[Congressional Record Volume 146, Number 85 (Thursday, June 29, 2000)]
[House]
[Pages H5617-H5626]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PROVIDING FOR CONSIDERATION OF H.R. 1304, QUALITY HEALTH-CARE COALITION 
                              ACT OF 2000

  Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call 
up House Resolution 542 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 542

       Resolved, That at any time after the adoption of this 
     resolution the Speaker may, pursuant to clause 2(b) of rule 
     XVIII, declare the House resolved into the Committee of the 
     Whole on the state of the Union for consideration of the bill 
     (H.R. 1304) to ensure and foster continued patient safety and 
     quality of care by making the antitrust laws apply to 
     negotiations between groups of health care professionals and 
     health plans and health insurance issuers in the same manner 
     as such laws apply to collective bargaining by labor 
     organizations under the National Labor Relations Act. The 
     first reading of the bill shall be dispensed with. All points 
     of order against consideration of the bill are waived. 
     General debate shall be confined to the bill and shall not 
     exceed one hour equally divided and controlled by the 
     chairman and ranking minority member of the Committee on the 
     Judiciary. After general debate the bill shall be considered 
     for amendment under the five-minute rule. It shall be in 
     order to consider as an original bill for the purpose of 
     amendment under the five-minute rule the amendment in the 
     nature of a substitute recommended by the Committee on the 
     Judiciary now printed in the bill. The committee amendment in 
     the nature of a substitute shall be considered as read. All 
     points of order against the committee amendment in the nature 
     of a substitute are waived. No amendment to the committee 
     amendment in the nature of a substitute shall be in order 
     except those printed in the report of the Committee on Rules 
     accompanying this resolution. Each amendment may be offered 
     only in the order printed in the report, may be offered only 
     by a Member designated in the report, shall be considered as 
     read, shall be debatable for the time specified in the report 
     equally divided and controlled by the proponent and an 
     opponent, shall not be subject to amendment, and shall not be 
     subject to a demand for division of the question in the House 
     or in the Committee of the Whole. All points of order against 
     the amendments printed in the report are waived. The Chairman 
     of the Committee of the Whole may: (1) postpone until a time 
     during further consideration in the Committee of the Whole a 
     request for a recorded vote on any amendment; and (2) reduce 
     to five minutes the minimum time for electronic voting on any 
     postponed question that follows another electronic vote 
     without intervening business, provided that the minimum time 
     for electronic voting on the first in any series of questions 
     shall be 15 minutes. At the conclusion of consideration of 
     the bill for amendment the Committee shall rise and report 
     the bill to the House with such amendments as may have been 
     adopted. Any Member may demand a separate vote in the House 
     on any amendment adopted in the Committee of the Whole to the 
     bill or to the committee amendment in the nature of a 
     substitute. The previous question shall be considered as 
     ordered on the bill and amendments thereto to final passage 
     without intervening motion except one motion to recommit with 
     or without instructions.

  The SPEAKER pro tempore. The gentleman from Florida (Mr. Goss) is 
recognized for 1 hour.
  Mr. GOSS. Mr. Speaker, for the purpose of debate only, I yield the 
customary 30 minutes to the gentleman from Ohio (Mr. Hall), pending 
which I yield myself such time as I may consume. During consideration 
of this resolution, all time yielded is for the purpose of debate only.
  Mr. Speaker, this is a fair and appropriately structured rule for 
debate on this matter. We have made six amendments in order on a 
bipartisan basis. These amendments cover a full range of topics 
concerned with the underlying bill.
  The Committee on Rules has clearly erred on the side of inclusion to 
ensure a full, yet I believe efficient debate on this very important 
subject, which has caught the attention of Members.
  We are here today because doctors have become disillusioned with some 
aspects of our modern healthcare delivery system. They rightly assert 
that some HMOs are interfering too much in the doctor-patient 
relationship undermining their ability to effectively do their job. 
Their complaints are understandable, and they do need to be addressed.
  H.R. 1304 seeks to level the playing field between insurers and 
doctors. While HMOs should not be able to dictate to physicians because 
of their size, it is equally wrong for doctors to

[[Page H5618]]

collude and force the hand of insurers and employers. If we get it 
wrong, the end result could be higher health care prices and more 
uninsured Americans without improving patient quality of care which 
concerns all of us.
  Those are the things we need to avoid, so we have to get it right. We 
have to find the correct balance, and this rule fairly provides for 
meaningful debate on how to proceed.
  H.R. 1304 is a simple, straightforward bill. It proposes to give 
doctors and other health care professionals a limited exemption from 
antitrust laws when bargaining with health plans conferring on them the 
same rights afforded to unions operated under the National Labor 
Relations Act.
  But based on testimony from some colleagues, there may be a hitch, 
unlike traditional unions, these doctor cartels, as they are called, 
would exist without any real regulatory oversight.

                              {time}  2100

  Doctors could refuse to negotiate in good faith and even engage in 
selective boycotts. Obviously, this is a problem that needs a remedy. 
We all know that Congress does have a role in curtailing HMO abuse. I 
am very proud to be one of many House Members and Senators who have 
been serving on the conference, working on a bipartisan basis, to 
finalize the details of the Patient's Bill of Rights. But while we 
still have some work to do on it, it is no secret that we are pretty 
well agreed to the need for an independent, binding review process 
where doctors' decisions will be evaluated by other physicians. In 
other words, meaningful and appropriate oversight.
  We also understand that HMOs should be held accountable when they 
interfere in the doctor-patient relationship and harm occurs. But as 
encouraged as I am by this, I have reservations about H.R. 1304. It 
appears to be a necessary, simple solution to a tough problem, but as a 
wide range of experts have stated from the Congressional Budget Office 
to the Federal Trade Commission, the costs could outweigh any potential 
benefits. In fact, the CBO's projection put the cost at well over $3 
billion over 10 years, not an insignificant amount of money, even 
around here; and that is worrisome to me.
  I am hopeful that my colleagues will support this rule so that we can 
get on with deliberation of these and other issues and weigh the 
potential costs and benefits. That is, after all, why we are here and 
what a deliberative body does. America's doctors and patients do 
deserve relief from bad HMOs. Indeed, Congress is addressing HMO reform 
in a tough and serious manner; I am a firsthand witness to that. The 
gentleman from California (Mr. Campbell) and the gentleman from 
Michigan (Mr. Conyers) and some others urge that H.R. 1304 is the right 
direction we should pursue as part of congressional consideration. As 
our colleagues, they deserve respect for bringing this forward, and I 
urge a yes vote on this fair rule and look forward to a fair exchange 
on the underlying bill after everybody has the chance to hear all 
sides. However, we do not get that chance if we do not approve this 
rule.
  Mr. HALL of Ohio. Mr. Speaker, I yield myself such time as I may 
consume, and I thank the gentleman from Florida for yielding me this 
time.
  This is a restricted rule. It will allow for the consideration of 
H.R. 1304, which is the Quality Health Care Coalition Act. As my 
colleague from Florida has explained, this rule provides for 1 hour of 
general debate. It will be equally divided and controlled by the 
chairman and ranking minority member of the Committee on the Judiciary. 
The rule makes in order only six amendments. No other amendment may be 
offered.
  This bill provides limited antitrust exemptions for doctors who 
negotiate contracts with health plans and insurance companies. Other 
workers enjoy a similar exemption under collective bargaining laws.
  In recent years, health maintenance organizations and insurance 
companies, not doctors, have dictated the terms of health care for most 
Americans. Antitrust laws have prevented doctors from organizing to 
counterbalance the influence of the health care managers. Many people 
believe that this legislation is needed now more than ever because 
growth and consolidations among the HMOs and the insurance companies 
have only increased the bargaining power of the health care industry 
against the doctors. Obviously, the purpose of the bill is to swing the 
balance of power back in favor of the doctors.
  The House sometimes uses restrictive rules like this, but it should 
only do it in sparing ways. However, as with some bills reported from 
the Committee on the Judiciary, it can be appropriate in the case to 
limit amendments. The few amendments that may be offered will give 
opponents of the current bill an opportunity to further debate and 
perfect it.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GOSS. Mr. Speaker, I am happy to yield 3 minutes to the 
distinguished gentleman from California (Mr. Campbell), the author on 
this side.
  Mr. CAMPBELL. Mr. Speaker, I thank the gentleman from Florida for all 
of his kindness and hard work in this field.
  I wish to say that the rule is critical. The rule is critical. There 
will be no other means to address H.R. 1304. To those who have 
sponsored this bill, and I have a list of all of them, please, if they 
think that they might vote against the rule but have a chance to vote 
for the bill again, they are wrong. It is not going to come back. So 
this is the issue, this is the moment, this is the time to vote in 
favor of patients if we believe that they are not being adequately 
taken care of under today's medical system, because there is not a 
balance between the doctors and the HMOs.
  The focus of the controversy is on the amendment by the gentleman 
from Oklahoma (Mr. Coburn). I understand that there is concern that his 
amendment was made in order, but the second degree amendment of the 
gentleman from Pennsylvania (Mr. Greenwood) was not.
  Let me address this directly. I have a 100 percent pro-choice voting 
record. I am second to none in my support of a woman's right to choose. 
My record stands for that. The Coburn amendment says, ``Nothing in this 
section shall apply to negotiations specifically relating to requiring 
a health plan to cover abortion or abortion services.''
  Whereas I would not have singled out abortion, I would not have 
treated this in any manner different than any other medical procedure, 
I emphasize to my colleagues that the Coburn amendment is a null set. 
There is no evidence of any health care plan, any HMO, requiring 
doctors to perform abortion or abortion services. I draw to the 
attention of all of the cosponsors of this bill that the amendment by 
the gentleman from Oklahoma (Mr. Coburn) uses the word ``requiring,'' 
not ``permitting.''
  This amendment, in other words, is, in my judgment, an effort to 
introduce the topic of abortion into an area where it has no place. It 
is not a substantive amendment. Mr. Speaker, let me repeat, it deals 
with a case that has not been shown to exist--where an HMO requires a 
doctor to perform an abortion.
  In conclusion, the gentleman from Florida (Mr. Goss) noted two things 
with which I would like to take respectful disagreement. First of all, 
the concern he expressed for a boycott was addressed by an amendment by 
the gentleman from New York (Mr. Nadler), accepted in the Committee on 
the Judiciary, so that a boycott is not possible under this bill. 
Secondly, the cost estimate that the vice chairman of the Committee on 
Rules gave was for 10 years, but we adopted a 3-year sunset for the 
bill, so the cost is substantially less, actually, it's less than one 
third of the cost that the gentleman from Florida estimated.
  With that, I conclude with one last request. For those who care about 
this bill, for those who care about the 3\1/2\ years those of us have 
put into it, this is the moment. Do not let the rule keep us from the 
merits of this bill. It is not a perfect rule. I did not wish 
everything to go into it that has, but we will have no other chance.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from California (Mr. Dooley).
  Mr. DOOLEY of California. Mr. Speaker, I rise in opposition to the 
rule on H.R. 1304.
  I rise in opposition primarily because I think it is irresponsible 
for us to exempt this legislation from the budget

[[Page H5619]]

rules, and this bill I think clearly violates the budget rules.
  Mr. Speaker, the original bill was scored by CBO as costing in excess 
of $11 billion. Even with the modifications that were added in the 
Committee on the Judiciary, it is still estimated to have significant 
cost in reduced Federal tax revenues of almost $11 billion if this was 
made permanent for the 10-year period. Obviously, it would be less if 
it only survives for the 3-year sunset period.
  But it also is projected to have costs not only to the government in 
terms of increased cost to Medicare, Medicaid, and the Federal employee 
health benefit plans, but it is also estimated to cost consumers, as we 
will see an increase in health care premiums as a result of this, which 
are estimated to be on average of almost 2 percent by the third year of 
the enactment of this bill.
  If we are going to maintain consistency with the budget rules that 
are to guide the legislation in this House, we should not exempt this 
legislation. We should not exempt legislation that is going to have 
budgetary impacts in the billions of dollars. I think anyone that 
prides themselves on being a fiscal conservative should not support 
this rule; they should send this bill back to the Committee on Rules 
where we will have the opportunity to bring this bill up when we can 
give adequate consideration to the fiscal and the revenue impacts they 
will have to the Federal Government and to the taxpayers of America.
  Mr. GOSS. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Oklahoma (Mr. Coburn).
  Mr. COBURN. Mr. Speaker, I want to, first of all, say that as a 
practicing physician I am extremely frustrated with the position 
physicians are placed in in this country in not being able to make 
decisions to care for their patients. I think the problem that the 
gentleman from California (Mr. Campbell) is trying to address with this 
bill is a real problem, but I think this is the wrong fix. I do want to 
take exception to what he said about the position as to certain 
organizations wanting to require people to have to perform abortion 
services or to offer them. In his own State, in the California 
legislature this year, by a very narrow margin, a bill that would have 
forced Catholic hospitals in his own State was offered and barely 
defeated. It is the position of the California Medical Association 
that, in fact, that be the policy in California. That position was 
offered in the House of Delegates at the AMA this year.
  So to claim that this is not an intent is not true; it is an intent 
in the long run to limit the conscious objection of health care 
providers and the hospitals to not provide abortion services.
  I am leaving this House at the end of this session, and I will be in 
practice; and I will tell my colleagues that if the Campbell bill 
becomes law, I will utilize it vigorously. But it will not be, in the 
long term, the best thing for medicine. Because the prices would rise 
exorbitantly; and after that has happened, then the focus of the health 
care problems that we have in the country then will be on the doctors, 
and we are not the ones to blame. But through our frustration, through 
the lack of fees to keep pace, through our inability to care for our 
patients, we are bound to do the wrong thing.
  So I adamantly oppose the Campbell bill. I was originally a cosponsor 
of this bill, and my first thought was, I thought this was a good idea. 
Thinking through of what I want the profession of medicine to be 10 
years from now, I think this is a terrible bill. I think the rule is 
fair.
  Mr. HALL of Ohio. Mr. Speaker, I yield 3 minutes to the gentleman 
from Texas (Mr. Bentsen).
  (Mr. BENTSEN asked and was given permission to revise and extend his 
remarks.)
  Mr. BENTSEN. Mr. Speaker, I want to talk about the rule. I am not 
going to talk about the underlying bill, except what the rule provides 
for in the underlying bill.
  It is interesting what a difference a day makes. We have a rule 
before us today that waives all points of order against the bill 
pursuant to the budget resolution, because the underlying bill would 
exceed the discretionary spending caps in the fiscal year 2001 budget 
resolution. In addition, it would violate the pay-go rules per the 
fiscal year 2001 budget resolution.
  Now, why is that so significant in this context? It is significant 
because yesterday, Democrats were told and, in fact, a number of 
Republicans as it turned out, were told that we could not offer a 
broad-based, voluntary, universal prescription drug program under 
Medicare because the fiscal year 2001 budget resolution did not provide 
for it. But today, barely 24 hours later, as I and others predicted, 
the Republican leadership has decided that the paper that the budget 
resolution is written on is not worth very much.
  So, we have before us a rule that shows the true hypocrisy of the 
Republican leadership when it comes to the question of providing true 
prescription, affordable prescription drug coverage for America's 
senior citizens. That is what this rule tells us today. We can debate 
the underlying bill later; but the sad fact of it is, there was a sham 
put upon the American people yesterday, 39 million senior citizens, 
under some phoney rule about what could be considered in the House and, 
today, we have thrown that out the window with a rule that waives 
points of order regarding the budget resolution. I think that is a real 
shame, and I would imagine that our friends will have something to 
answer about come this fall.
  Mr. GOSS. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from North Carolina (Mr. Ballenger).
  Mr. BALLENGER. Mr. Speaker, I thank the gentleman for yielding me 
this time.
  First, I would like to say antitrust exemption will not improve 
health care quality at all. Proponents of this bill say that it will 
level the playing field between doctors and health plans. But what 
happens to the consumer when the providers get together and 
collectively negotiate with insurers?

                              {time}  2115

  Although such behavior violates Federal and State law, it is not at 
all that unusual. Federal antitrust regulators have dealt with more 
than 50 such cases over the past number of years, and none of these 
cases, not one, involved collective efforts to improve the health care 
quality. Every case involved efforts by the providers to raise their 
fees to anticompetitive levels at the expense of the consumers, 
employers, and taxpayers who finance programs for seniors, the disabled 
and the poor.
  Testifying before the Committee on the Judiciary last year, Assistant 
Attorney General of the Department of Justice Antitrust Division Joel 
Klein stated:
  ``Our history of investigations, including our recent cases against 
two federations of competing doctors involving group boycots and price-
fixing conspiracies, leads us to have concerns because the proposed 
bill provides no assurance that health care professionals would direct 
their collective negotiating efforts to improving quality of care, 
rather than their own financial circumstances.''
  Klein went on to cite a case in which ``Twenty-nine otherwise 
competing surgeons who made up the vast majority of general and 
vascular surgeons with operating privileges at five hospitals in Tampa 
formed a corporation solely for the purpose of negotiating jointly with 
managed care plans to obtain higher fees. Their strategy was a success. 
Each of the 29 surgeons gained, on average, over $14,000 in annual 
revenues in just the few months of joint negotiations before they 
learned that the Antitrust Division was investigating the conduct. The 
participants in that scheme did not take any collective action that 
improved the quality of care.''
  This case is typical of what happens when physicians illegally engage 
in collective negotiations with health care plans.
  In April of this year, the Federal Trade Commission announced a 
settlement with a group of surgeons in Austin, Texas, who used 
collective negotiations with health plans to win handsome increases in 
their fees. If we were to pass H.R. 1304, the antitrust exemption would 
make all of what I just read legal, it is now illegal, and with no 
oversight at all. At least labor unions must obey the NLRB.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from Florida (Mr. Deutsch).

[[Page H5620]]

  Mr. DEUTSCH. Mr. Speaker, I wish all of us could be honest. This rule 
is maybe the most disingenuous rule I have seen in my 8 years in the 
United States Congress.
  The fact that this rule allows the Coburn amendment on the bill is a 
convoluted attempt to, I do not know, kill the bill, or put the 
Democrats in a politically disadvantageous position.
  The vast majority of Democrats who are pro-choice, and the majority 
of Democrats who support this bill, have a Hobson's choice under this 
rule. If the rule is passed, and then the Coburn amendment with similar 
things that have passed this floor is then on the bill, then where do 
Democrats vote?
  The reality is that the Coburn amendment is an awful amendment from a 
policy perspective. It is a gag rule. Let me read what the American 
College of Obstetricians and Surgeons said about it: ``We must pass a 
bill that allows health providers to effectively advocate for the care 
of their patients, not gag providers in an attempt to limit women's 
access to needed reproductive health services.''
  This is a gag rule. It is incredible, the scope of it. It would 
prevent those physicians who benefit from the Campbell rule from even 
talking to providers about providing reproductive or family planning 
services, a complete ban. They could not even talk about that in terms 
of their negotiation. It is an extremely large attempt to limit women's 
choices in America.
  For the Members, and again, I know this has been a very difficult 
afternoon for many Members as they have looked at it, because there are 
many Members who are cosponsors of this; again, a majority of Democrats 
who want to see changes in health care, who support what the gentleman 
from California (Mr. Campbell) is trying to do.
  But the leadership on the Republican side has created this 
disingenuous rule. If the rule is defeated, which I urge its defeat, if 
the rule is defeated the choice clearly falls upon those who created 
the rule, which is the majority, the Republican leadership.
  I urge the gentleman from California (Mr. Campbell) to once again 
threaten to leave this Congress if his leadership does not give him a 
true rule and a true vote on the bill.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from North Dakota (Mr. Pomeroy).
  Mr. POMEROY. Mr. Speaker, this House is demonstrating that it cannot 
competently and fairly deal with difficult health policy questions. 
Reference yesterday, a long, contentious day debating one of the most 
important issues before this country: whether we can give our seniors 
prescription drug coverage.
  All of that debate and much of the venom generated within that debate 
concerned an unfair rule cooked up in the Committee on Rules at 2:30 in 
the morning the morning of the debate. I guess it was not the last bad 
rule we were going to see on important health policy coming out of the 
Committee on Rules this week.
  So here we are, late in an absolutely exhausting week, considering 
another vital health policy question under another unfair rule.
  Take, for example, the issue of allowing the Coburn amendment and 
striking the Greenwood amendment. I do not care whether within this 
body Members are pro-choice, whether they are pro-life, or anywhere in 
between. The fact of the matter is to allow one side their amendment 
and not allow the other side their amendment is unfair and speaks to 
what a skewed, unfortunate rule this is that brings this bill to the 
floor.
  That is not the end of the problems within this bill. Allowing 
physician collusion on fee structures has obvious consequences for 
Medicare that pays the bills, for Medicaid. But Members do not see any 
offsets. We do not see any pay-fors in this legislation. There would 
surely be a budget point of order that could be raised against this 
bill, but guess what, they shred the budget rules and waive all points 
of order. Do not even think about trying to point out that we are 
spending money we have not offset in the Federal budget, it is waived 
under this rule.
  Mr. Speaker, the Committee on the Judiciary has ruled on this bill, 
but the Committee on Commerce has not ruled, the Committee on Ways and 
Means has not ruled. This is an unfair rule. It should be voted down.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from Colorado (Ms. DeGette).
  Ms. DeGETTE. Mr. Speaker, the Republican leadership is truly offering 
us a Hobson's choice here. I am a cosponsor of this bill and proud to 
be one, but I am standing here to urge defeat of this rule because of 
the Coburn amendment.
  The Coburn amendment could gag physicians and other providers in two 
ways. First, providers who have a medical and ethical responsibility to 
promote the well-being of their patients could be unable to advocate 
with health plans on their patient's behalf for comprehensive 
reproductive health care.
  Second, providers could not negotiate against any onerous 
restrictions that appear in their contracts.
  Why did the Republican leadership do this? They did this because they 
know pro-choice Members like myself, who also are cosponsors of the 
bill, will never support legislation with provisions that could be 
construed as gag rules.
  The gentleman from Pennsylvania (Mr. Greenwood) was denied the 
opportunity to offer a second degree amendment that would have 
clarified and improved the bill. Was this allowed? No, it was not. 
Tragically, we have to defeat this rule. We have to send it back, and 
we have to say, let us pass a bill that is free of poison pills.
  We have sadly, in my view, reached a point in this Congress where 
virtually no health care legislation can be passed. The Committee on 
Commerce, on which I sit, has repeatedly failed to mark anything up, 
including a children's health bill, because of repeated and ill-fated 
efforts to impose abortion language.
  The National Institutes of Health has not been reauthorized for years 
because of the threat of anti-abortion riders. We have reached a 
virtual gridlock over abortion riders in every form imaginable. The 
American public needs to know this, and they need to know how wrong it 
is.
  So let us defeat this bill. Let us send it back to the Committee on 
Rules. Let us write a clean bill. Let us allow the Greenwood amendment 
to go forward, and let us pass legislation that will allow doctors to 
organize, just as my colleague, the gentleman from California (Mr. 
Campbell), wants to have happen.
  Mr. GOSS. Mr. Speaker, I yield 3 minutes to my colleague and friend, 
the distinguished gentleman from California (Mr. Rohrabacher).
  Mr. ROHRABACHER. Mr. Speaker, tonight I rise in strong support of the 
rule and even stronger support for the bill of the gentleman from 
California, H.R. 1304. I do so as a strong advocate of market-related 
solutions to meet many of today's challenges. This is a market-based 
solution.
  Ours is a multi-layered system of competing interests and checks and 
balances. America's health care is part of that system, but yet, it is 
an area today where we see justified concern and even perhaps alarm.
  Our citizens feel out of control. The HMO revolution that brought 
costs under control has brought with it new problems and new 
complications and new frustrations. New checks and balances have not 
emerged to see that the power vested in this new power, the HMOs, the 
new power that is vested in them and the authority that they have is 
not abused or that the cost controls do not go too far.
  The gentleman from California (Mr. Campbell) is, as I said, offering 
a market-based approach to this challenge, instead of just 
strengthening government or putting new regulations in place. H.R. 1304 
empowers health care professionals to balance the new power of the 
business managers who make policy decisions for America's health care, 
health care that is so vital to our families and the American people.
  Doctors should be able to act together as a unit if they choose to do 
so, just as investors, managers, and other voluntary associates join 
together to form HMOs and other businesses.
  The Campbell bill would result in a new balance that will well serve 
the families and people of our country. This system of competing 
interests has worked very well in other industries. It has worked to 
make us the most effective system in the world at providing

[[Page H5621]]

good care and good products for our people, services for people. It can 
work in the health care industry, as well.
  The gentleman from California (Mr. Campbell) is to be applauded for 
his creativity and his innovative approach. Rather than just trying to 
offer simplistic answers of giving more regulations or having more 
government that costs money, he is empowering people to do a better job 
and to work together to provide health care for America.
  Let us make sure that we use the power of the market. Let us make 
sure we use voluntary association, just as we have in every other 
industry, to provide quality health care to our people, and health care 
that we can ensure will not be abused because there is too much power 
just in the hands of the managers. This is true in every other 
industry, it will be true in health care as well.
  I rise in strong support of the rule and the Campbell amendment.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from California (Ms. Pelosi).
  Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding time to 
me.
  Mr. Speaker, I rise with great reluctance in opposition to this rule. 
I say ``reluctance'' because I do support the bill. We need to 
strengthen the ability of physicians to be effective advocates for the 
health care needs of their patients.
  However, by choosing once again to bring legislation to this floor 
that attempts to limit a woman's right to choose, the Committee on 
Rules has undermined the spirit of this legislation. This bill seeks to 
assure patient safety and increase the quality of health care by 
allowing physicians to collectively have a greater say in negotiations 
on the terms of a health plan.
  The intent is to clearly empower physicians in their relationship 
with HMO administrators, some of whom attempt sometimes to put profits 
over patient care when making decisions about medical care.
  Mr. Speaker, reproductive health services are an essential component 
of primary care for women. To my male colleagues, I say this again, 
gentlemen, reproductive health services are an essential component of 
primary care for women.
  Although this amendment has been framed as a conscience clause for 
religious health care entities, it does in fact prevent physicians, 
regardless of their religion, from even mentioning abortion in their 
negotiations with health plans.
  I repeat some of the points that have been made earlier. The result 
is that providers who have a medical and ethical responsibility to 
promote the well-being of their patients would be unable to advocate 
with health plans on their patients' behalf for comprehensive 
reproductive health care.
  In addition, providers could not negotiate any onerous restrictions 
that appear in their contracts concerning the provision of abortion 
services. Such restrictions could include a ban on referring clients 
for abortion elsewhere, or from even discussing abortion as a medically 
appropriate and legal option for patients.
  Mr. Speaker, reproductive health services are an essential component 
of primary care for women and must be part of all negotiations. I urge 
my colleagues to vote no.

                              {time}  2130

  Mr. HALL of Ohio. Mr. Speaker, I yield 4 minutes to the gentleman 
from Michigan (Mr. Conyers), the ranking minority member of the 
Committee on the Judiciary.
  Mr. CONYERS. Mr. Speaker, I want to admit that we are now on the 
horns of a dilemma in terms of the rule. We have a rule that presents 
an obstacle course of poison pills designed to drag the bill down. 
Virtually all of the amendments that have been allowed by the Committee 
on Rules are hostile, in many cases unrelated, amendments.
  For example, the Coburn amendment is an anti-choice amendment that 
would prevent doctors from making referrals for abortion-related 
services for victims of rape and incest. The Cox amendment is an insult 
to the collective bargaining idea and would constitute the first-ever 
Federal right-to-work mandate on the States.
  Neither of these amendments have anything to do with the underlying 
bill, of course, and the Committee on Rules have waived all points of 
order to leave these poison bills intact. We know the game. It is to 
split 220 cosponsors of a very important and fine bill.
  And so my solution that I propose to my colleagues tonight is that 
since we have been gamed, I am going to oppose the previous question on 
the adoption of the rule and ask the Members to support me in 
opposition to the previous question so that I can offer an amendment 
that would remove the Cox amendment and also make in order the 
amendment submitted by the gentleman from Pennsylvania (Mr. Greenwood) 
to the Committee on Rules.
  This would allow us to have a clean debate on the underlying 
legislation, free of the poison pill amendments. And my amendment is 
supported by NARAL, the Pro-Choice Caucus, the AFL-CIO, and AFSCME. So 
a vote to defeat the previous question may well be the only chance 
Members have in this Congress to vote for the right of health care 
professionals to collectively bargain on behalf of their patients. It 
is a tough choice. We have been split on this, but I hope it will bring 
us back together again.
  Mr. GOSS. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Iowa (Mr. Ganske).
  Mr. GANSKE. Mr. Speaker, well, here we are again with a difficult 
rule. We will see whether we can work this out. I think I need to spend 
a couple of minutes talking about why this bill should pass.
  Blue Cross/Blue Shield of Iowa controls the health care of 98 percent 
of the hospitals and 90 percent of the doctors. One insurance company 
controls the access and health costs of 60 percent of insured 
Oregonians. Market competition in Texas is all but gone. Twenty-four 
competing companies have compressed into four mega-managed care 
companies.
  Sixty percent of the Pittsburgh market is controlled by one plan. 
More than 50 percent of the Philadelphia market is controlled by one 
plan. Each plan has maintained its dominance by virtue of an agreement 
not to compete in each other's territory.
  One insurance company dictates health care in over half of Washington 
State. Since I came to Congress and closed my practice in 1994, there 
have been 275 mergers and acquisitions of health plans. There are now 
seven managed health care plans and Blues control the cost and access 
of the majority of people in this country.
  What does that mean? That means if one is a provider, a doctor, and 
that HMO controls 50 or 60 percent of their patients and they present a 
contract and say take it or leave it, and that doctor has a child in 
college, they are making mortgage payments, how do they turn them down 
when they have a contract clause that says medical necessity means the 
shortest, least expensive or least intense level of care as defined by 
us? Or maybe they say like this Blue Cross/Blue Shield contract of 
Iowa, where the health plan shifts responsibility to physicians for the 
health plan's breaches of confidentiality that they release any 
liability for disclosure made by the company.
  Or how about the gag clauses that companies want providers to sign on 
to? A lot of providers just do not have a choice. I have had a lot of 
Republican colleagues, when we have had our managed care debate, say 
just let the market work. If we get to a vote on this, vote ``yes'' 
because this will let the market work.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from Texas (Ms. Jackson-Lee).
  (Ms. JACKSON-LEE of Texas asked and was given permission to revise 
and extend her remarks.)
  Ms. JACKSON-LEE of Texas. Mr. Speaker, many of the physicians I know 
in my community need this legislation. Frankly, the physicians are put 
at a disadvantage with the HMOs and the conglomerates that are now 
taking over health care. The gentleman from California (Mr. Campbell) 
had the right idea. But unfortunately, the legislation that we had in 
the Committee on the Judiciary, I would say to the gentleman from 
Michigan (Mr. Conyers), with all the good work that we did, is not here 
today.
  Frankly, we have the complete opposite picture from what we wanted to 
bring to the floor of the House. First of all, about a year ago, 
doctors at the AMA convention indicated they wanted

[[Page H5622]]

to organize; they wanted to have the opportunity to be stronger and 
negotiate on behalf of their patients. Minority doctors in particular 
have been shut out from HMOs and so inner-city physician many times 
cannot serve the patient needs of their base.
  Frankly, I think we have a responsibility to put this bill forward. 
But the Committee on Rules, the Republican Committee on Rules knew what 
they were doing when they added the Coburn amendment and the Cox 
amendment to prevent something the bill doesn't do anyhow--force a 
physician to join a union. That is not in the Bill--plain and simple. 
The Supreme Court just 48 hours ago just indicated to this Congress 
that the right to an abortion is the law of this Nation however the 
Coburn brings up unnecessary anti-choice provisions. Why we have this 
legislation in this way in order to undermine the very good bill 
offered by the gentleman from California (Mr. Campbell), of which I am 
a cosponsor, I do not know.
  Mr. Speaker, I support the ranking member's proposal that we defeat 
the previous question and allow a redrafting of this rule to eliminate 
the Cox amendment and to offer the Greenwood amendment, to get on with 
the business that health care providers need to serve the people of 
America's health needs.
  Mr. GOSS. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Texas (Mr. Paul).
  (Mr. PAUL asked and was given permission to revise and extend his 
remarks.)
  Mr. PAUL. Mr. Speaker, I rise in strong support of the rule. It is an 
imperfect rule, but this bill needs to be brought to the floor.
  H.R. 1304 is the only bill that I have seen in the last 3 years, 
probably in the last 30 years, that would move us in a proper direction 
for health care in this country. For 30 years now we have moved in the 
direction, not toward socialized medicine, we do not have socialized 
medicine, we have a mess. We have a monster we created called ``medical 
management.'' But we have moved toward corporate medicine.
  Who are the greatest opponents of H.R. 1304? The HMOs and the 
insurance companies.
  All we are asking for here is a little bit of return of freedom to 
the physician, that is, for the right of the physician to freedom of 
contract, to associate. We are giving no special powers, no special 
privileges. Trying to balance just to a small degree the artificial 
power given to the corporations who now run medicine, who mismanage 
medicine, who destroyed the doctor-patient relationship.
  Mr. Speaker, this has given me a small bit of hope. I am thankful the 
leadership was willing to bring this bill to the floor tonight. We 
should go through, get the rule passed, and vote on this. This is the 
only thing that has offered any hope to preserve and to restore the 
doctor-patient relationship.
  We need this desperately. We do not need to support the special 
corporate interests who get the money. The patient does not get the 
care. The doctors are unhappy. The hospitals are unhappy. And who 
lobbies against this? Corporate interests. This is total destruction of 
the doctor-patient relationship.
  All we want to ask for is the freedom to associate and the freedom to 
contract. If they do not want to become a union, doctors do not have 
to. They had the power to become unions in the 19th century, but under 
ethical conditions they did not. Nobody tells doctors that they have 
to, if we remove this obstacle.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2\1/2\ minutes to the 
gentleman from New York (Mr. Nadler).
  Mr. NADLER. Mr. Speaker, this bill is one of the most essential 
pieces of legislation I have seen in the last several years, and I 
commend the gentleman from California (Mr. Campbell) for the work he 
has done to bring it to the floor, and I condemn the underhanded 
actions of the Republican leadership of this House in allowing poison 
pill amendments to put those of us who think this bill essential in a 
quandary in supporting it.
  Mr. Speaker, I will talk more during the general debate about why 
this bill is essential, but the gentleman from Texas (Mr. Paul) hit it 
on the head. An HMO comes into town, signs up the employers, controls 
all the health care, controls all the patients, and says to the 
doctors: sign on the bottom line. Take it or leave it.
  If they do not want to have to treat 20 patients an hour, 5 minutes 
apiece, if they think it requires more time to give them decent 
treatment, too bad. They do not have to sign up with us; we will get 
plenty of doctors who will not have such scruples.
  The bill authored by the gentleman from California will enable the 
doctors to get together and say: no, we need time to talk to our 
patients and we need time to do proper services.
  Mr. Speaker, this is profoundly in the interests of the patients of 
the United States. This is easily as important as the Patients' Bill of 
Rights in destroying the tyranny the HMOs have taken over the doctors 
and patients in this country.
  But then we have the Coburn amendment made in order as a poison pill 
with one purpose and one purpose only. Nothing to do with abortion. 
That is the fig leaf. The real purpose of this amendment is to get 
people to vote against the rule and vote against the bill who otherwise 
would vote for it.
  The real purpose of this amendment is to get people who would vote 
against the insurance interests and for patients' rights, which is what 
this bill is about, to put them in a quandary so they cannot do it.
  Mr. Speaker, I urge that Members vote against the previous question 
so that we can rewrite the rule. If the previous question motion is 
passed, I will reluctantly vote for the rule and hope that we can then 
defeat the Coburn amendment. Because this bill is as important a bill 
as any bill we have seen on this floor; and we should not allow a 
leadership that does not dare get up and say its real purpose, that we 
are beholden to the insurance companies and we do not want to serve the 
patients of the United States, we want doctors to be slaves to the 
insurance companies, so let us hide behind the fig leaf of an 
extraneous issue. We should not hide behind that issue.
  Mr. GOSS. Mr. Speaker, I yield myself such time as I may consume only 
to point out to the gentleman that the real purpose of me being here is 
to pass this rule, and I appreciate his help.
  Mr. Speaker, I yield 2 minutes to the distinguished gentleman from 
Ohio (Mr. Boehner), the chairman of the Subcommittee on Employer-
Employee Relations of the Committee on Education and the Workforce.
  Mr. BOEHNER. Mr. Speaker, I thank the gentleman from Florida (Mr. 
Goss) for yielding me this time.
  Mr. Speaker, we all know this is a very difficult bill. I 
congratulate my colleagues on the Committee on Rules for doing the best 
they could with a difficult situation. But I say to you, Mr. Speaker, 
you can put lipstick on a pig, but it is still a pig.
  We have problems in our health care system, and I think all of us 
know it. There are ways to address these problems, such as the 
Patients' Bill of Rights that we are working on in conference today. 
There are other things that we can do. But this, I would argue, will 
destroy our health care system.
  What protection are we giving our Nation's patients when we take away 
their health insurance because of increasing costs? What other group of 
Americans have we ever exempted from our antitrust laws that were 
created over 100 years ago to stop the big steel trusts, to stop the 
big oil trusts? We put those antitrust laws in place to prevent 
consumers from being harmed.
  What we are doing here is we are exempting one group of Americans in 
our health care system, one group of Americans to go out and to 
negotiate on whose behalf? Come on, they will be negotiating on their 
own behalf. That is why the Congressional Budget Office and others have 
talked about the tremendous increase in cost that will result if this 
bill is passed.

                              {time}  2145

  So, Mr. Speaker, let us quit kidding ourselves. This is a bad 
solution to a problem that does exist. There are better solutions. Let 
us defeat the rule, send this bill back to committee and go home and 
visit with our constituents over the next week.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from New York (Mrs. Maloney).
  Mrs. MALONEY of New York. Mr. Speaker, I thank the gentleman from 
Ohio for yielding.

[[Page H5623]]

  Mr. Speaker, I rise reluctantly in support of the rule. I regret that 
the amendment of the gentleman from Pennsylvania (Mr. Greenwood) was 
not placed in order. He should have the right to bring his amendment to 
the floor and have it fully debated.
  I am very much opposed to the Coburn amendment. The Coburn amendment 
is a transparent and deceptive attempt to politicize the debate on the 
underlying bill. The Coburn amendment is not just an anti-choice 
amendment, which I believe would be defeated in this House, would be 
definitely defeated in the Senate, and vetoed by the President, it is 
unconstitutional according to the court decision yesterday. But its 
real role in this debate is to bring down the rule so that this body 
does not have a chance to debate and vote for and hopefully pass the 
very thoughtful Quality Health Care Coalition Act of the gentleman from 
California (Mr. Campbell).
  The bill of the gentleman from California (Mr. Campbell) deserves to 
be debated on this floor; therefore, I support this resolution. The 
bill is a very creative attempt to empower doctors to make medical 
decisions for their patients.
  This bill has been before this Congress for 3 years. It has over 220 
cosponsors. There have been hearings on it, markups. The committee 
voted favorably by a vote of 26 to 2. Time and time again, this 
leadership has brought bills before this body on which there have been 
no hearings, no committee, and no amendments allowed.
  This time, the gentleman from Oklahoma (Mr. Coburn) and this body 
have played by the rules, and we deserve a vote on his bill before this 
House.
  My colleagues do not have to support the bill. If they do not like 
the bill, then do not vote for it. But to be fair to our colleague, let 
us pass this rule and allow a vote on his bill.
  If we do not vote for this bill, this rule, it will not get to the 
floor for a vote. Patients, doctors, and the health care system are 
depending on it. Let us bring the Campbell bill to the floor and fully 
debate it fairly.
  Mr. GOSS. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Montana (Mr. Hill).
  Mr. HILL of Montana. Mr. Speaker, I thank the gentleman for the time; 
and as a cosponsor of the bill, I stand here in support of the bill and 
support of the rule. We need to pass this rule tonight because it is 
the only way that we are going to get a chance to vote on this bill.
  Now, this is surely a controversial issue. Should doctors be able to 
bargain collectively on an equal footing with the insurance companies. 
I happen to think they should.
  An earlier Speaker said we have never exempted anybody else from 
anti-trust laws. But the truth of the matter is we did. When we passed 
McCarran-Ferguson, we gave special provisions to the insurance industry 
that they use today.
  Now, we have been debating HMO reform for over 2 years. Everybody 
says doctors, not bureaucrats, doctors, not adjusters, but doctors 
ought to be making medical decisions that impact their patients. Well, 
tonight, here is my colleagues' chance to empower doctors to be making 
those kind of medical decisions. But the only way we are going to do 
this is to pass this rule.
  Now, if my colleagues oppose the amendments, defeat the amendments. 
Let the House work its will. But let us pass this rule, let us give the 
bill a chance, and let us support the rule and support the bill.
  Mr. HALL of Ohio. Mr. Speaker, how much time do I have remaining?
  The SPEAKER pro tempore (Mr. Shimkus). The gentleman from Ohio (Mr. 
Hall) has 6 minutes remaining. The gentleman from Florida (Mr. Goss) 
has 9 minutes remaining.
  Mr. GOSS. Mr. Speaker, I am totally ambivalent about the rotation 
here. We are prepared to go.
  Mr. HALL of Ohio. That would be fine, Mr. Speaker.
  Mr. GOSS. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentleman from Florida (Mr. Weldon), a distinguished doctor.
  Mr. WELDON of Florida. Mr. Speaker, I thank the gentleman from 
Florida for yielding to me, and I rise in support of the rule and 
support of the underlying piece of legislation.
  I, too, am an original cosponsor of this bill. In the general debate, 
I hope to be able to elaborate further on my experience in this 
particular arena. I do have some real experience, and it is underlying 
my strong support for the bill.
  But one thing I want to just amplify on, and the gentleman from 
Montana (Mr. Hill) really covered this very nicely, but he was very, 
very pressed for time, there are some people going around saying this 
is going to unfairly tip the playing field, this Campbell legislation.
  Mr. Speaker, the field is not level. The gentleman from Montana just 
explained that to us. This Congress passed legislation that tilts the 
negotiations and strengthens the hand, I think, excessively of 
insurance companies. This legislation I believe is going to take a 
situation that is like this and level it out.
  Regarding the issue of the amendment of the gentleman from Oklahoma 
(Mr. Coburn), I happen to personally feel that the gentleman from 
Oklahoma is very well intentioned, and his concerns, I think, are 
legitimate. I happen to personally believe his concerns are most likely 
not necessary, but the language in his amendment I find to be 
acceptable. I intend on supporting his amendment.
  I would encourage all of my colleagues on both sides of the aisle to 
support the rule. We have amendments allowed under the rule that would 
allow people on both sides of this issue to cast their vote in good 
faith and then ultimately get the final product up for a vote.
  Support the rule and, of course, support the underlying bill.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from Pennsylvania (Mr. Hoeffel).
  Mr. HOEFFEL. Mr. Speaker, I thank the gentleman from Ohio for 
yielding me this time.
  Mr. Speaker, I rise in strong support of the Campbell bill and, 
accordingly, in strong support of motion to defeat the previous 
question by the gentleman from Michigan (Mr. Conyers).
  The gentleman from Michigan (Mr. Conyers) would allow us to avoid 
this outrageously rigged rule that is designed certainly to scuttle the 
Campbell bill. The Campbell bill is desperately needed. We have a 
situation where doctors are put into a very unfair situation, unable to 
negotiate on a level playing field with the large HMOs and managed care 
companies.
  The Campbell bill will stop the arbitrary, unfair, one-sided 
contracts that the managed care companies are offering to doctors.
  I listened intently to the gentleman from Iowa (Mr. Ganske) a few 
minutes ago. He got one fact wrong. He said that the largest managed 
care company in Philadelphia is controlling 50 percent of the market. 
They are actually controlling 62 percent of the market, growing every 
day. That large managed care company recently offered orthopedic 
surgeons in the Philadelphia area a 40 percent pay cut. That kind of 
arbitrary activity is unacceptable.
  The Campbell bill will allow collective bargaining and allow doctors 
a level playing field, not just to improve their fee agreements, but to 
avoid the kinds of changes in their medical practices that managed care 
companies often demand.
  They want to impose gag rules on doctors so they cannot discuss their 
treatment options. They want to discourage appropriate referrals. 
Companies want frequently to block appropriate tests and delay care. 
They want to grant financial rewards to doctors for not giving care.
  Those things must be stopped. They can be stopped through appropriate 
negotiations. But first we must pass the Conyers motion to defeat the 
previous question.
  Mr. Speaker, I urge a yes vote on that motion.
  Mr. GOSS. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Pennsylvania (Mr. Greenwood).
  Mr. GREENWOOD. Mr. Speaker, I thank the gentleman for yielding me 
this time.
  Mr. Speaker, I am very conflicted by the vote on this rule.
  As has been referenced, I took to the Committee on Rules last night 
an amendment to amend the amendment of the gentleman from Oklahoma (Mr. 
Coburn) because I have a difference of

[[Page H5624]]

opinion with him with regard to the policy. The gentleman from Oklahoma 
(Mr. Coburn); and I tried to work out our differences last night and 
cooperate, so we decided that what we would do is each have our 
opportunity to debate on the floor.
  The Committee on Rules denied me the opportunity to bring my 
amendment to the floor this evening, and I do not like that. My normal 
inclination when the Committee on Rules denies me one of the few 
amendments that I take to the Committee on Rules is to oppose the rule. 
That was my inclination.
  However, the gentleman from California (Mr. Campbell) has been made a 
promise, and that promise is that his bill would be debated on the 
floor. I think he deserves it. He worked hard to have his day, his 
night on the floor, and I think he is deserving of that.
  More importantly, there are thousands and thousands of physicians 
across this country who have felt frustrated by the present situation 
and whether we agree with their position or not, whether we agree with 
the position of the gentleman from California (Mr. Campbell) or not, 
they went to the United States Congress, and they said, ``Please debate 
this issue. We think it is deserving of the greatest deliberative body 
on earth. Please take our issue to the Congress and have a debate.'' If 
this rule is defeated, imagine all of those physicians all over the 
country saying the Congress does not work.
  We are frustrated. We get a bill. We get over 220 cosponsors on the 
bill; and for something to do with abortion, we are not even allowed to 
have our issue debated after all of these years.
  I think it would be a tremendous disservice to those advocates of 
those bills and, frankly, those opponents of the bill to deny the 
opportunity for this Congress to do its work, to take these issues 
important to our times, and to debate them.
  Ms. DeGETTE. Mr. Speaker, will the gentleman yield?
  Mr. GREENWOOD. I yield to the gentlewoman from Colorado.
  Ms. DeGETTE. Mr. Speaker, I really agree with a lot of what the 
gentleman of Pennsylvania (Mr. Greenwood) is saying. My concern is, 
what happens with all of these physicians if we go to debate, if the 
Coburn amendment passes, and then the bill, then we all have to vote on 
the bill, and how will those physicians feel if we vote against a bill 
we support because of this?
  Mr. GOSS. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from New York (Mr. Reynolds), a highly valued member of the 
Committee on Rules. We only have highly valued members in the Committee 
on Rules.
  Mr. REYNOLDS. Mr. Speaker, I thank the gentleman from Florida. Today, 
as I have listened to this debate, we have people supporting this rule, 
some not in love with it, but in support of it from the most liberal 
perspective of our viewpoints in this House to some of the most 
conservative.
  Today, as we have this rule before us, it is an appropriately 
structured rule. The proposed legislation makes dramatic changes in 
current law. The rule provides for comprehensive debate. Six amendments 
of the 12 submitted were included. Everyone but the gentleman from 
Pennsylvania (Mr. Greenwood) was granted an amendment. He was not 
granted an amendment, and he supports the rule this evening.
  The amendments offered cover most of the contentious parts of debate 
throughout this legislation. I urge my colleagues to support the rule 
and let the debate begin.
  Mr. GOSS. Mr. Speaker, it is my privilege to yield 3 minutes to the 
gentleman from California (Mr. Dreier), the distinguished chairman of 
the Committee on Rules.
  Mr. DREIER. Mr. Speaker, I thank the gentleman for yielding, and I 
appreciate the fact that he said that all members of the Committee on 
Rules are doing a reasonably decent job. I hope it will include me 
along with the gentleman from New York (Mr. Reynolds) in that group.
  Mr. Speaker, I rise in strong support of this rule. There are 220 
Members, Mr. Speaker, who are cosponsors of the legislation of the 
gentleman from California (Mr. Campbell), and a commitment was made 
that we would move ahead with this bill.
  I know that there are some people who are not ecstatic with the way 
that this rule has been structured. But the fact of the matter is we 
have done what we could to move this legislation forward.
  So it sounds like we are going to have a vote on the previous 
question that the gentleman from Michigan (Mr. Conyers) will be 
pursuing. I hope very much that we will defeat the previous question 
and move ahead and pass this rule. We have a responsibility to move 
legislation.
  The Speaker has said that he hopes very much that Members will vote 
in support of this rule so that we can move the package forward. 
Arguments have been made on both sides of the aisle by a number of our 
colleagues that if one is a supporter of this rule, do not stand behind 
the procedure and cast a no vote on the rule, because this is the 
opportunity that we have to move ahead with this legislation.
  So I would also say to Members on both sides regardless of one's 
position on the issue, even if one is not a supporter of the 
legislation of the gentleman from California (Mr. Campbell). Let us 
have a debate on the measure and then allow the House to work its will.
  So I urge my colleagues to vote in favor of the previous question, 
and I urge my colleagues to vote in favor of the rule so that we can 
have the opportunity here to have what the gentleman from South 
Carolina (Mr. Spratt) likes to describe as a full, wholesome, and hard-
hitting debate.

                              {time}  2200

  The SPEAKER pro tempore (Mr. Shimkus). For clarification, the 
gentleman from Ohio (Mr. Hall) has 4 minutes remaining, and the 
gentleman from Florida (Mr. Goss) has 2 minutes remaining.
  Mr. HALL of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from New Jersey (Mr. Rothman).
  Mr. ROTHMAN. Mr. Speaker, I thank the gentleman for yielding me this 
time, and I am pleased to rise as a cosponsor and in support of H.R. 
1304, the Quality Health Care Coalition Act.
  We are here today to restore a sense of balance to a health care 
system that is now dominated by the health care insurance companies. 
H.R. 1304 will put doctors on a level playing field with the giant 
health care companies. Specifically, it will allow doctors to join 
together and negotiate the terms and conditions of their HMO contracts 
without violating the antitrust laws. With the power to bargain 
collectively, doctors will then have the clout to negotiate for fair 
terms for their services and for their patients rights.
  When large HMOs dictate all the terms to individual doctors, patients 
suffer. To make up for low HMO payments, doctors are forced to see more 
patients each day. When doctors see more patients daily, they are not 
able to spend the kind of time they want to and need to spend with each 
patient. Their offices often look like assembly lines because the HMOs 
and the health insurance companies dictate to the doctors how quickly 
they must move those patients in and out.
  Doctors and other health care professionals need to be able to 
negotiate health care service contracts with HMOs and health insurance 
companies on a level playing field so that their patients can receive 
the quality health care treatment they deserve.
  Freedom of assembly and freedom of speech are rights guaranteed in 
the first amendment for all Americans. How about for doctors? Defeat 
the previous question; support H.R. 1304.
  Mr. GOSS. Mr. Speaker, I yield 30 seconds to the gentleman from 
California (Mr. Campbell), the distinguished author of the bill.
  Mr. CAMPBELL. Mr. Speaker, I rise for two purposes. Although 
colleagues have referred to this as the Campbell bill, this is the 
Campbell-Conyers bill. There is no one who has fought as hard as the 
gentleman from Michigan (Mr. Conyers) for this bill, and that includes 
me from the very start. I understand shorthand and that people say the 
Campbell bill, but this is the Campbell-Conyers bill. I am proud of my 
colleague and proud to stand with him. Both of our names are in this 
effort.
  Lastly, to the fellow pro-choice Members of this body, NARAL, NARAL, 
has said that the rule is not a key vote.

[[Page H5625]]

NARAL has said the rule is not a key vote. NARAL has said final passage 
is not a key vote. NARAL has said final passage is not a key vote. The 
Coburn amendment is a key vote, but not the rule. Please support the 
rule.
  Mr. GOSS. Mr. Speaker, I yield 1 minute to the gentleman from Arizona 
(Mr. Shadegg).
  (Mr. SHADEGG asked and was given permission to revise and extend his 
remarks.)
  Mr. SHADEGG. Mr. Speaker, this bill is clearly well-intended. It 
attempts to address an imbalance that exists because HMOs are too 
powerful. I have many HMOs in my State of Arizona. Indeed, more HMOs 
percentage-wise than perhaps any State in the Nation, and I have fought 
HMOs and I will continue to fight them through the fight on the 
Patients' Bill of Rights. But this bill is tragically misguided.
  The discussion we have heard here tonight has been about the power of 
HMOs and the lack of power of doctors. The reality is that there is an 
omitted party. The omitted party is the patients. If we empower doctors 
to unionize, there will be one thing that will happen, mark my words. 
The cost of health care will go up.
  I love doctors, and they will try to protect patients, but their 
number one motivation will be to negotiate increased fees for them. The 
cost of care will go up, and patients will not be protected.
  Many of us on the Patients' Bill of Rights Task Force, many of my 
colleagues on the other side who fought for patients' rights and this 
side who fought for patients' rights have fought this battle. We need 
to empower patients by giving them choice, not unionizing doctors and 
causing prices to go up.
  Mr. HALL of Ohio. Mr. Speaker, I yield the balance of my time to the 
gentleman from Michigan (Mr. Conyers).
  Mr. CONYERS. Mr. Speaker, I thank the gentleman from Ohio (Mr. Hall) 
for yielding me this time.
  My colleagues, this bill is so incredibly important that enough 
Members are cosponsors that could normally pass the bill, 220 Members.
  We have a rule that is laden with poison pills. Solution: defeat the 
previous question and vote ``no.'' I have an amendment that will cure 
the problem, I think quite well, but this will give those of us who are 
definitely pro-choice a way out to get this measure to the floor. 
Believe me, if this bill does not come up tonight, my colleagues will 
not see this measure again in the 106th Congress.
  So I urge all of my colleagues, the cosponsors and the friends of 
Campbell-Conyers, to vote ``no'' on the previous question.
  Mr. GOSS. Mr. Speaker, I yield myself the balance of my time.
  As Members can tell from the debate, this was a hard rule to write. 
There are many interested in this. The guiding principle was to try to 
get this matter to the floor for debate because we think there is a 
compelling need to have this debate. We have heard many facets of it.
  I heard the distinguished gentleman from Michigan (Mr. Conyers) speak 
of an obstacle course. Authors of bills often refer to amendments to 
their legislation as obstacles. Obviously, we all understand why.
  The Committee on Rules made a very fair, I think valiant effort to 
try to make in order all the amendments that came forward, and we did 
all but one. The gentleman has spoken to that, and that gentleman is 
going to support this rule tonight.
  I would suggest that it is very important that we pass this rule. I 
urge we vote ``yes'' on the previous question.
  Mr. Speaker, I yield back the balance of my time, and I move the 
previous question on the resolution.
  The SPEAKER pro tempore. The question is on ordering the previous 
question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. CONYERS. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Evidently a quorum is not present.
  The Sergeant at Arms will notify absent Members.
  Pursuant to clause 9 of rule XX, the Chair will reduce to a minimum 
of 5 minutes the period time within which a vote by electronic device, 
if ordered, will be taken on the question of agreeing to the 
resolution.
  The vote was taken by electronic device, and there were--yeas 241, 
nays 174, answered ``present'' 3, not voting 17, as follows:

                             [Roll No. 364]

                               YEAS--241

     Abercrombie
     Aderholt
     Archer
     Armey
     Bachus
     Baker
     Ballenger
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bateman
     Bereuter
     Berry
     Biggert
     Bilbray
     Bilirakis
     Bliley
     Blunt
     Boehlert
     Boehner
     Bonilla
     Bono
     Borski
     Boucher
     Brady (TX)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Castle
     Chabot
     Chambliss
     Chenoweth-Hage
     Coble
     Coburn
     Collins
     Combest
     Cooksey
     Cox
     Crane
     Cubin
     Cunningham
     Davis (VA)
     Deal
     DeLay
     DeMint
     Diaz-Balart
     Dickey
     Dingell
     Doolittle
     Doyle
     Dreier
     Duncan
     Dunn
     Ehlers
     Ehrlich
     Emerson
     English
     Everett
     Ewing
     Fletcher
     Foley
     Forbes
     Fossella
     Fowler
     Franks (NJ)
     Frelinghuysen
     Gallegly
     Gekas
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Goode
     Goodlatte
     Goodling
     Goss
     Graham
     Granger
     Green (WI)
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hansen
     Hastert
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (MT)
     Hilleary
     Hobson
     Hoekstra
     Holden
     Horn
     Hostettler
     Houghton
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Isakson
     Istook
     Jenkins
     Johnson (CT)
     Johnson, Sam
     Jones (NC)
     Kanjorski
     Kasich
     Kelly
     Kildee
     King (NY)
     Kingston
     Knollenberg
     Kolbe
     Kuykendall
     LaFalce
     LaHood
     Largent
     Latham
     LaTourette
     Lazio
     Leach
     Lewis (KY)
     Linder
     LoBiondo
     Lucas (KY)
     Lucas (OK)
     Manzullo
     Martinez
     Mascara
     McCollum
     McCrery
     McHugh
     McInnis
     McIntyre
     McKeon
     Metcalf
     Mica
     Miller (FL)
     Miller, Gary
     Moakley
     Mollohan
     Moran (KS)
     Morella
     Murtha
     Myrick
     Nethercutt
     Ney
     Northup
     Norwood
     Nussle
     Oberstar
     Ose
     Oxley
     Packard
     Paul
     Pease
     Peterson (MN)
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Pombo
     Porter
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Rahall
     Ramstad
     Regula
     Reynolds
     Riley
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Roukema
     Royce
     Ryan (WI)
     Ryun (KS)
     Salmon
     Sanford
     Saxton
     Scarborough
     Schaffer
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shays
     Sherwood
     Shimkus
     Shows
     Simpson
     Skeen
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Souder
     Spence
     Stark
     Stearns
     Stenholm
     Stump
     Stupak
     Sununu
     Sweeney
     Talent
     Tancredo
     Tauzin
     Terry
     Thornberry
     Thune
     Tiahrt
     Toomey
     Traficant
     Turner
     Upton
     Vitter
     Walden
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weller
     Weygand
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)

                               NAYS--174

     Ackerman
     Allen
     Andrews
     Baca
     Baird
     Baldacci
     Baldwin
     Barrett (WI)
     Becerra
     Bentsen
     Berkley
     Berman
     Blagojevich
     Blumenauer
     Bonior
     Boswell
     Boyd
     Brady (PA)
     Brown (FL)
     Brown (OH)
     Campbell
     Capps
     Capuano
     Cardin
     Carson
     Clayton
     Clement
     Clyburn
     Condit
     Conyers
     Costello
     Coyne
     Cramer
     Crowley
     Cummings
     Danner
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dixon
     Doggett
     Dooley
     Edwards
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Ford
     Frank (MA)
     Frost
     Gejdenson
     Gephardt
     Gonzalez
     Gordon
     Green (TX)
     Gutierrez
     Hastings (FL)
     Hill (IN)
     Hilliard
     Hinchey
     Hinojosa
     Hoeffel
     Holt
     Hooley
     Hoyer
     Inslee
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     John
     Johnson, E. B.
     Jones (OH)
     Kaptur
     Kennedy
     Kilpatrick
     Kind (WI)
     Kleczka
     Lampson
     Lantos
     Larson
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Lofgren
     Lowey
     Luther
     Maloney (CT)
     Maloney (NY)
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McKinney
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller, George
     Minge
     Mink
     Moore
     Moran (VA)
     Nadler
     Napolitano
     Neal
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Phelps
     Pickett
     Pomeroy
     Price (NC)
     Rangel
     Reyes
     Rivers
     Rodriguez
     Roemer
     Rothman
     Roybal-Allard
     Rush
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Schakowsky
     Scott
     Serrano
     Sherman

[[Page H5626]]


     Sisisky
     Skelton
     Slaughter
     Smith (WA)
     Snyder
     Spratt
     Stabenow
     Strickland
     Tanner
     Tauscher
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Thurman
     Tierney
     Towns
     Udall (CO)
     Udall (NM)
     Velazquez
     Visclosky
     Waters
     Watt (NC)
     Waxman
     Weiner
     Wexler
     Wise
     Woolsey
     Wu
     Wynn

                        ANSWERED ``PRESENT''--3

     Ganske
     Greenwood
     Kucinich

                             NOT VOTING--17

     Barcia
     Bishop
     Clay
     Cook
     Filner
     Hastings (WA)
     Klink
     Lewis (CA)
     Markey
     McIntosh
     McNulty
     Shuster
     Taylor (NC)
     Thomas
     Vento
     Weldon (PA)
     Young (FL)

                              {time}  2226

  Mr. HINOJOSA changed his vote from ``yea to ``nay''.
  Messrs. LaHOOD, QUINN, BERRY, BURTON of Indiana, GILLMOR, and FORBES 
changed their vote from ``nay to ``yea''.
  Mr. KUCINICH changed his vote from ``nay'' to ``present.''
  So the previous question was ordered.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore (Mr. Shimkus). The question is on the 
resolution.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. GOSS. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 225, 
noes 197, not voting 13, as follows:

                             [Roll No. 365]

                               AYES--225

     Abercrombie
     Aderholt
     Andrews
     Armey
     Baca
     Bachus
     Baker
     Barcia
     Barr
     Bartlett
     Bass
     Berkley
     Berry
     Bilbray
     Bilirakis
     Blumenauer
     Blunt
     Bonior
     Boswell
     Boucher
     Brady (TX)
     Bryant
     Callahan
     Calvert
     Campbell
     Canady
     Cardin
     Castle
     Chabot
     Chenoweth-Hage
     Coble
     Coburn
     Collins
     Conyers
     Cooksey
     Costello
     Cox
     Coyne
     Cramer
     Crane
     Cubin
     Davis (VA)
     Deal
     DeFazio
     DeLay
     Diaz-Balart
     Dickey
     Dingell
     Doggett
     Doolittle
     Doyle
     Dreier
     Duncan
     Edwards
     Ehlers
     Emerson
     English
     Everett
     Fletcher
     Foley
     Forbes
     Fossella
     Fowler
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Frost
     Gallegly
     Ganske
     Gephardt
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Goode
     Goodlatte
     Gordon
     Goss
     Graham
     Granger
     Green (TX)
     Greenwood
     Hall (OH)
     Hall (TX)
     Hansen
     Hastert
     Hayes
     Herger
     Hill (MT)
     Hilleary
     Hinchey
     Hoeffel
     Holden
     Holt
     Horn
     Hulshof
     Hutchinson
     Hyde
     Isakson
     Istook
     Jackson-Lee (TX)
     Jenkins
     Jones (NC)
     Kanjorski
     Kasich
     Kelly
     Kennedy
     Kildee
     Kilpatrick
     King (NY)
     Kleczka
     Knollenberg
     Kuykendall
     LaFalce
     Lampson
     LaTourette
     Lazio
     Leach
     Levin
     Linder
     Lipinski
     LoBiondo
     Lucas (KY)
     Lucas (OK)
     Maloney (CT)
     Maloney (NY)
     Manzullo
     Mascara
     McCarthy (NY)
     McCollum
     McIntyre
     McKeon
     McKinney
     Meehan
     Metcalf
     Mica
     Miller (FL)
     Moakley
     Mollohan
     Moran (KS)
     Morella
     Myrick
     Nadler
     Neal
     Ney
     Norwood
     Oberstar
     Obey
     Ortiz
     Ose
     Pallone
     Pascrell
     Paul
     Payne
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pombo
     Porter
     Portman
     Pryce (OH)
     Radanovich
     Rahall
     Rangel
     Regula
     Reynolds
     Riley
     Roemer
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Roukema
     Salmon
     Sanchez
     Sandlin
     Sanford
     Sawyer
     Saxton
     Scarborough
     Scott
     Sessions
     Shaw
     Sherwood
     Shimkus
     Shows
     Simpson
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Snyder
     Souder
     Spratt
     Stearns
     Stenholm
     Strickland
     Stump
     Stupak
     Sweeney
     Talent
     Tancredo
     Tauzin
     Taylor (MS)
     Thomas
     Thornberry
     Thune
     Toomey
     Traficant
     Turner
     Upton
     Vitter
     Walden
     Wamp
     Waters
     Watts (OK)
     Weiner
     Weldon (FL)
     Weldon (PA)
     Weller
     Weygand
     Whitfield
     Wilson
     Wise
     Wolf

                               NOES--197

     Ackerman
     Allen
     Archer
     Baird
     Baldacci
     Baldwin
     Ballenger
     Barrett (NE)
     Barrett (WI)
     Barton
     Bateman
     Becerra
     Bentsen
     Bereuter
     Berman
     Biggert
     Blagojevich
     Bliley
     Boehlert
     Boehner
     Bonilla
     Bono
     Borski
     Boyd
     Brady (PA)
     Brown (FL)
     Brown (OH)
     Burr
     Burton
     Buyer
     Camp
     Cannon
     Capps
     Capuano
     Carson
     Chambliss
     Clayton
     Clement
     Clyburn
     Combest
     Condit
     Crowley
     Cummings
     Cunningham
     Danner
     Davis (FL)
     Davis (IL)
     DeGette
     Delahunt
     DeLauro
     DeMint
     Deutsch
     Dicks
     Dixon
     Dooley
     Dunn
     Ehrlich
     Engel
     Eshoo
     Etheridge
     Evans
     Ewing
     Farr
     Fattah
     Ford
     Gejdenson
     Gekas
     Gonzalez
     Goodling
     Green (WI)
     Gutierrez
     Gutknecht
     Hastings (FL)
     Hayworth
     Hefley
     Hill (IN)
     Hilliard
     Hinojosa
     Hobson
     Hoekstra
     Hooley
     Hostettler
     Houghton
     Hoyer
     Hunter
     Inslee
     Jackson (IL)
     Jefferson
     John
     Johnson (CT)
     Johnson, E. B.
     Johnson, Sam
     Jones (OH)
     Kaptur
     Kind (WI)
     Kingston
     Kolbe
     Kucinich
     LaHood
     Lantos
     Largent
     Larson
     Latham
     Lee
     Lewis (CA)
     Lewis (GA)
     Lewis (KY)
     Lofgren
     Lowey
     Luther
     Martinez
     Matsui
     McCarthy (MO)
     McCrery
     McDermott
     McGovern
     McHugh
     McInnis
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller, Gary
     Miller, George
     Minge
     Mink
     Moore
     Moran (VA)
     Murtha
     Napolitano
     Nethercutt
     Northup
     Nussle
     Olver
     Owens
     Oxley
     Packard
     Pastor
     Pease
     Pelosi
     Peterson (MN)
     Pickett
     Pitts
     Pomeroy
     Price (NC)
     Quinn
     Ramstad
     Reyes
     Rivers
     Rodriguez
     Rothman
     Roybal-Allard
     Royce
     Rush
     Ryan (WI)
     Ryun (KS)
     Sabo
     Sanders
     Schaffer
     Schakowsky
     Sensenbrenner
     Serrano
     Shadegg
     Shays
     Sherman
     Sisisky
     Skeen
     Skelton
     Slaughter
     Smith (WA)
     Spence
     Stabenow
     Stark
     Sununu
     Tanner
     Tauscher
     Terry
     Thompson (CA)
     Thompson (MS)
     Thurman
     Tiahrt
     Tierney
     Towns
     Udall (CO)
     Udall (NM)
     Velazquez
     Visclosky
     Walsh
     Watkins
     Watt (NC)
     Waxman
     Wexler
     Wicker
     Woolsey
     Wu
     Wynn
     Young (AK)

                             NOT VOTING--13

     Bishop
     Clay
     Cook
     Filner
     Hastings (WA)
     Klink
     Markey
     McIntosh
     McNulty
     Shuster
     Taylor (NC)
     Vento
     Young (FL)

                              {time}  1038

  Ms. CARSON, and Messrs. OWENS, BLAGOJEVICH, HEFLEY, SPENCE and 
PACKARD changed their vote from ``aye'' to ``no.''
  Ms. WATERS, Mrs. KELLY, Ms. BERKLEY, Ms. PRYCE of Ohio, and Messrs. 
BLUMENAUER, WEINER, HINCHEY, KENNEDY of Rhode Island, SCOTT, 
KILPATRICK, BILIRAKIS, LEVIN, FOSSELLA, and BACA changed their vote 
from ``no'' to ``aye.''
  So the resolution was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________