denied coverage of needed diagnostic test...          149,000          100,000           51,000           10,000
Denied referral for needed specialty care...          122,000           76,000           37,000            7,000
Denied overnight hospital stay..............          110,000           65,000           29,000            6,000
Denied referral for mental health or                  116,000           63,000           30,000            6,000
 substance abuse treatment..................
----------------------------------------------------------------------------------------------------------------
Source: Committee Analysis Based on Kaiser Family Foundation and Harvard School of Public Health, ``Survey of
  Physicians and Nurses,'' July, 1999.

                              methodology

       The data presented in this report was drawn from two 
     sources. Patients' self-reports on difficulties with their 
     health plans and illness and injury caused by actions of 
     their health plans was drawn from a random sample survey of 
     individuals in California with private health insurance 
     conducted by the Center for Health and Public Policy Studies, 
     School of Public Health, University of California at 
     Berkeley. Helen Schauffler, Ph.D., was the principal 
     investigator. The survey was conducted during September, 1997 
     for the Managed Care Improvement Task Force of the State of 
     California, and reported in Improving Managed Health Care in 
     California, Findings and Recommendations, Volume Two, 
     January, 1998, Tables 4 and 19.
       The survey asked whether the respondent experienced 
     specific difficulties with a health plan. Those who 
     experienced difficulties were asked about the impact of the 
     difficulty on their health. The figures presented in this 
     report assume that the incidence of such events is the same 
     among the total U.S. population of privately insured 
     individuals as it is among the privately insured population 
     in California. Daily, weekly, and monthly figures were 
     derived by dividing annual rates by 365, 52, and 12, 
     respectively. All figures in the tables are rounded to the 
     nearest 1,000 patients.
       Data on physicians' reports of health plan practices and 
     serious declines in health experienced by patients as the 
     result of health plan actions were drawn from the 1999 Survey 
     of Physicians and Nurses by the Kaiser Family Foundation and 
     the Harvard School of Public Health. The survey was conducted 
     between February 11 and June 5, 1999. Physicians were asked 
     how frequently a set of plan practices occurred (weekly, 
     monthly, every six months, yearly, never, or not applicable 
     to my practice). Physicians who reported that the practice 
     occurred were asked for the impact on the health of their 
     patients.
       The figures reported in the survey were converted into 
     daily, weekly, monthly, and annual totals by adding the 
     proportions seeing the specified event during the specified 
     time period. For example, to derive a weekly total, the 
     numbers of doctors reporting seeing such patients weekly was 
     added to one-fourth of the doctors reporting seeing such 
     patients monthly plus one-fifty-second of the doctors 
     reporting seeing such patients annually. The proportion was 
     then multiplied by the size of the sampling universe of 
     470,364 physicians. All figures reported in the table are 
     rounded to the nearest 1,000 patients.
       Note that the tables are not comparable, since one reports 
     on numbers of patients affected, while the other reports on 
     numbers of doctors seeing affected patients. Many doctors saw 
     numerous affected patients. Moreover, judgments of doctors 
     who attribute health declines to specific plan practices may 
     not coincide with patients' own conclusions. Also, the doctor 
     survey reports on patient injuries due to specific plan 
     practices which are not identical with the problems 
     identified in the patient survey.

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