[Congressional Record Volume 146, Number 85 (Thursday, June 29, 2000)]
[House]
[Pages H5627-H5652]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
QUALITY HEALTH-CARE COALITION ACT OF 2000
The SPEAKER pro tempore. Pursuant to House Resolution 542 and rule
XVIII, the Chair declares the House in the Committee of the Whole House
on the State of the Union for the consideration of the bill, H.R. 1304.
{time} 2259
In the Committee of the Whole
Accordingly, the House resolved itself into the Committee of the
Whole House on the State of the Union, for the 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, with Mr. Shimkus in the chair.
The Clerk read the title of the bill.
The CHAIRMAN. Pursuant to the rule, the bill is considered as having
been read the first time.
Pursuant to the order of the House, the gentleman from Illinois (Mr.
Hyde) and the gentleman from Michigan (Mr. Conyers) each will control
10 minutes.
The Chair recognizes the gentleman from Illinois (Mr. Hyde).
{time} 2300
Mr. HYDE. Mr. Chairman, I yield 5 minutes to the gentleman from
California (Mr. Campbell) and 5 minutes to the gentleman from Ohio (Mr.
Boehner), and I ask unanimous consent that they be permitted to control
that time.
The CHAIRMAN. Is there objection to the request of the gentleman from
Illinois?
There was no objection.
Mr. CAMPBELL. Mr. Chairman, I yield 2\1/2\ minutes to the gentleman
from Florida (Mr. Weldon).
Mr. WELDON of Florida. Mr. Chairman, I thank the gentleman for
yielding me this time. I rise in support of the bill, and I wanted to
relate to my colleagues in the Chamber my experience on this issue, the
very issue we are discussing today.
Many years before I got elected to the U.S. House, and as most of my
colleagues know, I am a physician; we had an insurance company come to
the community offering a product, they called it a PPO, Preferred
Provider Organization, or network; and it had a fee schedule in it that
was substantially below what was the prevailing rates in the
communities. So a whole bunch of the providers, the doctors in the
community, were concerned about this because this was a big company, it
insured a lot of people. So we all agreed to gather together in a hotel
ballroom to discuss this issue, and we invited an attorney to join us
and asked him to get up first and explain to us the antitrust laws so
that we would not run afoul of antitrust.
So we allowed him to speak, and he got up and he said, if you want to
stay out of trouble, go home. You can't talk about this. If you discuss
it at all, you can be prosecuted. So we all went home.
Now, back in those days there was one group that had about 20
doctors, a few other small groups, and then a lot of solo
practitioners. Now, in that community there are four large groups, my
group, which had 20 doctors, has 100 doctors, and there is virtually no
solo practitioners left. That is really what this bill is about.
We are talking about the solo pediatrician, the two-man group, the
family practitioner who operates alone, being
[[Page H5628]]
able to negotiate with these insurance companies.
There are some people who will argue against this bill and say it is
going to tip the playing field. The playing field is overwhelmingly in
the favor of the insurance companies. We have provided them antitrust
exemptions. They can trade information amongst each other. They can
trade information about providers, their pricing, but the doctors
cannot talk amongst themselves at all.
So what we are really talking about here is evening out the playing
field, and I think it is the right thing to do. I commend the gentleman
from California for moving this legislation and the gentleman from
Michigan.
Mr. CONYERS. Mr. Chairman, I yield myself 2 minutes.
In the spirit of us moving as rapidly as we can, is it correct that
the Chair is now going to roll the votes? Has that been arrived at?
The CHAIRMAN. When we get into the amendment process, the Chair will
exercise that discretion.
Mr. CONYERS. I thank the Chair.
Mr. Chairman, we are dealing with a trinity of health care bills, the
Prescription Drug bill, the Patients' Bill of Rights, and this modest
antitrust exemption for doctors.
Now, please remember, this is a labor exemption. The antitrust
legislation was written for capital corrections and guidance. But what
we are doing here is doing what the doctors need to be able to discuss
how between HMO administrators and other professionals that they are
now being restricted in their ability to make decisions for their
patients.
We all know about this problem. We now have the opportunity to deal
with this question, and all I would like my colleagues to keep in mind
is that the time has come. For several years now we have brought this
measure forward. We are now debating it.
Most Americans receive their health insurance coverage through
managed care plans, but we have seen the massive coalitions and
consolidations of the managed care market to just a dozen health
insurance competitors. As a result of this market concentration, we
need to give some relief to these doctors. They are really feeling the
pinch. They are depending on us. And, by the way, so are the patients.
The decisions that the doctors make in the patient-doctor relationship
are under a severe test at this present point.
So we respond to this problem by allowing medical professionals to
jointly negotiate the terms of their contract with health care plans.
There is a 3-year sunset on the bill. Please support it.
Mr. BOEHNER. Mr. Chairman, I yield 1 minute to the gentleman from
Oklahoma (Mr. Coburn).
Mr. COBURN. Mr. Chairman, every doctor in this country, unless they
work for an HMO firm as a company doctor judging other doctors, is
frustrated in this country. What the gentleman from Florida (Mr.
Weldon) just described to you is a situation that does, in fact, occur.
One of the things that happens is the doctor is consolidated into a
group. That group as a group can decide whether or not they will or
will not take an HMO contract.
The problem is that in urban areas, we have way too many doctors, and
the only way an HMO or an insurance company can take advantage of that
is when there is an excess of physicians. So the real answer to this
problem is to, in fact, allow the marketplace to work. The problem is
the former bill of the gentleman from California (Mr. Campbell), which
we should be voting on, which takes away the exemption from the
insurance companies rather than giving it to the physicians.
Mr. CONYERS. Mr. Chairman, I yield 30 seconds to the gentleman from
Michigan (Mr. Dingell), the Dean of the House of Representatives.
Mr. DINGELL. Mr. Chairman, I thank my old friend for yielding to me.
Mr. Chairman, this is a good piece of legislation. It shifts the
balance back to the point where it is fair to the doctors and to the
HMOs by whom they are employed. I think it is time that we do this. It
is simple justice and simple equity, and it will improve a situation
which has grown increasingly intolerable from the standpoints of
doctors, of patients, and, very frankly, if they were smart enough to
know, also the HMOs.
Mr. Chairman, managed care has dramatically changed health insurance
in the past 30 years. Once upon a time,it actually managed the care a
patient received and because that was more efficient, it actually
saving some money. But, managed care has taken this cost-saving ability
to new levels and as a result has made the relationship between
doctors, patients, and insurers more complicated. The balance of power
has tilted away from the doctor and the patient to the insurer.
Insurance companies hold supreme power over both payment decisions
and treatment decisions, potentially compromising the quality of care
along the way. The Quality Health Care Coalition Act addresses
providers' concerns with their unequal bargaining position with
insurers--a problem which hurts the quality of care patients receive.
For that reason, Congress should act to restore balance to the
provider-insurer relationship.
However, passing H.R. 1304 does not relieve us of our responsibility
to restore the balance to the patient-insurer relationship by enacting
a meaningful, enforceable Patients' Bill of Rights that covers all
Americans. The House of Representatives passed such a bill on a
bipartisan basis last October. The Norwood-Dingell bill provides a
fair, independent, and expeditious appeals process, and guarantees that
doctors, not accountants, are making medical decisions. The bill
ensures that patients have basic rights such as access to specialists,
access to emergency care, access to ob-gyn care, and access to needed
drugs. It also ensures that patients can hold their HMO accountable for
acting irresponsibly, if those actions cause injury or death. More than
nine months have passed, the conference has failed, and Congress still
has not delivered a bill to the President.
The Quality Health Care Coalition Act is one step toward leveling the
playing field for doctors, but Congress must finish its work for
patients and get a meaningful, enforceable Patients' Bill of Rights to
the President. I hope that we will see both bills signed into law this
year.
Mr. CONYERS. Mr. Chairman, I yield 30 seconds to the distinguished
gentleman from Michigan (Mr. Bonior).
{time} 2310
Mr. BONIOR. Mr. Chairman, let me just say that I want to commend the
gentleman from Michigan (Mr. Conyers) and the gentleman from California
(Mr. Campbell) on crafting this legislation. Not only is this good for
doctors and patients, but it reinforces the idea that collective
bargaining and workers coming together and being able to bargain for
their work is a valuable, valuable asset in our society today.
It is not just blue collar workers or technical workers or clerical
workers. We are finding more and more teachers and scientists and
people of professional status involved in this kind of collective
bargaining and organization. I commend them for giving this opportunity
to the doctors.
Mr. Chairman, one of history's most enduring lessons is that
collective bargaining is the only institution that offers Americans the
voice they need to win fairness in the workplace.
Most of us understand how that's worked for blue-collar workers and
clerical and technical employees--but it's just as true for
professionals.
That's why, over the years, we've seen teachers, journalists and even
scientists organize.
That's why I was proud to join a union when I was an adoption
caseworker.
And that's why health care professionals are organizing today.
They're organizing because they understand what every family in this
country knows: that American health care today is big business.
And it's a business where, all too often, the quality of patient care
has taken a back seat to the demand for profit.
By passing H.R. 1304, we're giving health professionals an important
new tool to fight back.
Through collective bargaining, they'll have the added clout they need
to talk back to the health plans that dominate American medicine.
That's not just good for health providers--it's good for the patients
who depend on them.
Because when health professionals negotiate they won't only be
speaking out for themselves, they'll be bargaining for better care.
The bottom line is that joining a union doesn't undermine
professionalism--it only bolsters it.
I'm proud to salute the leadership of my colleagues, Tom Campbell and
John Conyers, in crafting this measure.
And I'm proud to join with them in voting for H.R. 1304 today.
But, like other supporters of this bill I strongly oppose the Cox
amendment to H.R. 1304.
The Cox amendment is a shameless attempt to undermine the ability of
health professionals both to organize and to bargain. It will render
this legislation virtually useless.
[[Page H5629]]
Vote ``no'' on the Cox amendment, and, once it's defeated, vote
``yes'' on H.R. 1304.
Mr. CAMPBELL. Mr. Chairman, I yield 1 minute to the gentleman from
Georgia (Mr. Barr).
Mr. BARR of Georgia. Mr. Chairman, I rise in support of H.R. 1304,
because it is a bill that is simple in concept and based on fundamental
principles of fair market, and the freedom and right to contract fairly
as equals on a level playing field.
This legislation does nothing except remove the current artificial
barriers that prevent doctors from doing what every other citizen has
the right to do, and that is to bargain as equals in good faith and on
a level playing field.
It is not giving them any special advantage. It is simply saying to
the doctors of America as they try and practice medicine with the best
interests of their patients in mind that they can negotiate as equals
on behalf of their patients. That is all this bill does. It does no
more and no less. That is why it enjoys the support on both sides of
the aisle of a majority of Members of this House.
I urge Members to vote in support of H.R. 1304.
Mr. BOEHNER. Mr. Chairman, I yield 1 minute to the gentleman from
Arizona (Mr. Shadegg).
Mr. SHADEGG. Mr. Chairman, I thank the gentleman for yielding time to
me.
Mr. Chairman, it is true that doctors are not on a level playing
field. I have immense sympathy for their situation. But as well-
intended as this legislation is, we have to look beyond what it says to
what it will do. What it will do is drive up the cost of health care.
What we have done in America is we have disempowered patients. The
reality is patients in America today cannot pick their own doctor
because they are trapped in a health care plan selected by their
employer.
We need to create a marketplace in health care in America today by
empowering patients. Let us ask ourselves, are doctors not powerful
enough, are HMOs not powerful enough, or are patients not powerful
enough? The answer is that it is the patient that has been left out of
this equation. They are trapped in the health care plan. They cannot
get to the doctor they want.
Rather than empowering patients to go hire the doctor they want and
bring down the cost of health care and get the care they need, what we
are going to do is we are going to allow doctors to collectively
bargain.
The net effect of that will be to increase the cost of health care
and, mark my words, we will have Hillary care. We will have a single-
payer system within 5 years when this bill becomes law.
Mr. CONYERS. Mr. Chairman, I am pleased to yield 1\1/2\ minutes to
the gentleman from New York (Mr. Nadler), a member of the committee.
(Mr. NADLER asked and was given permission to revise and extend his
remarks.)
Mr. NADLER. Mr. Chairman, today's health care marketplace is
dominated by six large companies who enjoy monopoly or near monopoly
power in certain areas of the country. These companies possess
unchallenged power in their negotiations with health care providers
because providers are restricted by antitrust laws from bargaining
collectively for more favorable terms.
We hear from critics of this legislation that the bill is just about
helping doctors get rich, but I say it is about helping patients get
quality care. When a doctor is told they may only provide the cheapest
treatment available, it is the patient who suffers. When a doctor is
told he may not even discuss alternative treatments not covered by the
insurance plan, it is the patient who suffers. When a doctor is told he
must see a dozen patients in an hour in order to make the reimbursement
rates viable, it is the patient who inevitably suffers.
This bill is not about lining the pocketbooks of doctors, it is about
allowing doctors to stand up to the insurance companies and say, we
will not accept conditions that harm our patients or put them in
jeopardy.
Opponents argue that this bill would significantly raise costs in the
health care industry because doctors will be able to extract exorbitant
reimbursement rates from insurance companies if they were able to
negotiate collectively. But to suggest that doctors will have these
monolithic, multibillion dollar companies at their mercy defies logic
and credulity.
What this bill would do, all this bill would do, is to place doctors
on a somewhat less tilted, a somewhat more level playing field on which
to negotiate decent rates and decent conditions for their patients.
This may be the most important bill we could pass this year. I urge
its adoption.
Mr. Chairman, I rise in strong support of H.R. 1304, the Quality
Health Care Coalition Act of 1999. This is a very important piece of
legislation that will immensely improve the quality of patient care in
this Nation.
Mr. Chairman, the health care landscape is increasingly being
controlled by just a few large insurance companies. Today's health care
marketplace is dominated by six large companies, who enjoy monopolies
or near monopolies in certain areas of the country. These companies
possess unchallenged power in their negotiations with health care
providers because providers are restricted by antitrust laws from
bargaining collectively for more favorable terms. It has gotten to the
point where insurance companies are effectively dictating the terms of
an agreement to the providers.
We hear from critics of this legislation that this bill is just about
helping doctors get rich, but I say that it's about helping patients
get quality care. When a doctor is told he may only provide the
cheapest treatment available, it's the patient who suffers. When a
doctor is told he may not even discuss alternative treatments not
covered by the insurance plan, it's the patient who suffers. And when a
doctor is told that he must see a dozen patients an hour in order to
receive viable reimbursement rates, it's the patient who inevitably
suffers.
This bill is not about lining the pocketbooks of doctors. It's about
allowing doctors to stand up to insurance companies and say, ``We will
not accept conditions that harm our patients or put them in jeopardy.''
We must once again place medical decisions in the hands of doctors
rather than an HMO bureaucrat who is not involved in our care.
Opponents argue that this bill would significantly raise costs in the
health care industry because doctors would be able to extract
exorbitant reimbursement rates from insurance companies if they were
able to negotiate collectively. But to suggest that doctors will have
these monolithic, multibillion dollar companies at their mercy defies
credulity. What this bill would do is place doctors on a somewhat more
level playing field on which to negotiate. We do not tip the scales in
their favor.
Let me also mention another criticism of this bill raised by
nonphysician providers such as nurse midwives and nurse practitioners.
When the Judiciary Committee held hearings on this bill, these groups,
among others, expressed in important concern over H.R. 1304, namely
that doctors would be able to use the collective bargaining power
granted under the bill to effectively exclude them from the field or
severely limit their ability to practice. That is certainly not the
intent of the bill.
The purpose of this bill is to ensure that no member of the health
care profession has the terms of his or her practice dictated to them.
This includes all of the licensed nonphysician providers who have
worked alongside doctors to provide quality care to patients. We do not
want to provide a tool for one class of health care professionals to
squeeze out another.
That is why I worked with Representatives Frank and Jackson-Lee to
amend the bill in the Judiciary Committee to specifically bar doctors,
or any other provider, from entering into an agreement or conspiracy
which would exclude, limit the participation or reimbursement of, or
otherwise limit the scope of services to be provided by any other
health care professional or group of professionals.
Under this language, no member of the health care field can have the
terms of their practice dictated to them by insurance companies,
doctors, or anyone else. All terms will be worked out by negotiation,
exactly as this bill intends. I am confident that this language fully
protects all nurses and other nonphysician providers from attempts by
doctors to limit their ability to practice.
Mr. Chairman, this is responsible legislation that will release
doctors from the grip of insurance companies and help them negotiate
terms that best serve their patients. I believe this bill will help
restore confidence in the doctor-patient relationship and ensure that
it is only doctors and other licensed professionals who practice
medicine. I urge my colleagues to support H.R. 1304 so that all
providers will be free to practice in the best interests of their
patients.
Mr. CONYERS. Mr. Chairman, I am pleased to yield 1 minute to the
gentlewoman from Texas (Ms. Jackson-Lee), a distinguished member of the
Committee on the Judiciary.
Ms. JACKSON-LEE of Texas. Mr. Chairman, I thank the gentleman for
yielding time to me.
[[Page H5630]]
Since 1974, there have been 275 mergers and acquisitions of health
plans. That is why I support the work of the gentleman from Michigan
(Mr. Conyers) and the gentleman from California (Mr. Campbell). With
this wave of consolidation, seven giant health care insurers have come
to dominate the marketplace, and 80 percent of all Americans get their
coverage through managed care.
The enormous size of these companies allows insurers to not only
control the costs of but also the quality and access to health care.
The health care system has become David and Goliath. We have to give
David something to fight with.
In my State of Texas, although we already passed legislation that
allows health care professionals to jointly negotiate, this is limited
only to physicians in Texas. So national or regional health plans still
have a stronger negotiating power, whereas a Federal law would help
address this imbalance.
Any amendments on this bill, unfortunately, are driven by the
insurance companies to destroy the bill, so I hope my colleagues will
vote down these poison pill amendments. This legislation would enable
medical professionals to serve their patients in the way their best
medical judgment indicates. To do that, they will occasionally have to
present a united front to the giant HMOs.
Mr. Chairman, this is a key vote for medicine. Therefore, I urge my
colleagues to support this legislation by the Committee on the
Judiciary.
Mr. CAMPBELL. Mr. Chairman, may I inquire how much time is left on
each side? I have only one more speaker in the general debate, myself,
and I intend to close.
The CHAIRMAN. The gentleman from Ohio (Mr. Boehner) has 3 minutes
remaining, the gentleman from California (Mr. Campbell) has 1\1/2\
minutes remaining, the gentleman from Michigan (Mr. Conyers) has 4\1/2\
minutes remaining.
Closing comments will be in this order: The gentleman from Ohio will
start first, the gentleman from Michigan will go second, and the
gentleman from California has the right to close.
The Chair recognizes the gentleman from Michigan (Mr. Conyers).
Mr. CONYERS. Mr. Chairman, I am pleased to yield 1 minute to the
gentlewoman from New York (Mrs. Maloney).
Mrs. MALONEY of New York. Mr. Chairman, I thank the gentleman for
yielding time to me, and I rise in strong support of the Campbell-
Conyers Quality Health Care Coalition Act, and congratulate both of
them on their really thoughtful and creative legislation.
Mr. Chairman, what this bill is really about is who do we want in
charge of our health care decisions, an HMO accountant bean counter, or
our doctor who knows our health needs?
This bill will level the playing field between enormous health care
plans and physicians and patients, allowing physicians to come together
to negotiate with health care plans over contract provisions. Patients'
interests should be at the bargaining table, and this bill allows it.
Many doctors in my district tell me that insurers are imposing
greatly unfair contract terms on them. They say they have no choice but
to sign the contracts unless they want to risk losing many of their
patients.
The choice is very clear. The patients want it, the doctors want it.
The only opposition is the HMO accountants. I urge a yes vote.
Mr. BOEHNER. Mr. Chairman, I yield 1 minute to the gentleman from
Oklahoma (Mr. Largent).
Mr. LARGENT. Mr. Chairman, I thank the gentleman for yielding time to
me.
I rise in opposition to this bill. I have been sitting listening to
this debate. It is most unusual. I hear my friends, the Democrats, my
friend, the gentleman from Michigan, talk about those poor doctors
feeling the pinch. We need to help those poor doctors. Yet, when
Republicans bring tax cuts to the floor, they holler no, no, those are
tax cuts for the wealthy. We cannot give them a break on their taxes.
What the Democrats want to do to help those poor doctors is to let
them form a union. That is how we level the playing field, let them
form a union.
I have finally figured out and was able to put together the pieces of
the puzzle, because when those proverbial union thugs go out to break
knees, they will have the doctors there to fix them. It all makes
perfect sense.
{time} 2320
Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentleman from
Pennsylvania (Mr. Hoeffel).
Mr. HOEFFEL. Mr. Chairman, I thank the gentleman from Michigan (Mr.
Conyers) for yielding me this time. I rise in strong support of the
Campbell-Conyers bill, a bill that would allow collective bargaining,
not unions I would say to the previous speaker, but collective
bargaining, so that doctors can deal with the one-sided, unfair
arbitrary contracts that are forced upon them by the big managed care
companies. Contracts that impose gag rules so that doctors cannot
discuss all of their treatment options with their patients. Contracts
that discourage referrals to specialists. Contracts that block
appropriate tests and delay care to patients. Contracts that give
financial rewards for denying care.
Mr. Chairman, in southeastern Pennsylvania where one managed care
company controls 62 percent of the marketplace, they not only have
offered orthopedic surgeons, as one example, a 40 percent cut in
compensation, but they have also required that all doctors sign
confidentiality agreements before negotiations begin as a precondition
of negotiations one-on-one with the doctors. These agreements are
unfair. They deny rights that doctors ought to have.
Mr. Chairman, I support the bill.
Mr. BOEHNER. Mr. Chairman, I yield myself the balance of my time.
Mr. Chairman, I think we all know that we are going through major
changes in the delivery of health care in America. Those issues have
been fought out on this floor over the 10 years that I have been a
Member and all of the changes are disconcerting to all involved.
First, the patients, doctors, hospitals, employers who pay the costs,
insurance companies, everyone is in turmoil trying to find the right
balance making sure the patients get what they need and trying to hold
costs under control.
Every year that I have been here, we have debated Medicare and the
tremendous increases in the costs of Medicare. We have been through all
types of changes trying to what? Give the patients what they need while
controlling the costs.
And so as we look at the situation in managed care today, we have a
number of those groups in the middle with their lobbyists coming to
Washington wanting us to level the playing field. Now, leveling the
playing field is like beauty. It is in the eye of the beholder. Of
course, they all want it level as long as it is slightly tilted toward
them.
Mr. Chairman, this bill is no exception, except one small little
exception. This is a big tilt, A big tilt to one group at the expense
of all others that are locked into this system.
Why would we provide an antitrust exemption to one group in the
medical profession with no oversight, no regulatory body overseeing
their actions? Every time we have provided an antitrust exemption in
the law, there has been some Federal regulatory body that has the
responsibility to provide oversight. The National Labor Relations Act
allows for collective bargaining. That is why we have the National
Labor Relations Board to oversee these activities between labor and
management.
To allow any group of Americans to go out and to form a cartel to
prey on America's consumers is not good for our country. We know what
happened with the OPEC cartel; we have higher prices at the gas pump
today. What we are doing here is we are creating another cartel. It is
a bad bill.
Mr. CONYERS. Mr. Chairman, I yield 1 minute and 15 seconds to the
gentleman from New Jersey (Mr. Andrews).
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
Mr. NADLER. Mr. Chairman, will the gentleman yield?
Mr. ANDREWS. I yield to the gentleman from New York.
Mr. NADLER. Mr. Chairman, I must correct the statement made a moment
ago. This bill does not grant any privilege to one group. I presume the
gentleman meant doctors. The bill refers
[[Page H5631]]
to ``all health care professionals,'' doctors, nurses, physical
therapists, everybody in the field. It is not a cartel of one group. It
is simply a mistaken fact and a misquote of the bill.
Mr. ANDREWS. Mr. Chairman, reclaiming my time, I thank the gentleman
from New York, my friend.
In our economy, actors are regulated either by litigation, regulation
or competition. None of those three things applies to the oligarchs of
the managed care industry.
This Congress, I am confident, is going to take a step to impose the
quality control of litigation through the Patients' Bill of Rights.
This bill is a very important step in imposing some competition in the
health care market for the first time in a long time.
This really is about leveling the playing field. It is about reining
in the conduct of the oligarchs of managed care. For that reason, I
strongly support the legislation and commend the gentleman from
California (Mr. Campbell) and the gentleman from Michigan (Mr.
Conyers), my friend, for offering it.
The CHAIRMAN. The gentleman from Michigan (Mr. Conyers) has 1 minute
and 15 seconds remaining. The gentleman from California (Mr. Campbell)
has 1\1/2\ minutes remaining. The gentleman from California has the
right to close.
Mr. CONYERS. Mr. Chairman, I yield myself the balance of my time.
Mr. Chairman, this Quality Health Care Coalition Act is an important
antitrust exemption for doctors. I want to begin my closing remarks in
general debate by merely commending the gentleman from California (Mr.
Campbell) for all the work that he has done on this measure and for
allowing me to work with him.
Mr. Chairman, we would not be here today if we were not concerned
about the doctor-patient relationship which is in crisis. We are giving
an exemption that the labor movement already has. This is not ground-
breaking legislation. It sunsets in 3 years. The original costs were
based on a 10-year basis; and of course, it is only going to run for 3
years.
The managed care market has consolidated. Some of my colleagues may
know that some doctors are in very dire circumstances. Private
practices are in decline.
Mr. Chairman, I urge my colleagues to support the antitrust exemption
for doctors.
Mr. CAMPBELL. Mr. Chairman, I yield 1 minute to the gentleman from
Virginia (Mr. Davis).
Mr. DAVIS of Virginia. Mr. Chairman, I also compliment the gentleman
from California (Mr. Campbell) for bringing this forward. The American
health care system has many players, but doctors and health care
providers are essential. They are the essential players. They are on
the frontline making life and death decisions every day, and they are
being picked apart.
Fees are cut unilaterally. Their medical advice that they are giving
to patients is being countermanded by nondoctors, and they have no say
in this situation the way it has come today. We have come to this that
if we do not make these changes today, we are jeopardizing the best
health care system in the world. People who want to enter and stay in
the medical profession are looking outward at other options because,
frankly, not only is the remuneration not there, and the respect is not
there, but they are not able to carry out their advice to patients
because they are being countermanded.
Mr. Chairman, that is what makes this legislation essential. I
commend the gentleman from California (Mr. Campbell) for bringing this
to the floor tonight. I hope we will give it a resounding ``yes'' for
American health care, for doctors, the providers, and the patients.
Mr. CAMPBELL. Mr. Chairman, I yield myself the balance of my time.
Mr. Chairman, the key point I want to stress in closing is that this
does not create a union of doctors. The words ``collective bargaining''
only occur in the statute with reference to an antitrust exemption
already in law for unions. We do not use the words ``collective
bargaining'' at all with regard to health care professionals.
We explicitly say ``there shall be no right to strike,'' in case
somebody thought there might be. No right to cease work that does not
already exist. The bill has a 3-year sunset, and it explicitly provides
the right for individuals not to be choosing an exclusive bargaining
agent; and hence there is no need for the regulatory oversight such as
the NLRB provides.
Ms. DeLAURO. Mr. Chairman, today I cast my vote in support of the
Quality Health Care Coalition Act, because I believe that physicians
and other health care professionals should be on an equal playing
ground when they negotiate contracts with health plans. The Quality
Health Care Coalition Act would provide limited relief from the
antitrust laws by allowing self-employed physicians to negotiate
collectively with large managed care organizations regarding contract
terms that protect patient confidentiality, increase patient choice and
improve quality of care. It would restore balance in the market by
increasing physicians' power to negotiate for their patients with large
managed care organizations. It would not force health plans to accept
terms and conditions sought by health care professionals, it would
simply allow physicians to band together as a bargaining unit for
purposes of negotiation.
Unfortunately, this bill has been plagued by ``poison pill''
amendments, designed to divide and conquer the long-time supporters of
this legislation. Representative Tom Coburn, authored a poison pill
amendment that attempts to limit access to legal abortions. Mr.
Coburn's amendment would restrict health care professionals from
discussing health insurance coverage for abortions. Many fear that this
restriction could prevent physicians not only from negotiating coverage
for legal abortions, but also prevent them from discussing methods and
procedures for providing referrals elsewhere. I joined my pro-choice
colleagues in voting against this amendment. However, this amendment
passed.
As was the intention of this poison pill, this left me and my pro-
choice colleagues with a Hobson's choice--an affirmative vote for
physicians and patients tied to a restriction on choice or a negative
vote against physicians and patients to prevent an anti-choice measure
from going forward.
I voted for final passage of this legislation with the hope that the
Coburn amendment will be struck when this bill reaches conference with
the Senate. If this legislation proceeds through conference and reaches
the President's desk with the anti-choice Coburn amendment intact, I
urge the President to veto the bill.
Mr. POMEROY. Mr. Chairman, H.R. 13204, which provides a broad
exemption from federal anti-trust laws for health care professionals,
is intended to restore parity between providers and third-party payers.
I believe that this is a good intention, and I agree that in some
markets, third-party payers have taken a hold so strong as to be able
to dictate health care fees and standards.
As a former state insurance commissioner, however, I know that the
answer is not to completely tilt the scales in the opposite direction.
No other organization or segment of our economy, except for Major
League Baseball, enjoys such a broad, federal anti-trust exemption.
Even the Business of Insurance is regulated under the McCarran Ferguson
Act.
Unfortunately, some proponents of this legislation have
misinterpreted that McCarran Ferguson Act. They have stated that this
act gives the insurance industry an exemption from anti-trust laws, and
that H.R. 1304 simply levels the playing field for health care
providers. Mr. Chairman, I want to emphasize something for my
colleagues: the McCarran Ferguson Act creates a partial exemption for
the business of insurance that is regulated by state law. Activities
that do not relate to the business of insurance--such as a health
plan's negotiations with health care providers--are still subject to
federal antitrust laws.
As a representative of rural America, I am also concerned about the
effect this legislation will have on quality of care. H.R. 1304 would
allow unrestrained, unregulated price fixing by all of the health care
providers in a given market. Such price-fixing schemes would give
physicians a monopoly within their market, permitting physicians to
raise their own salaries, through higher reimbursement rates, at the
expense of consumers, employers and taxpayers.
Again, let me say that I know this is not the intent of the
legislation or the plan of my respected colleagues and the professional
organizations who support H.R. 1304. We probably do not need antitrust
consumer protections for the leading, most ethical participants in the
health care market. Unfortunately, in an industry as vast as health
care, there will inevitably be those of other, less reputable
intentions.
For those well-intentioned physicians, legitimate antitrust
mechanisms already exist under which physicians and other health care
providers who have formed legitimate legal entities can collaborate and
negotiate with health plans. Physicians do not need exemptions from the
antitrust laws to collectively discuss
[[Page H5632]]
quality of care issues among themselves or with these plans.
Mr. Chairman, I would be inclined to support a more moderate measure.
I understand that my colleagues on the Judiciary Committee adopted an
amendment that would allow H.R. 1304 to sunset in three years. In my
opinion, however, three years is enough time to increase both private
and public health care costs and decrease quality of care. In fact, the
CBO has estimated that a three-year exemption will raise insurance
premiums by 1.5% by 2003 and cost the government $1.7 billion over 5
years.
Instead I suggest that if we really want to level the playing field,
we regulate these medical providers in their bargaining groups,
subjecting them to oversight as we have with other organizations, from
trading companies to newspaper operations.
Mr. Chairman, while well-intended, this is flawed policy. I urge my
colleagues to think seriously about the effects this legislation may
have on consumers, providers and payers alike. Please vote no.
Ms. JACKSON-LEE of Texas. Mr. Chairman, I rise in support of H.R.
1304, The Quality Health Care Coalition Act of 1999. As we consider
this bill, let us remember what a truly bipartisan piece of legislation
it has been thus far. In fact, H.R. 1304 passed the Judiciary Committee
by a vote of 26-2. With that in mind, I wish to applaud Congressman
Campbell and Congressman Conyers for their genuinely bipartisan efforts
respecting this bill.
H.R. 1304 would modify the anti-trust laws and would apply only to
conduct in conjunction with good faith negotiations. The modifications
would allow health care professionals to collectively settle the terms
of their contracts with health care plans. I support this legislation
because I believe that health care providers should be allowed to
bargain collectively with health plans and insurance providers.
In my state of Texas, although we already passed legislation that
allow health care professionals to jointly negotiate, this is limited
only to physicians in Texas. So, national or regional health plans
still have a stronger negotiating power whereas a federal law would
help address this imbalance.
Since 1994, there have been 275 mergers and acquisitions of health
plans. With this recent wave of consolidations, seven giant health care
insurers have come to dominate the marketplace and 80% of all Americans
get their coverage through managed care.
The enormous size of these companies allows insurers to not only
control the cost of, but also the quality and access to health care.
These powerful health plans intimidate and threaten physicians with
antitrust violations in order to bar them from talking to one another
and to insurers about patient care. As a result, the decisions of
health care professionals have been compromised.
With the increased level of market concentration, HMOs have been
practically setting the terms of contracts with health care providers,
including forcing patients to accept the least expensive care and
preventing patients from being fully informed of all available
treatment options. Insurers should not make decisions such as these.
We rely upon health care professionals to advocate for our care. No
one is comfortable with the idea of a physician who withholds treatment
information! In cases where doctors are prohibited from discussing all
available treatment options, it could be a matter of life or death.
Health care professionals need decision-making power to determine what
is best for their patients.
H.R. 1304 would provide guarantees that patients are protected from
bureaucratic abuses. There is no way to predict what kind of healthcare
quality issues will arise in the future. H.R. 1304 would enable
healthcare providers to address managed care abuses and other patient
care issues as they arise through contract negotiations.
For doctors who provide specialty services, this bill will assist
them in negotiating contracts with the health care plan to make their
services more readily accessible. African-American physicians
especially need this bill because they face special barriers that
impede their full participation in managed care networks.
African-American doctors are more likely to serve minority
communities that are disproportionately low-income and severely ill.
Because of these patients' special needs, African-American doctors
often face the constant threat of being excluded from health plans
because their patients are exceedingly sick and too costly to treat.
In my district in Houston, Texas, where 70% of the people in the 5th
Ward are infected with HIV/AIDS, these patients are often poverty
stricken and need special care that most managed care networks will not
provide. Physicians are often forced to pay out of pocket for the cost
of prescription drugs for their patients if the cost is excessive.
Thus, caring for any patient with AIDS is a money-losing endeavor.
In California, a 1999 Price Waterhouse Cooper's study indicated that
physicians there are filing for bankruptcy at an alarming rate because
they cannot afford to provide quality care when they receive less than
50% of the cost it takes to care for a patient! These health care
providers should not be punished for living up to their pledge to
faithfully care for the people of America to the best of their ability.
Despite what critics may say, this bill does not allow doctors to fix
the prices of their services. Price-fixing is illegal and will remain
illegal under H.R. 1304. Health care professionals support this
legislation because they want the ability to negotiate with HMOs in
order to do their jobs and provide quality care for their patients.
Although doctors will be able to join together to negotiate the terms
of their contracts, they will not be able to determine the actual
prices for services.
This bill simply places doctors on the same level of market power as
the health care plans. In fact, the oversight currently exercised by
the Department of Justice and the Federal Trade Commission would remain
intact so that H.R. 1304 would not decrease their authority to
prosecute health care professionals for illegal activities such as
exclusive dealing or price-fixing.
Critics claim that allowing health care professionals the right to
collectively bargain would permit professionals like nurse
practitioners and chiropractors to be discriminated against. I continue
to be approached by organizations like the Academy of Nurse
Practitioners, The Texas Chiropractic Association and the American
Chiropractic Association who are sincerely concerned about the negative
effect this legislation will have on their ability to continually serve
their patients.
As a result of their concerns I introduced an amendment, along with
Representative Nadler that clarifies our objective to not sanction
discriminatory practices between physicians and health insurers.
This amendment, which is included in H.R. 1304 includes several
important safeguards. The bill would prohibit any group of health care
professionals from negotiating contract language which limits any other
group of professionals from doing work that they are licensed to do
under applicable scope of practice acts and regulations. In addition,
Medicaid managed care plans, Medicare+Care plans and plans covering
federal employees are excluded from the legislation. Finally, the bill
sunsets after three years, unless re-approved by Congress.
If the insurance industry is allowed a special exemption under the
antitrust laws, physicians who act on behalf of their patients should
also be able to ensure that the contracts they enter are not
detrimental to patient care.
Currently, the bargaining power of managed care organizations dwarfs
the bargaining power of individual physicians and other professionals.
As a result, insurers are able to impose contracts on a take-it-or-
leave-it basis, no matter how egregious the contract terms. Physicians
often have no choice but to sign the contracts offered. Otherwise, they
run the risk of losing a large share of their patients and being force
out of business. These one-sided contracts often violate professional
and ethical standards and prevent practitioners from providing adequate
care.
Of course, the health insurers claim the bill would drive up costs.
But note what they are really saying is if they take a hit in their own
profits, they will seek to make up for the loss by charging patients
more for the same services. With this in mind, we know that any
resulting increases in medical cost will not be due to the passage of
H.R. 1304, but will be the direct result of greed.
Because this bill has already been through an intense amendment
process in the Judiciary committee where four amendments were adopted
by a vote of 26-2, I ask my colleagues not to allow additional
amendments to this important legislation. There has been a bipartisan
effort to work with professional health care organizations and we
should respect the work that has been done to develop this bill.
Any amendments at this point would be purely insurance driven
attempts to destroy the bill. As reported by the judiciary, the bill
would ensure that Congress could address any potential concerns that
may arise before the legislation is re-authorized. Adding unnecessary
and burdensome requirements would harm patients and effectively gut the
bill.
This legislation would enable medical professionals to serve their
patients in the way their best medical judgement indicates. And to do
that, they will occasionally have to present a united front to a group
of HMOs. Mr. Speaker, this is a key vote for medicine and therefore, I
urge my colleagues to support this legislation as presented by the
Judiciary.
Mr. GOODLING. Mr. Chairman, I rise in opposition to H.R. 1304. I have
many concerns regarding this bill, but I wish first to focus on one: is
cost. The bill before the House costs $6.1 billion in mandatory federal
funds, yet does not include a single penny to pay for it. Ordinarily,
legislation like this would be subject to several Budget Act points of
order for this failure, but the rule waived all those points of order.
For what does this bill spend federal money? It increases doctors'
incomes!
[[Page H5633]]
Since the bill doesn't spell out how to pay for this $6.1 billion
benefit to doctors, the money will have to come out of the existing
federal budget. My colleagues know that the federal budget includes the
National School Lunch Act, a program that provides a healthy nutritious
meal to millions of school age children across this country. If I had
$6 billion to spend, I think I would use some of that money for school
lunches, rather than for forming doctor cartels.
My colleagues know that the federal budget includes the Individuals
with Disabilities Education Act, a program ensuring that children with
disabilities will received an education. This is a program that is
woefully underfunded, where we have never met our 40 percent of funding
commitment. If I had $6 billion to spend, I think I would use some of
that money for educating children with disabilities instead of for
hiking the net worth of doctors.
The federal budget also includes student aid programs in the Higher
Education Act--programs that help students across this country attend
college. If I had $6 billion to spend, I think I would use some of that
money for student aid instead of for increasing doctors' incomes. The
federal budget includes healthcare; it includes Social Security; it
includes aid for farmers, including crop insurance; it includes our
national defense; it includes programs for literacy. If I had $6
billion to spend, I think I would use some of that money for these
worthy purposes, rather than for lining the pockets of doctors.
As a matter of fact, I can't think of a single current program,
issues, or concern that should receive a lower priority than this bill.
On the issue jurisdiction, Mr. Chairman, I want the record to reflect
that I have been making the point--repeatedly--for the past year that
H.R. 1304 is a labor bill that should have been referred to the
Workforce Committee.
I am going to include in the record a memorandum prepared by the
American Law Division of the Congressional Research Service, discussing
case law and House precedent in support of the Workforce Committee's
jurisdiction over H.R. 1304.
I know that sometimes issues do not lend themselves to easy sound
bites. Sometimes they require a bit of patience to understand. I want
members to understand that this bill is a labor bill--and a very bad
labor bill at that.
If this bill becomes law, health care costs will skyrocket, and
Congress will have granted a group of professionals the rights of
collective bargaining without any corresponding responsibilities.
H.R. 1304 allows doctors and other health care professionals to band
together and collectively bargain. This is done by exempting them from
the antitrust laws. The Supreme Court has held that the ``nonstatutory
labor exemption'' which this bill extends to doctors is a concept
arising in labor law, and is applicable only in the context of labor
law. Simply put, H.R. 1304 is about collective bargaining, and it is a
labor bill. It is a flawed labor bill because it grants rights similar
to those contained in the National Labor Relations Act, but fails to
provide any mechanism to make sure those rights are effective, or fair.
Mr. Chairman, on all counts this six billion dollar special interest
gift is misguided, irresponsible, and unnecessary. I urge my colleagues
to vote against this legislation.
The aforementioned memorandum follows:
Congressional Research Service,
Library of Congress,
Washington, DC, July 12, 1999.
memorandum
To: Honorable Bill Goodling, Chairman House Committee on
Education and the Workforce
From: Morton Rosenberg, Specialist in American Public Law,
American Law Division
Subject: Jurisdictional Basis for Referral of H.R. 1304, the
Quality Health-Care Coalition Act of 1999 to the Committee
on Education and the Workforce
On March 25, 1999, Representative Campbell, for himself and
27 co-sponsors, introduced H.R. 1304, the Quality Health-Care
Coalition Act of 1999, which was referred to the House
Judiciary Committee. The purpose of the bill is stated in its
preamble to be ``[t]o 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 Relation Act.'' The
bill makes a congressional finding that ``[p]ermitting health
care professionals to negotiate collectively with health care
plans will create a more equal balance of negotiating power,
will promote competition, and will enhance the quality of
patient care.'' Section 2(4). The purpose of the bill is to
be accomplished by treating health care professionals who are
engaged in bargaining with health care plans and health
insurance issuers as if they were employees in collective
bargaining units under the National Labor Relation Act (NLRA)
and by entitling all parties to such negotiations ``to the
same treatment under the antitrust laws as the treatment to
which bargaining units which are recognized under the
National Labor Relation Act are entitled in connection with
such collective bargaining.'' Section 3(a). Health care
professionals are denied any right to strike ``not otherwise
permitted by law.'' The proposed legislation is silent with
respect to mechanisms for resolving disputes that may occur
during the collective bargaining process or as to the
establishment and enforcement of a legal ``duty to bargain.''
You inquire whether your Committee has a substantial claim
to jurisdiction over H.R. 1304. From our review, it would
seem that the broad authority delegated to the Committee
under House Rule X(g)(6) over labor matters generally, its
long history of legislative action and oversight with respect
to subject matter that is the same or closely analogous to
that of H.R. 1304, and the essentially labor-related nature
and orientation of the bill's core operational provision,
which imparts antitrust immunity to bargaining decisions over
wages, hours and conditions of employment, establish a
substantial basis for arguing for sequential referral of the
bill to your committee.
The courts have provided significant guidance in
determining the appropriate jurisdiction and authority of
legislative committees. A congressional committee is a
creation of its parent House and only has the power to
inquire into matters within the scope of the authority that
has been delegated to it by that body. Therefore, the
enabling rule or resolution which gives the committee life or
particular direction is the charter which defines the grant
and the limitations of the committee's power. United States
v. Rumely, 345 U.S. 41, 44 (1953); Watkins v. United States,
354 U.S. 178, 201 (1957); Gojak v. United States, 384 U.S.
702, 708 (1966). In construing the scope of a committee's
authorizing rule or resolution, the Supreme Court has adopted
a mode of analysis not unlike that ordinarily followed in
determining the meaning of a statute: it looks first to the
words of the resolution itself, and then, if necessary, to
the usual sources of legislative history. As explained by the
Court in Barenblatt v. United States, 360 U.S. 109, 117
(1959), ``Just as legislation is often given meaning by the
gloss of legislative reports, administrative interpretation,
and long usage, so the proper meaning of an authorization to
a congressional committee is not to be derived alone from its
abstract terms unrelated to the definite content furnished
them by the course of congressional actions.''
Thus, the starting point for analysis is the House's
delegation of jurisdictional authority under Rule X. Under
Rule X (g) (6) and (7) the Committee on Education and the
Workforce is currently vested with jurisdiction over matters
relating to ``education and labor generally'' and ``mediation
and arbitration of labor disputes,'' and has been so vested
with the same authority for at least 30 years. In addition,
Rule X(2)(b)(1) directs each standing committee to:
``Review and study on a continuing basis, the application,
administration, execution, and effectiveness of those laws,
or parts of laws, the subject matter of which is within the
jurisdiction of that committee and the organization and
operation of the Federal agencies or entities having
responsibilities in or for the administration and execution
thereof, in order to determine whether such laws and the
programs thereunder are being implemented and carried out in
accordance with the intent of the Congress and whether such
programs should be continued, curtailed or eliminated. In
addition, each such committee shall review and study any
conditions or circumstances which may indicate the necessity
or desirability of enacting new or additional legislation
within the jurisdiction of that committee (whether or not any
bill or resolution has been introduced with respect thereto),
and shall on a continuing basis undertake future research and
forecasting on matters within the jurisdiction of the
committee.''
In turn, this oversight obligation of standing committees
is buttressed by the express grant under Rule XI (1)(B)(1) to
each committee of authority ``at any time to conduct such
investigations and studies as it may consider necessary and
appropriate in the exercise of its responsibilities under
Rule X.'' Thus, on its face, your Committee has been vested
with broad legislative and oversight jurisdiction over laws,
proposals and activities that implicate labor relations
generally and collective bargaining particularly, and in the
past the Committee and its immediate predecessor, the
Committee on Education and Labor, has dealt with subject
matter and issues directly analogous to those found in
H.R. 1304.
In the 92d Congress, the Special Subcommittee on Labor of
the Committee on Education and Labor held hearings on H.R.
11357, a bill to repeal the NLRA's exemption for coverage of
employees of private non-profit hospitals which was added by
the Taft-Hartley Amendments of 1947. A critical issue was
whether affording NLRA coverage for health care institutions
would result in increased strikes which could endanger
patient care. The Committee's hearings revealed that, in
fact, recognition strikes and labor unrest had increased at
the exempt hospitals in contrast with the situation at
covered proprietary hospitals. The bill, which was
unanimously reported by the full Committee and passed the
House on August 7, 1972, contained a number of special
provisions designed to facilitate bargaining settlements
(i.e., a 90 day notice requirement of termination or
expiration of a contract, a 60 day
[[Page H5634]]
notice of termination or expiration to the Federal Mediation
and Conciliation Service (FMCS), and a requirement that a
health care institution and a labor organization had to
participate in mediation if so directed by the FMCS), and
that a health care institution had to be given a 10 day
notice by a labor organization before any picketing or strike
could take place. No action was taken by the Senate on that
bill. An identical bill was re-introduced in the 93d
Congress, H.R. 1236, and hearings were held by the Special
Subcommittee in Labor on April 12 and 19, 1973. A new
modified bill, H.R. 13678, was subsequently introduced,
reported by the full Committee, passed the House on July 11,
1974, and was signed by the President on July 26, 1974. The
new law contained the Committee proposed bargaining
facilitation and picketing and strike notification
provisions.
The Committee's interest in the bargaining rights of health
care professionals in non-proprietary hospitals continued
after the 1974 health care amendments. In the 94th Congress
the Committee held a hearing to consider a National Labor
Relations Board (Board) decision denying coverage of the NLRA
to hospital interns, residents and follows (housestaff) on
the grounds that they were students and not employees. In the
95th and 96th Congress's the Committee held hearings on
legislation to amend the NLRA to expand the definition of
professional employees covered under collective bargaining
provisions to include hospital interns, residents and
housestaff. In the 98th Congress Committee held oversight
hearings on two NLRB decisions in 1982 and 1984 involving St.
Francis Hospital that adhered to earlier Board decisions with
respect to NLRA coverage of housestaff employees.
In the 97th Congress the Committee held hearings to
consider Health Care Financing Administration (HCFA)
guidelines permitting medical reimbursement to hospitals and
nursing houses for the costs of influencing employee
organizing activities conducted under the NLRA.
In the 103d Congress the Committee held hearings on H.R.
226, The Live Performing Artist Labor Relations Act, a bill
that would have amended the NLRA to define the employer-
employee relationship between musicians and purchasers of
musical services, permitted employers to enter into pre-hire
agreements with unions representing live performing artists,
and allowed for the establishment of employee collective
bargaining rights in the performing arts industry.
In the 101st, 102d, and 103d Congresses the Committee held
hearings on proposed legislation to extend coverage of the
NLRA and the Fair Labor Standards Act to seamen working on
foreign flag, U.S.-owned cargo vessels regularly engaged in
U.S. foreign trade or on foreign flag passenger ships
operating primarily from U.S. ports. The bills were intended
to address alleged problems with union organization, wages,
and working conditions aboard foreign flag cruise ships whose
contact with the U.S. is central to their business, and
aboard U.S.-owned vessels registered with so-called flag of
convenience countries allegedly for the purpose of exempting
the vessels from U.S. labor laws.
Finally, reference may be made to evidence of your
Committee's historic interest in the so-called nonstatutory
labor exemption to the antitrust laws which is incorporated
as the key operational provision of H.R. 1304. See Section
3(a). The nonstatutory labor exemption is a creation of the
Supreme Court founded on its recognition that the antitrust
laws could not be applied with full force to the parties to a
collective bargaining relationship if the compulsory
collective bargaining policies of the labor laws were to be
successfully realized. To ``accommodate . . . the
congressional policy favoring collective bargaining under the
[NLRA] and the congressional policy favoring free competition
business markets,'' the Court recognized an implicit
exemption to the antitrust laws applicable to certain conduct
by unions and employers alike. Connel Construction Co. v.
Plumbers and Steamfitters, Local Union No. 100, 421 U.S. 616,
622 (1975); See also, Local No. 189, Amalgamated Meat Cutters
v. Jewel Tea Co., 381 U.S. 676 (1965); United Mine Workers v.
Pennington, 381 U.S. 657 (1965). The Supreme Court has
explained that the nonstatutory exemption is a labor law
concept and is part of the broad, independent body of law
that encourages and protects the collective organizational
and bargaining processes:
``Federal policy as . . . developed not only a broad labor
exemption from the antitrust laws, but also a separate body
of labor law specifically designed to protect and encourage
the organizational and representational activities of labor
unions. Set against his background, a union, in its
capacity as bargaining representative, will frequently not
be part of the class the Sherman Act was designed to
project, especially in disputes with whom it bargains.''
Association Gen. Contractors of California, Inc. v.
California State Council of Carpenters, 459 U.S. 519, 339-40
(1983).
The rationale of the nonstatutory exemption as enunciated
by the High Court mandates that concerted conduct by
management or by labor organizations in a collective
bargaining relationship is exempt from antitrust attack as
long as it principally affects the employees' terms and
conditions of employment. Labor market restraints reached
through the collective bargaining process are immune from
antitrust scrutiny when three conditions are met: (1) the
restraints primarily affect only the parties to the
collective bargaining agreement; (2) the restraints concern
mandatory subjects of bargaining; and (3) agreement on the
restraints was the product of bona fide arms-length
bargaining or the restraints were implemented during on
ongoing collective bargaining relationship.
The most recent Supreme Court articulation of these
precepts and understandings was in Brown et al. v. Pro
Football, Inc., 518 U.S. 231 (1996). That case involved an
antitrust suit by professional football players against team
owners of the National Football League charging that the
unilateral imposition of a salary cap on ``developmental
squad'' players after a collective bargaining contract had
expired and after an impasse in bargaining had been reached,
was a violation of the antitrust laws. The Court held that
employers may lawfully form multiemployer bargaining groups
and agree amongst themselves to impose controls on a labor
market as long as those actions ``grew out of'' and were
``directly related to'' a multiemployer bargaining process,
did not offend the federal labor laws that sanction and
regulate that process, affected terms of employment subject
to compulsory bargaining, and directly concerned only parties
to the collective bargaining relationship. Brown, 518 at U.S.
at 250. Neither the expiration of a collective bargaining
agreement nor the reaching of an impasse serves to terminate
the bargaining relationship. Thus lawful unilateral actions
taken by the multiemployer group were held immune from
antitrust scrutiny. In the course of its opinion, the Court
reviewed the development of the implicit labor exemption,
noting that it finds its support in both the history of and
logic of the federal labor laws:
``The immunity before us rests upon what this Court has
called the `nonstatutory' labor exemption from the antitrust
laws. . . . The Court has implied this exemption from federal
labor statutes, which set forth a national labor policy
favoring free and private collective bargaining, see 29
U.S.C. Sec. 151; Teamsters v. Oliver, 358 U.S. 283, 295
(1959); which require good-faith bargaining over wages,
hours, and working conditions, see 29 U.S.C.
Sec. Sec. 158(a)(5), 158(d); NLRB v. Wooster Div. of Borg-
Warner Corp., 356 U.S. 342, 348-349 (1958); and which
delegate related rulemaking and interpretive authority to the
National Labor Relations Board (Board), see 29 U.S.C.
Sec. 153; San Diego Building Trades Council v. Garmon, 359
U.S. 236, 242-245 (1959).
``This implicit exemption reflects both history and logic.
As a matter of history, Congress intended the labor statutes
(from which the Court has implied the exemption) in part to
adopt the views of dissenting Justices in Duplex Printing
Press Co. v. Deering, 254 U.S. 443 (1921), which Justices had
urged the Court to interpret broadly a different explicit
`statutory' labor exemption that Congress earlier (in 1914)
had written directly into the antitrust laws. Id., at 483-488
(Brandeis, J., joined by Holmes and Clarke, JJ., dissenting)
(interpreting Sec. 20 of the Clayton Act, 38 Stat. 738, 29
U.S.C. Sec. 52); see also United States v. Hucheson, 312 U.S.
219, 230-236 (1941) (discussing congressional reaction to
Duplex). In the 1930's, when it subsequently enacted the
labor statutes Congress, as in 1914, hoped to prevent
judicial use of antitrust law to resolve labor disputes--a
kind of dispute normally inappropriate for antitrust law
resolution. See Jewel Tea, supra, at 700-709 (opinion of
Goldberg, J.); Marine Cooks v. Panama S. S. Co., 362 U.S.
365, 370, n. 7(1960); A. Cox, Law and the National Labor
Policy 3-8 (1960); cf. Duplex, supra, at 485 (Brandeis, J.,
dissenting) (explicit `statutory' labor exemption reflected
view that `Congress, not the judges, was the body which
should declare what public, policy in regard to the
industrial struggle demands'). The implicit (`nonstatutory')
exemption interprets the labor statutes in accordance with
this intent namely, as limiting an antitrust court's
authority to determine, in the area of industrial conflict,
what is or is not a `reasonable' practice. It thereby
substitutes legislative and administrative labor-related
determinations for judicial antitrust-related determinations
as to the appropriate legal limits of industrial conflict.
See Jewel Tea, supra, at 709-710.
``As a matter of logic, it would be difficult, if not
impossible, to require groups of employers and employees to
bargain together, but at the same time to forbid them to make
among themselves or with each other any of the competition-
restricting agreements potentially necessary to make the
process work or its results mutually acceptable. Thus, the
implicit exemption recognizes that, to give effect to federal
labor laws and policies and to allow meaningful collective
bargaining to take place, some restraints on competition
imposed through the bargaining process must be shielded from
antitrust sanctions. See Connell, supra, at 622 (federal
labor law's `goals' could `never' be achieved if ordinary
anti-competitive effects of collective bargaining were held
to violate the antitrust laws); Jewel Tea, supra, at 711
(national labor law scheme would be `virtually destroyed' by
the routine imposition of antitrust penalties upon parties
engaged in collective bargaining); Pennington, supra, at 665
(implicit exemption necessary to harmonize Sherman Act
with `national policy . . . of promoting `the peaceful
settlement of industrial disputes by subjecting labor-
management controversies to the mediatory influence of
negotiation) (quoting Fibreboard Paper Products Corp. v.
NLRB, 379 U.S. 203, 211 (1964).''
[[Page H5635]]
518 U.S. at 235-37 (emphasis in original).
Your committee's most recent opportunity to address the
implications of the nonstatutory exemption was in the context
of the 1994 Major League Baseball labor-management dispute
which resulted in the cancellation of part of that years
regular season as well as the World Series. The Committee's
Subcommittee on Labor-Management Relations had before it for
consideration H.R. 5095, the Major League Play Ball Act of
1995, which would have required mandatory binding arbitration
of the baseball strike if the strike was not resolved by the
players and owners by February 1, 1995; and H.R. 4994, which
would have partially created antitrust law exemption for
major league baseball. The crucial issue before the
Subcommittee was whether baseball's unique antitrust
exemption was the cause of the sport's seemingly endemic
labor unrest, and whether repeal of the exemption would be
proper resolution. Uncontradicted testimony elicited at the
hearing made it clear that even if baseball's judicial
exemption were eliminated, the nonstatutory labor exemption
would remain.
analysis and conclusion
The Committee on Education and the Workforce (and its
predecessor) has been vested by the House with plenary
legislative and oversight jurisdiction over matters relating
to ``labor generally'' as well as the ``mediation and
arbitration of labor disputes,'' and over the years has
engaged in legislative and oversight actions encompassing the
fullest range of activities directly or indirectly within the
broad purview of that assigned subject matter. H.R. 1304
attempts to deal with emerging difficulties of the key actors
in the health care industry.-- health care professionals,
health plans, and health insurance issuers--to reconcile
their divergent interests and concerns with respect to
HMO's. Court decisions have raised antitrust issues with
respect to certain resolutions. Also, a recent unit
determination decision by a regional office of the NLRB
found that a group of doctors seeking to be certified by
the Board as the exclusive bargaining representative at an
HMO were independent contractors and therefore not
employees eligible to be covered by the NLRA.
H.R. 1304 proposes to overcome these legal difficulties by
legally deeming health care professionals who wish to bargain
with HMO's or insurance companies as employees in collective
bargaining units under the NLRA, and then cloaking the
products of negotiations with the equivalent of the
nonstatutory labor exemption to the antitrust laws. Perhaps
because on the face of the bill it appears to be primarily
concerned with traditional antitrust law issues--Section 3
(d)(1) defines the term ``antitrust laws'' as referencing
provisions in the Clayton Act and the Federal Trade
Commission Act--it was referred to the Judiciary Committee.
But in fact the principal thrust of the bill is to import a
judicial construct--the implied labor antitrust exemption--
that is well understood as applicable exclusively in the
context of labor law. As indicated in the discussion of the
Supreme Court decisions in this area, the implied exemption
emanates from the national labor laws alone and when
applicable displaces the antitrust laws. Also key in H.R.
1304 is the notion that health care professionals should
bargain collectively with HMO's and insurers, again a concept
rooted firmly in labor relations. Thus the two essential
concepts of the proposal are labor relations--related. They
may be also be seen as ``incomplete.'' For example, though
collective bargaining appears contemplated, there is no
definition or requirement of a ``duty to bargain,'' no
mechanism to resolve disputes that might arise during the
bargaining process, not any enforcement mechanism to ensure
good faith bargaining, which presumably is the ultimate goal
of the execise.
This is not say that any such provisions are necessary. But
given the strong labor orientation of the bill, the
Committee's labor expertise and perspective could be brought
to bear on the issues. As has been catalogued above, the
Committee in the past has dealt with legislative proposals
and engaged in oversight of activities comparable to the
subject matter and concerns raised by H.R. 1304. The 1974
private non-proprietary health care institutions amendments
to the NLRA and 1994 hearings on legislation dealing with the
antitrust implications of the baseball strike are among the
prominent and analogous examples which evidence the
Committee's past concerns in this area.
Mr. TIAHRT. Mr. Chairman, I arise today in opposition to H.R. 1304,
the Quality Health Care Coalition Act. This may surprise some as I
became a cosponsor of this bill last summer. I strongly believe that we
need to improve the quality of and access to our nation's health care
system and support measures to do so. I originally felt that exempting
negotiations between groups of health care professionals and health
from antitrust laws would be an important step towards fostering
continued patient safety and quality of care. Upon further reflection,
however, I have changed my opinion. Despite its name, I believe that
this bill has nothing to do with health care quality and will only
impede efforts to improve access and quality.
This legislation will be a major burden to employers and employees--
the exact people we should be trying to help. A CBO study shows that
the increased costs to health insurance companies as a result of
physician collective bargaining will surely be passed on to employers
who provide health care coverage to their employees. This will either
result in less employers providing coverage or less overall wages and
benefits for employees. Neither of these is an acceptable outcome. The
costs will not go towards patient care but towards sustaining doctor
unionization and salary hikes. This bill also allows for physician
boycotts of health plans, an outcome that could have a devastating
effect on insurance plans in rural areas that already struggle to
survive. I do not see how these effects will improve the quality of our
health care.
Additionally, I am disturbed by CBO's finding that if enacted H.R.
1304 will costs the taxpayers $3.6 billion dollars in lost revenue over
the next ten years. We all know where these lost revenues will be made
up--through Social Security and Medicare. We have made a pledge to
protect the Social Security surplus and shore up Medicare, a pledge we
must honor. We cannot support the so-called doctor cartels at the
expense of our senior citizens.
I have carefully considered this bill over the last two months. Since
April, as this bill approached the floor, I have not received any
support for H.R. 1304 from physicians in my district. Without their
urging and upon realizing the devastating effect H.R. 1304 could have
on our health care system, I decided to vote against the Quality Health
Care Coalition Act.
I consider my vote today a vote for increased access to health care
and to move affordable health care for everyone. We all owe a debt of
gratitude to the lengths physicians must go to be ready to serve our
health care needs. I honor their dedication and am proud that the very
highest quality health care in the world is within our borders. While I
want and encourage our best and brightest to become doctors, I do not
think this bill will be helpful in the long run. Therefore, I urge my
colleagues, even those who at first blush might have been favorably
disposed to this, to vote against H.R. 1304.
Mr. CROWLEY. Mr. Chairman, today, most American families receive
their health coverage from managed care providers. In recent years,
physician and patients have lost control over this market due to the
rapid consolidation of managed care organizations.
I am a proud co-sponsor of the Quality Health-Care Coalition Act,
which would allow health care professionals to collectively bargain the
terms of patient car with Health Care Organizations. Currently,
physicians are forced to accept contracts, which often contain
provisions that threaten the quality of patient care. In addition, many
health plans impose gag rules on physicians that force them to accept
arbitrary reimbursement rates with no thought to the quality of care
being provided to the patient. These days, dominant health plans are
not just managing costs, they are also determining the level, type,
frequency and hoops patients most jump through in order to receive
their health care.
Being married to a nurse has helped me recognize the issues many
health care professionals encounter each day. H.R. 1304 would help
physicians and other health care professionals fight for better patient
care by beginning to level the playing field between enormous,
controlling managed care plans and individual physicians and other
health care professionals. H.R. 1304 would provide physicians enough
leverage to effectively negotiate the terms of patient care with
Managed Care Organizations. In essence, this bill would restore a
physician's ability to provide quality care to patients without any
interference from an HMO. Additionally, H.R. 1304 would promote the
fairness and balance the health care marketplace needs and lacks today.
Those who oppose this legislation argue that patients would not be
protected under this bill. However, that is a false satement. H.R. 1304
guarantees the protection of patients by requiring the U.S. General
Accounting Office to study the impact of this bill over a three-year
trial period before Congress would be allowed to reauthorize the bill.
The Quality Health Care Coalition Act is an important piece of
legislation that would ensure the provisions of optimal health care to
all patients in New York City and the rest of the country. I urge you
to support this bill because all patients and their health care
providers should have the right to make informed decision about their
health care needs--without being subjected to the rules of an HMO.
Mr. PALLONE. Mr. Chairman, I rise in support of the Quality Health
Care Coalition Act. It is a good piece of legislation and I urge all of
my colleagues to join me in supporting it.
As you know, Mr. Chairman, current anti-trust law prohibits health
care professionals, including doctors, dentists, pharmacists, and
nurses from banding together to negotiate with managed care
organizations. Although this prohibition alone has stacked the deck
against health care professionals seeking to protect both themselves
and their patients from managed care abuse, consolidations in the
health insurance industry have exacerbated this imbalance even further
over the last several years.
[[Page H5636]]
To complement the enhanced negotiating power they have accrued
through mergers and acquisitions, managed care organizations also use
exclusionary contracting practices to bully health care professionals
into accepting terms they surely would not accept if they were able to
negotiate on a level playing field. These trends have enabled insurers
to employ a ``take it or leave it'' approach when negotiating with
health care professionals. As a result, the doctor-patient relationship
has been compromised and the quality of care for all patients has
suffered.
I have heard many first hand accounts of these abusive practices from
the New Jersey Medical Society, the New Jersey Pharmacists Association,
and countless other physicians with whom I have met over the last
several years. We must put an end to them.
The Quality Health Care Coalition Act would correct this problem by
giving health professionals the tools they need to band together when
negotiating with managed care organizations. This enhanced negotiating
power will level the playing field and allow health professionals to
stand up for what's right and make medical judgments based on patients'
medical needs rather than the managed care industry's financial
motivations.
Vote ``yes'' on final passage.
Mr. PAUL. Mr. Chairman, I am pleased to take this opportunity to lend
my support to H.R. 1304, the Quality Health Care Coalition Act, which
takes a first step towards restoring a true free-market in health care
by restoring the rights of freedom of contract and association to
health care professionals. Over the past few years, we have had much
debate in Congress about the difficulties medical professionals and
patients are having with Health Maintenance Organizations (HMOs). HMOs
are devices used by insurance industries to ration health care. While
it is politically popular for members of Congress to bash the HMOs and
the insurance industry, the growth of the HMOs are rooted in past
government interventions in the health care market though the tax code,
the Employment Retirement Security Act (ERSIA), and the federal anti-
trust laws. These interventions took control of the health care dollar
away from individual patients and providers, thus making it inevitable
that something like the HMOs would emerge as a means to control costs.
Many of my well-meaning colleagues would deal with the problems
created by the HMOs by expanding the federal government's control over
the health care market. These interventions will inevitably drive up
the cost of health care and further erode the ability of patents and
providers to determine the best health treatments free of government
and third-party interference. In contrast, the Quality Health Care
Coalition Act addresses the problems associated with HMOs by restoring
medical professionals' freedom to form voluntary organizations for the
purpose of negotiating contracts with an HMO or an insurance company.
As an OB-GYN with over 30 years in practice, I am well aware of how
young physicians coming out of medical school feel compelled to sign
contracts with HMOs that may contain clauses that compromise their
professional integrity. For example, many physicians are contractually
forbidden from discussing all available treatment options with their
patients because the HMO gatekeeper has deemed certain treatment
options too expensive. In my own practice, I have tried hard not to
sign contracts with any health insurance company that infringed on my
ability to practice medicine in the best interests of my patients and I
have always counseled my professional colleagues to do the same.
Unfortunately, because of the dominance of the HMO in today's health
care market, many health care professionals cannot sustain a medical
practice unless they agree to conform their practice to the dictates of
some HMO.
One way health care professionals could counter the power of the HMOs
would be to form a voluntary association for the purpose of negotiating
with an HMO or an insurance company. However, health care professionals
who attempt to form such a group run the risk of persecution under
federal anti-trust laws. This not only reduces the ability of health
care professionals to negotiate with HMOs on a level playing field, it,
like existing antitrust laws, are an unconstitutional violation of
medical professionals' freedom of contract and association.
Under the United States Constitution, the federal government has
no authority to interfere with the private contracts of American
citizens. Furthermore, the prohibitions on contracting contained in the
Sherman antitrust laws are based on a flawed economic theory: that
federal regulators can improve upon market outcomes by restricting the
rights of certain market participants deemed too powerful by the
government. In fact, anti-trust laws harm consumers by preventing the
operation of the free-market, causing prices to rise, quality to
suffer, and, as is certainly the case with the relationship between the
HMOs and medical professionals, favoring certain industries over
others. In fact, Mr. Speaker, I would hope that my colleagues would see
the folly of antitrust laws and support my Market Process Restoration
Act (H.R. 1789), which repeals all federal antitrust laws.
By restoring the freedom of medical professionals to voluntarily come
together to negotiate as a group with HMOs and insurance companies,
this bill removes a government-imposed barrier to a true free market in
health care. I am quite pleased that this bill does not infringe on the
rights of health care professionals by forcing them to join a
bargaining organization against their will. Contrary to the claims of
some of its opponents, H.R. 1304 in no way extends the scourge of
federally-mandated compulsory unionism to the health care professions.
While Congress should protect the right of all Americans to join
organizations for the purpose of bargaining collectively, Congress also
has a moral responsibility to ensure that no worker is forced by law to
join or financially support such an organization.
Mr. Chairman, it is my hope that Congress will follow up on its
action today by empowering patients to control their health care by
providing all Americans with access to Medical Saving Accounts (MSAs)
and large tax credits for their health care expenses. Putting
individuals back in charge of their own health care decisions will
enable patients to work with providers to ensure they receive the best
possible health care at the lowest possible price. If providers and
patients have the ability to form the contractual arrangements that
they found most beneficial to them, the HMO monster would wither on the
vine without the imposition of new federal regulations on the insurance
industry.
In conclusion, Mr. Chairman, I urge my colleagues to support the
Quality Health Care Coalition Act and restore the freedom of contract
and association to American's health care professionals. Antitrust laws
are no more legitimate or constitutional in the health care market than
they are on the software market. Therefore, I hope my colleagues will
not just pass this bill but will also support my Market Process
Restoration Act and exempt all Americans from antitrust laws. I also
urge my colleagues to join me in working to promote a true free-market
in health care by putting patients back in charge of the health care
dollar through means such as Medical Savings Accounts (MSAs) and
individual health care tax credits.
The CHAIRMAN. All time for general debate has expired.
Pursuant to the rule, the committee amendment in the nature of a
substitute printed in the bill shall be considered as the original bill
for the purpose of amendment under the 5-minute rule and shall be
considered read.
The text of the committee amendment in the nature of a substitute is
as follows:
H.R. 1304
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Quality Health-Care
Coalition Act of 2000''.
SEC. 2. APPLICATION OF THE ANTITRUST LAWS TO HEALTH CARE
PROFESSIONALS NEGOTIATING WITH HEALTH PLANS.
(a) In General.--Any health care professionals who are
engaged in negotiations with a health plan regarding the
terms of any contract under which the professionals provide
health care items or services for which benefits are provided
under such plan shall, in connection with such negotiations,
be entitled to the same treatment under the antitrust laws as
the treatment to which bargaining units which are recognized
under the National Labor Relations Act are entitled in
connection with such collective bargaining. Such a
professional shall, only in connection with such
negotiations, be treated as an employee engaged in concerted
activities and shall not be regarded as having the status of
an employer, independent contractor, managerial employee, or
supervisor.
(b) Protection for Good Faith Actions.--Actions taken in
good faith reliance on subsection (a) shall not be the
subject under the antitrust laws of criminal sanctions nor of
any civil damages, fees, or penalties beyond actual damages
incurred.
(c) Limitation.--
(1) No new right for collective cessation of service.--The
exemption provided in subsection (a) shall not confer any new
right to participate in any collective cessation of service
to patients not already permitted by existing law.
(2) No change in national labor relations act.-- This
section applies only to health care professionals excluded
from the National Labor Relations Act. Nothing in this
section shall be construed as changing or amending any
provision of the National Labor Relations Act, or as
affecting the status of any group of persons under that Act.
(d) 3-Year Sunset.--The exemption provided in subsection
(a) shall only apply to conduct occurring during the 3-year
period beginning on the date of the enactment of this Act and
shall continue to apply for 1 year after the end of such
period to contracts entered into before the end of such
period.
(e) Limitation on Exemption.--Nothing in this section shall
exempt from the application of the antitrust laws any
agreement or otherwise
[[Page H5637]]
unlawful conspiracy that excludes, limits the participation
or reimbursement of, or otherwise limits the scope of
services to be provided by any health care professional or
group of health care professionals with respect to the
performance of services that are within their scope of
practice as defined or permitted by relevant law or
regulation.
(f) No Effect on Title VI of Civil Rights Act of 1964.--
Nothing in this section shall be construed to affect the
application of title VI of the Civil Rights Act of 1964.
(g) No Application to Federal Programs.--Nothing in this
section shall apply to negotiations between health care
professionals and health plans pertaining to benefits
provided under any of the following:
(1) The medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(2) The medicaid program under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.).
(3) The SCHIP program under title XXI of the Social
Security Act (42 U.S.C. 1397aa et seq.).
(4) Chapter 55 of title 10, United States Code (relating to
medical and dental care for members of the uniformed
services).
(5) Chapter 17 of title 38, United States Code (relating to
Veterans' medical care).
(6) Chapter 89 of title 5, United States Code (relating to
the Federal employees' health benefits program).
(7) The Indian Health Care Improvement Act (25 U.S.C. 1601
et seq.).
(h) General Accounting Office Study and Report.--The
Comptroller General of the United States shall conduct a
study on the impact of enactment of this section during the
6-month period beginning with the third year of the 3-year
period described in subsection (d). Not later than the end of
such 6-month period the Comptroller General shall submit to
Congress a report on such study and shall include in the
report such recommendations on the extension of this section
(and changes that should be made in making such extension) as
the Comptroller General deems appropriate.
(i) Definitions.--For purposes of this section:
(1) Antitrust laws.--The term ``antitrust laws''--
(A) has the meaning given it in subsection (a) of the first
section of the Clayton Act (15 U.S.C. 12(a)), except that
such term includes section 5 of the Federal Trade Commission
Act (15 U.S.C. 45) to the extent such section 5 applies to
unfair methods of competition, and
(B) includes any State law similar to the laws referred to
in subparagraph (A).
(2) Health plan and related terms.--
(A) In general.--The term ``health plan'' means a group
health plan or a health insurance issuer that is offering
health insurance coverage.
(B) Health insurance coverage; health insurance issuer.--
The terms ``health insurance coverage'' and ``health
insurance issuer'' have the meanings given such terms under
paragraphs (1) and (2), respectively, of section 733(b) of
the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1191b(b)).
(C) Group health plan.--The term ``group health plan'' has
the meaning given that term in section 733(a)(1) of the
Employee Retirement Income Security Act of 1974 (29 U.S.C.
1191b(a)(1)).
(3) Health care professional.--The term ``health care
professional'' means an individual who provides health care
items or services, treatment, assistance with activities of
daily living, or medications to patients and who, to the
extent required by State or Federal law, possesses
specialized training that confers expertise in the provision
of such items or services, treatment, assistance, or
medications.
The CHAIRMAN. No amendment to that amendment is in order except those
printed in House Report 106-709. Each amendment may be offered only in
the order printed in the report, by a Member designated in the report,
shall be considered read, shall be debatable for the time specified in
the order of the House, 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.
The Chairman of the Committee of the Whole may postpone a request for
a recorded vote on any amendment and may reduce to a minimum of 5
minutes the time for voting on any postponed question that immediately
follows another vote, provided that the time for voting on the first
question shall be a minimum of 15 minutes.
{time} 2330
The CHAIRMAN. It is now in order to consider amendment No. 1 printed
in the House Report 106-709.
Amendment No. 1 Offered by Mr. Ballenger
Mr. BALLENGER. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 1 offered by Mr. Ballenger:
Page 3, line 9, strike ``Any'' and insert ``Except as
provided in paragraph (3) of subsection (c), any''.
Page 4, after line 20 insert the following:
(3) Application.--The exemption provided in subsection (a)
shall not apply to the following:
(A) Any negotiations with a health plan regarding or
relating to fees, payments, or reimbursement, including the
methodology of such fees, payments, or reimbursement between
health care professionals and health plans.
(B) Any negotiations with a health plan to permit health
care professionals to balance bill patients.
(C) Any health care professional who has not submitted to
and received approval from the Secretary of Health and Human
Services for a plan that specifies policies and procedures to
identify and reduce the incidence of medical errors.
(D) Any health care professional who has not disclosed to
patients and prospective patients information regarding the
professional's participation in such negotiations.
(E) Any acts by health care professionals to engage in
boycotts.
The CHAIRMAN. Pursuant to the order of the House of today, the
gentleman from North Carolina (Mr. Ballenger) and a Member opposed each
will control 5 minutes.
The Chair recognizes the gentleman from North Carolina (Mr.
Ballenger).
Mr. BALLENGER. Mr. Chairman, I yield myself 1\1/2\ minutes.
Mr. Chairman, I still do not understand why this bill is not under
the Fair Labor Standards Act. We all know that there has been a great
expansion of HMOs. Large insurance companies seem to care more about
the bottom line than the patients that they are supposed to serve.
These issues should be addressed. However, allowing doctors to
unionize without a governing body or any enforcement mechanism is not
the way to solve this problem.
This bill would create many opportunities for patients to be harmed
by boycotts and other union tactics but would do nothing for patients.
This means that, as presently written, there is absolutely nothing in
this bill for patients.
Simply put, my amendment would guarantee that doctors are using their
exempt status for quality care for their patients, not negotiating
higher fees, which would lead to higher fees and raise health care
costs, which would increase the present uninsured group in this country
from 40 million to 50 million people in a very short period of time
Mr. Chairman, I reserve the balance of my time.
Mr. CONYERS. Mr. Chairman, I rise in opposition to the amendment.
Mr. Chairman, the amendment of the gentleman simply very effectively
prevents negotiations over the quality of healthcare, which is what we
are all about here tonight.
Among other things, it would prohibit negotiations between doctors
and health plans regarding fees, payments, or reimbursement.
Why? It is not always possible to separate costs from quality. And
so, by forcing physicians to refrain from negotiating fees, payments,
and reimbursements, this amendment cleverly forces physicians to
provide less quality health care and, thus, potentially harms patients.
The result is more health plan profits and more unfair tactics.
Mr. Chairman, I hope the amendment will be rejected.
Mr. Chairman, I reserve the balance of my time.
Mr. BALLENGER. Mr. Chairman, I yield such time as he may consume to
the gentleman from California (Mr. Thomas).
(Mr. THOMAS asked and was given permission to revise and extend his
remarks.)
Mr. THOMAS. Mr. Chairman, I tell my friend the gentleman from
Michigan (Mr. Conyers) this amendment is not very clever at all. It is
very straightforward.
The gentleman from New York was very concerned about the precise
language used over here, and maybe he did not hear himself talk,
because he used the term ``collective bargaining.'' He said doctors
need collective bargaining.
Now, if this was about moving doctors under the National Labor
Relations Act, where they would get collective bargaining, where there
are rights associated with responsibilities, we would not have this
problem.
That is not the case. What we have got are giving people the rights
without the responsibilities.
Federal Trade Commission Chairman Robert Pitofsky has said, ``In
every case we have brought, it is really related to doctors' income and
not to patients' welfare.''
I think my colleagues can call this amendment ``trust but verify.''
If, in
[[Page H5638]]
fact, the doctors are really needing this suspension of antitrust to
help patients, then this amendment is exactly what it will do. Trust
but verify.
One: Do not negotiate regarding fees. Do not tell us that is about
patients and care. It is about money.
Two: Do not cost shift. Do not cut a deal in which the patient has to
bear the extra cost in balanced billing.
Three: Hey, we got a 100,000 deaths every year. How about getting
some medical error structure in place before they turn them loose in
terms of the ``collective bargaining.''
Let us have some truth in packaging.
And finally, this amendment says that any acts by health care
professionals engaging in boycotts is not allowed.
We have all read The New York Times story about a doctor bragging
about withholding medicines because the company that made the medicines
was not supporting the legislation. That is about patients' care?
Very simple. Let us help doctors help patients, but we should not let
doctors help doctors without this amendment to trust but verify. That
is what this is all about.
We have heard slips of the tongue over here about collective
bargaining, doctors should have the right to bargain collectively. It
is under the guise of patients' rights.
If they want doctors to bargain collectively, put them under the
National Labor Relations Act. That gives them rights and it gives them
responsibilities. This legislation does not do that.
If they believe that they get a right and they have a responsibility
to go with it, then the Ballenger amendment is the trust but verify.
Let them have the right, but make sure they do not abuse it, not for
fees, not for patient-balanced billing, not for boycotting.
If my colleagues want it for patients, everyone should vote for the
Ballenger amendment.
Mr. CONYERS. Mr. Chairman, I yield myself 1 minute.
It is so instructive that the previous speaker is from California and
is talking about preventing negotiations over the quality of health
care.
In California, pediatricians receive as little as $10 per month for
each patient, while the average monthly cost to care for a child in the
State is $24.
Now, how can a physician provide quality care for a child when he or
she cannot afford to keep their practice open and then we would add
this debilitating amendment?
Mr. Chairman, I yield 2 minutes to the gentleman from California (Mr.
Campbell).
Mr. CAMPBELL. Mr. Chairman, I thank the gentleman for yielding me the
time.
Mr. Chairman, let us be very clear. This is not a unionization bill.
My friend and colleague the gentleman from California (Mr. Thomas)
misperceives the bill.
First of all, the bill itself has explicitly in it section 2(e), a
prohibition on boycott.
Secondly, the question about putting them under the NLRA and an NLRB
is appropriate only if we were creating exclusive bargaining units.
That is to say that the doctors would have no one else to represent
them.
We are not doing that. We are simply removing the effect of a Supreme
Court opinion, which, 84 years after the passage of the Sherman Act, in
my judgment, erroneously applied antitrust to what is a profession. And
so, we do not need the National Labor Relations Act because we are not
creating exclusive bargaining units.
Furthermore, the National Labor Relations Board does not investigate
the content of contracts. It never does. It exists merely to create the
fair election process to determine the sole exclusive bargaining agent.
Since we do not have an exclusive bargaining agent, there is no need
for the labor model.
My friend the gentleman from California (Mr. Thomas) misapprehends
the purpose and effect and indeed the very words of the statute that we
are proposing tonight.
As to the fundamental amendment by my friend the gentleman from North
Carolina (Mr. Ballenger) I simply put this, and it is as simple as can
be said I think: If they want better quality of medicine, it might be
that they have to pay for it.
Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentleman from
Iowa (Mr. Ganske).
Mr. GANSKE. Mr. Chairman, I thank the gentleman for yielding me the
time.
Mr. Chairman, I think it is very important for my Republican
colleagues to understand that the Campbell-Conyers bill is not a bill
that will make physicians join unions. It is just the opposite.
Under current law, the only way that they can negotiate a contract is
if they are salaried and then they can join a union.
Under the Campbell-Conyers bill, individual practitioners can get
together, negotiate on behalf of their patients without being salaried,
without being in a union.
{time} 2340
This is a fundamental point to this bill that my Republican
colleagues need to understand. If they are worried about physicians,
ultimately all of them becoming members of a union, then vote against
this bill because that is ultimately what will happen if we do not
establish some level of competition.
The CHAIRMAN. The gentleman from Michigan (Mr. Conyers) has the right
to close.
Mr. CAMPBELL. Mr. Chairman, could the Chair inform me, unless I am
mistaken, I have not used any of my time. The gentleman from Michigan
(Mr. Conyers) yielded to me.
The CHAIRMAN. The time is controlled by the gentleman from Michigan
(Mr. Conyers).
Mr. CAMPBELL. Mr. Chairman, I apologize. I misunderstood. Then I
would ask my colleague, the gentleman from Michigan (Mr. Conyers), to
yield me 30 seconds.
The CHAIRMAN. The gentleman from Michigan (Mr. Conyers) has the right
to close and the gentleman from Michigan (Mr. Conyers) has 30 seconds
remaining. The gentleman from North Carolina (Mr. Ballenger) has 1
minute remaining.
Mr. BALLENGER. Mr. Chairman, I yield 1 minute to the gentleman from
California (Mr. Thomas).
Mr. THOMAS. Mr. Chairman, let us listen to what people say who have
to enforce the law. Federal Trade Commission Chairman Robert Pitofsky
again says, the stated goal of this bill is to promote quality of
patient care. The labor exemption, however, was not created to solve
issues regarding the ultimate quality of products or services consumers
receive. Collective bargaining rights are designed to raise the incomes
and improve working conditions of union members. We do not rely on the
United Auto Workers to bargain for safer cars. Joe Klein, assistant
Attorney General of the Justice Department's Antitrust Division, says
this about 1304: The AMA could pull every single doctor together or its
local doctors and go to each and every HMO or managed care program and
say we will not work for you unless you pay us X. That is
unprecedented, irrational economic power.
That is all the doctors are asking for.
Mr. BALLENGER. Mr. Chairman, I yield back the balance of my time.
Mr. CONYERS. Mr. Chairman, I yield myself the remainder of my time.
Mr. Chairman, this amendment effectively prevents negotiations over
the quality of health care. It would prohibit negotiations regarding
fees, payments or reimbursements, and therefore undercuts the whole
bill. We do not want a bill or an amendment that forces physicians to
provide, quote, ``the least costly,'' unquote, care, or a bill that
denies payments to health professionals for care already provided.
Mr. Chairman, I am strongly opposed to this amendment, which would
require pre-approval from the FTC or the Department of Justice to
health care groups which comprise 20 percent or more of a given
specialty area for a particular market area before they can engage in
collective negotiations. This amendment would gut the bill and decimate
the beneficial aspects of the legislation.
We have never required a labor union to obtain antitrust pre-approval
to have the right to collectively bargain, and there is no reason to
require it in the context of health care negotiations. As a matter of
fact, such a requirement would be in many respects even more onerous
than current law for health care professionals. Unlike Hart-Scott-
Rodino, the bill has no time frames or deadlines, so the approval
process could go on indefinitely. Delays would be compounded by the
provisions allowing for public comment on each application. The
amendment could also necessitate large filing fees, which would in
essence serve as a tax on health care.
[[Page H5639]]
The limitation raises several very serious concerns.
First, there is no guidance as to the meaning of what a particular
specialty or subspecialty is or how the market is to be determined. Is
gynecology different than fertility? Are these the same field or two
separate fields? And how would the bill apply if two separate subgroups
of health care providers sought to form a collective bargaining group?
Would you add up the numbers for each specialty or would this create a
whole new field?
Second, under the amendment, it is up to the group of health care
providers to determine if the 20 percent threshold applies. How is the
group supposed to have any idea what the relevant market is or what
their market share is? Only the government is in a position to make
these types of complex market share determinations. By placing the
burden on the group of health care providers, this amendment will force
every collective bargaining unit to file with the government,
subjecting them all to long and expensive delays.
Third, even if these issues could be worked out--and that could take
years of litigation--the bill's percentage limitation cannot be
justified. Why is 20 percent the threshold? Supreme Court legal
precedent says that a company or group of companies does not have
market power unless they have 70 percent or more of the market.
Determining market power is very much facts and circumstances based,
which is why the antitrust laws have intentionally avoided arbitrary
cutoffs. This bill creates an artificially low threshold, and threatens
to undercut more than a century of settled antitrust law.
I would remind the proponents of this amendment that the bill
provides for a three year sunset with a report by the GAO. In my
opinion this negates the need for any further oversight amendment
because it would be foolish for health care professionals to engage in
anti-consumer conduct given that it could cause them to lose their
rights under this legislation.
I urge the Members to oppose this dangerous amendment.
The CHAIRMAN. The question is on the amendment offered by the
gentleman from North Carolina (Mr. Ballenger).
The question was taken; and the Chairman announced that the noes
appeared to have it.
Mr. THOMAS. Mr. Chairman, I demand a recorded vote, and pending that,
I make the point of order that a quorum is not present.
The CHAIRMAN. Pursuant to House Resolution 542, further proceedings
on the amendment offered by the gentleman from North Carolina (Mr.
Ballenger) will be postponed.
It is now in order to consider amendment No. 2 printed in House
Report 106-709.
Amendment No. 2 Offered by Mr. Stearns
Mr. STEARNS. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 2 offered by Mr. Stearns:
Page 3, line 17, insert before the period the following:
``, but only if such health care professionals have received
prior approval for such negotiations from the Federal Trade
Commission or the Assistant Attorney General pursuant to
subsection (i).''.
Page 6, after line 21, insert the following new subsection
(and redesignate the succeeding subsection accordingly):
(i) Prior Approval.--
(1) In general.--Health care professionals who seek to
engage in negotiations with a health plan as provided in
subsection (a) must obtain approval from the Commission or
the Assistant Attorney General prior to commencing such
negotiations. The Commission or the Assistant Attorney
General shall grant such approval if the Commission or
Assistant Attorney General has determined that recognition
under subsection (a) of the group of health care
professionals for the purpose of engaging in collective
negotiations with the health plan will promote competition
and enhance the quality of patient care. The approval that is
granted under this subsection may be limited in time or scope
to ensure that these criteria are met. The Commission and the
Assistant Attorney General shall make a determination
regarding a request for approval under this paragraph within
30 days after the date it is received, if the request
contains the information specified in regulations issued
under paragraph (2). Failure by the Commission or Assistant
Attorney General to make such determination within such 30-
day period will be deemed to be an approval of the request by
the Commission or the Assistant Attorney General.
(2) Regulations.--The Commission, in consultation with the
Assistant Attorney General, shall publish regulations
implementing this subsection within six months of the
effective date of this Act. Such regulations shall include
the following:
(A) A description of the information that must be submitted
by health care professionals who seek to obtain approval to
engage in collective negotiations.
(B) Provisions for the opportunity for the public to submit
comments to the Commission or the Assistant Attorney General
for consideration in reviewing any request for approval by
health care professionals to engage in collective
negotiations under this section.
(C) Provision for a filing fee in an amount reasonable and
necessary to cover the costs of the Commission and the
Assistant Attorney General to implement this subsection. On
an annual basis, this fee shall be updated to reflect any
increases or decreases determined to be necessary to cover
such costs.
(3) Coordination.--The Commission and the Assistant
Attorney General shall coordinate so that an application is
reviewed under this subsection by either the Commission or
the Assistant Attorney General, but not both.
(4) Exemption for small groups.--
(A) In general.--Notwithstanding any other provision of
this subsection (other than subparagraph (B)), no prior
approval is required under this subsection in the case of a
group of health care professionals who are acting
collectively with respect to a negotiation if such group
constitutes less than 20 percent of the health care
professionals in a specialty (or subspecialty) in the market
area involved, as determined under regulations of the
Commission.
(B) Oversight.--The Commission shall establish a process
under which, if it receives a bona fide request that alleges
that the negotiations of a group described in subparagraph
(A) has not promoted competition or has not enhanced the
quality of patient care, the Commission will review the
request and may take such action as the Commission determines
to be appropriate. Such action may include ordering that the
results of the negotiations be vitiated and that the
exemption under subparagraph (A) not apply to such group for
such period as the Commission may specify.
Page 8, after line 8, insert the following:
(4) Commission.--The term ``Commission'' means the Federal
Trade Commission.
(5) Assistant attorney general.--The term ``Assistant
Attorney General'' means the Assistant Attorney General in
charge of the Antitrust Division of the Department of
Justice.
Mr. CAMPBELL. Mr. Chairman, just a point of procedure, if I might.
How may I go about claiming the time in opposition?
The CHAIRMAN. The gentleman from California (Mr. Campbell) may claim
the time.
Mr. CAMPBELL. With the consent of my colleague, the gentleman from
Michigan (Mr. Conyers), I claim the time in opposition.
Mr. CONYERS. Mr. Chairman, I am pleased to give the control of the
time to the gentleman from California (Mr. Campbell).
Mr. CAMPBELL. I appreciate that, Mr. Chairman. How much time is that,
Mr. Chairman?
The CHAIRMAN. The time in opposition will be 5 minutes.
Pursuant to the order of the House of today, the gentleman from
Florida (Mr. Stearns) and a Member opposed each will control 5 minutes.
The Chair recognizes the gentleman from Florida (Mr. Stearns).
Mr. THOMAS. Mr. Chairman, is there a motion available to object to
the use of the chart on the floor?
The CHAIRMAN. The Chair recognizes the gentleman from Florida (Mr.
Stearns).
Mr. STEARNS. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, I thank my colleague, the gentleman from California
(Mr. Thomas), for allowing me to have the charts here on the House
floor.
Mr. Chairman, my amendment is pretty simple. It is basically asking
for oversight on the Conyers-Campbell, Campbell-Conyers amendment. When
we look across the landscape at different groups that have been
exempted, labor unions, of course, as mentioned earlier, go to the
National Labor Relations Board. If one developed a cooperative, a
farming cooperative, they would have to go to the Secretary of
Agriculture to certify that they did not have any monopoly practices
and that they were not restraining trade.
If one were an export association or a trading company or even a
fishing association, even a fishing association, they would have to go
to the Secretary of the Interior or to the Federal Trade Commission.
If one is an insurance company and they tried to meet different
people, insurance companies tried to meet, they would also have to be
governed by antitrust laws.
Newspapers, national defense contractors, throughout all of America,
everybody has some oversight, but not in the Campbell-Conyers bill.
[[Page H5640]]
Now, in Texas, Governor George Bush passed a bill which had similar
language to the Campbell-Conyers bill, but it had oversight. In fact,
when one looked at it, and many other States are adopting this
language, provided for the doctors to be able to get together and to
negotiate with HMOs; but it had oversight.
One had to go to the State attorney general to certify that their
plan and what they were doing were not antitrust, was not developing a
monopoly.
So basically my amendment, which is very simple, adds a few words. It
says that when they go to the HMOs and when they develop their
collective strategy, that it will be certified by the Federal Trade
Commission or the Justice Department. So it is very simple. It brings
in that trust but verify.
So I ask my colleagues to say if they support the Campbell amendment,
the Conyers amendment, why not have a little bit of trust but verify by
having this group of doctors, much like everybody else in America, have
some oversight; and they would have to go to the Federal Trade
Commission or to the Justice Department to get certified for what they
are doing?
Mr. Chairman, I reserve the balance of my time.
Mr. CAMPBELL. Mr. Chairman, I yield 3 minutes to the gentleman from
Georgia (Mr. Norwood).
Mr. NORWOOD. Mr. Chairman, I thank the gentleman from California (Mr.
Campbell) for yielding me this time.
Mr. Chairman, I rise to strongly oppose the Stearns amendment. I am
not going to spend much time talking about it. It simply guts the bill.
Do not vote for it.
I do want to go back and refer to the Ballenger amendment for just a
moment which basically says that, okay, we will let the docs actually
get together and have a discussion about this great big insurance
company that comes to town, is going to take over all their practices;
and we will actually let them get in a room and talk about it without
prosecuting them, except they cannot talk about fees.
Now, I assure everyone that is part of the discussion. After having
practiced dentistry for 25 years and fooled around a few years
experimenting with this managed care environment, I can say absolutely
that it is not possible to negotiate with HMOs without bringing up fees
and payments.
Some HMOs have contracts that require doctors to spend no more than
12 minutes with a patient. Other HMOs pay doctors bonuses to provide
the cheapest possible care, even when another treatment is more
appropriate. The list goes on, such as bonuses for using HMO facilities
and suppliers even when they are inferior.
Mr. Chairman, those who support this amendment, and I am talking
about the Ballenger amendment, are technically correct when they say
that doctors could negotiate over spending more time with patients,
providing appropriate treatments with patients, or which facility to
use without specifically bringing up cost issues. But if that is all
the doctor can question in this negotiation, we will see every HMO in
this country switch to one of their other options, which is straight
capitation.
I have actually tried to practice dentistry under these conditions,
in which one is assigned a flat fee per person. Some years ago I think
it was $3.00, not $10.00 as the gentleman from Michigan (Mr. Conyers)
said, but $3.00. The plan does not put any standards in the contract,
but the fee received is based on the same 12-minute per patient,
cheapest care possible and the use of HMO facilities only.
If one does not do all of these things, they just simply go broke.
Now, the playing field out there is tilted. The gentleman from Ohio
(Mr. Boehner) mentioned it. It is tilted. It is tilted way out of line.
We have turned health care in this country over to the insurance
industries. We have said, you run it, we cannot. The Federal Government
will be solid about it. The States have all of their laws preempted,
and by the way let us give the insurance companies an exemption from
antitrust.
{time} 2350
That is what we have going on out there. Health care is not better
off for it. Now, we need to, if we cannot get a patient's protections
bill, at least level the playing field, so these men and women who care
for your bodies every day can come together in a room and actually
discuss their life.
Mr. STEARNS. Mr. Chairman, how much time is remaining?
The CHAIRMAN. The gentleman from Florida (Mr. Stearns) has 2 minutes
and 45 seconds remaining.
Mr. STEARNS. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, the gentleman from Georgia (Mr. Norwood) just finished
a very eloquent, emotional speech. The point is that a lot of the
States are already enacting these protections for the physicians, and
we do not need the Federal Government to go ahead and do it. For
example, Texas passed, as I mentioned earlier, an antitrust bill that
exempted physicians but had oversight with the Attorney General there
in the State.
Why not let the States throughout this country do what we are trying
to do and let them be first? Negotiations in the States will proceed on
an orderly manner, and in those States where it is not required, it
will not go forward.
Mr. Chairman, I have these charts that I want to show here briefly.
The myth, the bill would grant doctors the same type of labor
protections afforded other workers. Other workers can obtain a labor
exemption only, only if they are employees, not independent
contractors. Two, physicians who are employees are already entitled to
the exemption under existing law, and, third, under H.R. 1304,
physicians' collective bargaining would not be subject to the NLRA or
any other NLRB oversight.
I ask my colleagues, do we want to have them have that carte blanche
ability? Myth, doctors cannot organize without the exemption. Antitrust
laws permit physicians to perform large group practices and IPAs now.
In many areas, these groups have considerable leverage over plans,
particularly when they are organized around specialities. Three,
doctors already can discuss qualities and other contractual terms with
each other and with health care plans.
My colleagues, let us have some oversight. They did it in the State
of Texas. This bill would supersede Texas and all other States that are
moving forward. So I ask you to vote for the Stearns amendment and let
us have trust, but verify.
Mr. Chairman, I reserve the balance of my time.
Mr. CAMPBELL. Mr. Chairman, I have no further speakers, except to
close.
Mr. STEARNS. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, let me tell my colleagues on tonight's vote, whether
you are a Democrat or a Republican, we know how controversial this is.
We know that a lot of the people that went on the Campbell bill decided
they wanted to get off but they could not get off, and they are hoping
tonight that somehow this amendment would not be brought to the floor
or possibly there would be some way that they would have to vote for
it.
My colleagues if we want a fair compromise to this bill and still
retain our loyalty to it, then vote for the Stearns bill, because it
allows you to have oversight of these doctors, without it, everything
we heard from the other speakers could occur.
It does not hurt to have some verification through the antitrust
measures that are in this amendment, much like even the Fishery
Association has, so I urge passage of the Stearns bill.
Mr. CAMPBELL. Mr. Chairman, I yield myself such time as I may
consume.
Mr. Chairman, of 228 cosponsors, three have asked to come off the
bill. We have 225. I do not know where my good friend, the gentleman
from Florida (Mr. Stearns), believes that people have been asking to
get off the bill. Let me say eight have joined since our bill was
postponed a month ago, eight new sponsors have joined.
The capitation rate can be so low in some instances that quality of
health care suffers, that is just a fact. When people say that they
would try to limit negotiations only to matters unrelated to fees, they
miss the fact.
If your capitation rate requires you as a general practitioner to see
10 patients per hour, then they are not providing quality care. The
gentleman
[[Page H5641]]
from Florida (Mr. Stearns) suggests that we get the Federal Trade
Commission to oversee.
Let me tell my colleagues what the Stearns amendment does. It gives
the FTC the power. The gentleman did not discuss it but at page 4 in
his amendment, and it is in my handout so those colleagues that come on
the floor will see it, the FTC is given the authority and, I quote, to
determine whether the terms are appropriate and then take such action
as they think as appropriate, including the results of the negotiations
be vitiated. I am not kidding. The FTC has plenary authority under the
Stearns amendment to vitiate the bill, and all of its amendments.
Furthermore, the FTC does not want this authority.
In testimony before the Committee on the Judiciary, the chairman of
the FTC said they did not have the manpower, personpower to handle
this. Furthermore, the Stearns amendment says that there is an
exemption if you are 20 percent or less of a market. How is the FTC to
determine if we have 20 percent or less of a market?
Mr. Chairman, I used to be in charge of the Bureau of Competition at
the FTC, and we were doing mergers in 45 days with compulsory process.
How do we determine whether anybody has 20 percent of a market within
30 days? That is why the chairman of the FTC testified that it could
not be done, not without a huge increase in his budget.
Lastly that the doctors have existing authority; only if they
integrate, that is just the point. Some doctors do not choose to be
business people. They never choose to become in an IPA or an IPO, they
chose to be professional doctors, we should let them be professional
doctors.
Mr. Chairman, I yield back the balance of my time.
The CHAIRMAN. The question is on the amendment offered by the
gentleman from Florida (Mr. Stearns).
The question was taken; and the Chairman announced that the noes
appeared to have it.
Mr. STEARNS. Mr. Chairman, I demand a recorded vote, and pending
that, I make the point of order that a quorum is not present.
The CHAIRMAN. Pursuant to House Resolution 542, further proceedings
on the amendment offered by the gentleman from Florida (Mr. Stearns)
will be postponed.
The point of no quorum is considered withdrawn.
It is now in order to consider Amendment No. 3 printed in House
Report 106-709.
Amendment No. 3 Offered by Mr. Cox
Mr. COX. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 3 offered by Mr. Cox:
Page 4, after line 20, insert the following new paragraph:
(3) Physicians' right to choose whether to join a labor
organization.--Nothing in this Act shall impair the right of
any health care professional to refrain from self-organizing,
from forming, joining or assisting a labor organization
(including an organization of other health care
professionals), from bargaining collectively, or from
engaging in concerted activities, and no agreement with a
health care plan may require membership by a health care
professional (who under existing law prior to the enactment
of this Act would not have been treated as an employee) in a
labor organization, including any organization of other
health care professionals, as a condition of employment.
The CHAIRMAN. Pursuant to the order of the House of today, the
gentleman from California (Mr. Cox) and a Member opposed each will
control 5 minutes.
The Chair recognizes the gentleman from California (Mr. Cox).
Mr. COX. Mr. Chairman, I yield myself such time as I may consume.
The physicians who support this bill do so for one reason, they wish
to negotiate with HMOs and other managed care organizations in order to
improve the quality of the patient care. They do not seek this
legislation in order to force other doctors into a labor union if those
doctors do not wish to join one. America's physicians deserve the
fundamental right to choose whether to join a union or not, whether to
belong to a union and whether to pay dues to it.
This amendment states clearly that even as they are gaining the right
to collectively bargain, America's doctors will also be protected in
their right to join a labor organization or to choose not to.
It is necessary, because this bill states that doctors will
henceforth be treated as, this is the language of the bill, quote,
bargaining units, which are recognized under the National Labor
Relations Act in connection with such collective bargaining, but the
National Labor Relations Act says that workers can be compelled to join
a union as a condition of employment.
This would happen if, for example, some doctors under this bill
collectively bargain with an HMO and negotiated a contract that
required membership in a union as a condition of working for that HMO.
Without this amendment, a physician could be shut out from
participating in a health care plan were such a collective bargain
agreement negotiated with an HMO. That physician could be shut out of
the health care plan simply because he or she chose not to join a
union, simply because, for example, a physician exercised her right to
choose not to become a member of a union.
Unfortunately, forced unionization is a very real and very unfair
fact of life under the National Labor Relations Act. This amendment
makes clear the original intent of the bill's author, to allow
physicians to collectively bargain and leave them free to choose
whether or not to join a union.
If this bill is enacted, doctors will collectively bargain with HMOs.
Doctors and HMOs will undoubtedly enter into collective bargain
agreements. Under the National Labor Relations Act, those collective
bargaining agreements could legally require that in order for a doctor
to work at the HMO he or she must join a union.
{time} 2400
This amendment will protect doctors from such compulsory unionism
that is nowhere forced on them today.
Mr. Chairman, I reserve the balance of my time.
Mr. CONYERS. Mr. Chairman, I rise in opposition, and I yield myself 1
minute.
Mr. Chairman, this may be one of the most incredible amendments of
the evening, because we are now talking about mandating a Federal
right-to-work law with respect to health care professionals. I say to
my colleagues, we have never considered that before in any particular
field, and the practical impact of the amendment would be to harm the
ability of health care professionals to collectively bargain and
protect patients' rights.
This is an amendment that would seek to turn pro-labor Members
against H.R. 1306.
Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Michigan
(Mr. Bonior), our distinguished whip.
Mr. BONIOR. Mr. Chairman, most of us live in communities where we pay
taxes for the cost of operating schools, for paving the streets, for
picking up the garbage, and we each pay our share, so do our neighbors.
Everyone does their part, everyone reaps benefits. But imagine for a
moment if it were different. Imagine if our neighbors could each decide
to opt out of paying their fair share. They would still get the
benefits, they just would not pay for them. Well, I think it would be
pretty obvious it would not take long for that system to fall apart
because we could not afford a system like that.
That is exactly the kind of system that the Cox amendment would force
on to the health professionals. It says you can organize, you can
bargain, but you have to provide the same services for the freeloaders,
those who do not want to pay, as you do to provide for those who pay
their fair share.
Mr. Chairman, no one here would ever argue that individuals have a
right not to pay their taxes if they do not want to, yet this amendment
tells health care professionals they would have the right not to pay
their fair share of the cost of collective bargaining.
So I say to my colleagues, this amendment may not stop professionals
from organizing, but make no mistake about it, this amendment will
prevent them from succeeding. It is, as the gentleman from Michigan
(Mr. Conyers) has stated, an amendment that would kill the bill from
the perspective of many people in this Chamber, and I hope Members will
vote no on it.
[[Page H5642]]
Mr. CONYERS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from New Jersey (Mr. Andrews).
(Mr. ANDREWS asked and was given permission to revise and extend his
remarks.)
Mr. ANDREWS. Mr. Chairman, I rise in opposition to the Cox amendment.
Those who are sympathetic and in support of the underlying purpose of
this bill will surely see their intention defeated if this amendment is
adopted. Because no rational-thinking physician would proceed to try to
organize and bargain collectively if this amendment became law, because
those leaders in the collective bargaining process would bear all the
risk, and there is considerable risk of going up against the managed
care companies, considerable risk of being ostracized, considerable
risk of being leveraged in the marketplace, considerable risk of
suffering professional and economic harm. Those who would be the first
to step forward would bear all the risk, and then those who sat and
waited to see how it turned out would yield all the benefit if they so
chose.
No one, Mr. Chairman, would embark on that kind of risky venture if
he or she was not assured that those who would benefit from the hard-
won bargain would have to pay to support the process of winning the
hard-won bargain.
So this is an amendment that if it became law would act as a
significant disincentive for anyone ever stepping forward and taking
advantage of the rights that are contemplated in the underlying bill.
If one is sympathetic to the principles of the underlying bill, one
should oppose this amendment.
Mr. COX. Mr. Chairman, I yield 1 minute to the distinguished
gentleman from Virginia (Mr. Goodlatte).
(Mr. GOODLATTE asked and was given permission to revise and extend
his remarks.)
Mr. GOODLATTE. Mr. Chairman, I thank the gentleman for yielding me
this time, and I rise in strong support of this amendment and to debunk
some of the allegations made on the other side.
We have 21 States that have right-to-work laws now, and in all of
those States we have unions that are organized. To deny the right to
members of a health care organization to choose for themselves whether
or not to engage in collective bargaining is a fundamental principle
that every American should have. In fact, we should not just be voting
on this issue on this particular group of people; we should be bringing
the legislation that I have introduced and has been cosponsored by more
than 140 members for a national right-to-work law to be voted on here
in the Congress.
Mr. Chairman, I strongly support this provision being added to this
bill, to give people the right to choose for themselves whether or not
they want to participate in something. They should not be made
involuntarily to participate in collective bargaining if they choose
not to do so. So this is something that has worked well for a great
many people in a great many places, and to require somebody to do this
against their will is tyranny. We should support this amendment.
Mr. COX. Mr. Chairman, I yield 1 minute to the gentleman from
California (Mr. Rohrabacher), my distinguished colleague.
Mr. ROHRABACHER. Mr. Chairman, I rise in strong support of H.R. 1304,
and I want to note that I was an original cosponsor of H.R. 1304. Many
of us who feel strongly about this also strongly support the Cox
amendment.
Mr. Chairman, this bill, the base bill, is about voluntary
association, the right of people to gather to work together and to form
unions if they want to, yes, but to have voluntary associations, if
they want to do so. It is also about the right to choose. The Supreme
Court recently had two decisions based on freedom of association, the
Boy Scout decision and the political parties decision.
The Cox amendment will ensure that this bill's lofty goals are
actually achieved. The lofty goals of making sure that doctors are
working for the benefit of the public and that the medical profession
is not taken over by labor union bosses or anybody else, or managers of
HMOs, but instead, the freedom of association will ensure that doctors
can gather together and that they will remain true to the ideals that
brought them together in the first place. Support the Cox amendment.
Mr. CONYERS. Mr. Chairman, I yield 15 seconds to the gentlewoman from
Texas (Ms. Jackson-Lee).
Ms. JACKSON-LEE of Texas. Mr. Chairman, I rise in opposition to this
amendment. I wish the discussion was accurate. There is no coercion in
this bill whatsoever. There is no requirement to unionize, to organize;
there is perfect freedom in this legislation. I oppose this amendment,
because there is no need for clarification.
Mr. Chairman, I stand in opposition to the amendment offered by
Congressman Cox to ``clarify that a health care plan may not force a
physician to join a union as a condition of employment.''
H.R. 1304 would exempt health care professional from antitrust laws
when they negotiate with health plans over fees and other terms of any
contract under which they provide health care items of service.
Professionals who form coalitions for that purpose would receive the
same treatment under antitrust laws that labor organizations receive
for collective bargaining activities under the National Labor Relations
Act.
To this point, H.R. 1304 has truly been a piece of legislation formed
through the combined efforts of my colleagues who sit on the Judiciary
Committee, both on the left and the right. Now, our combined efforts
seem to be traveling down that destructive road called
``partisanship.'' Let us be careful not to be divided at this point.
As it stands, H.R. 1304 makes clear its objectives. There is no
ambiguity in this legislation. Hence, there is no need for
clarification! This amendment is proffered to ``reaffirm the right of
any health care professional to refrain from self-organizing, from
forming, joining, or assisting a labor organization, from bargaining
collectively, or from engaging in concerted activity.''
There is no language in H.R. 1304 that would minutely suggest that
collective bargaining, organization, or unionization is, or may be
required. Independent practitioners who wish to remain private in
practice and in negotiations with health care plans may do so. This
legislation would only give independent practitioners protection should
they ``choose'' to engage in collective bargaining.
For care givers who provide speciality services, this bill will
assist them in negotiating contracts with the health care plans to make
their services more readily accessible. This legislation is clear in
that it provides a benefit to health care providers and does not impose
any requirements.
H.R. 1304 has already been through an intense amendment process in
the Judiciary Committee and adopted by a vote of 26-2, I urge my
colleagues not to allow additional amendments to legislation that is
already crystal clear.
There has been a bipartisan effort to work with professional health
care organizations and we should respect the work that has been done to
develop this bill.
Any amendments at this point would be hidden attempts to destroy a
very simple and important piece of legislation. As reported by the
judiciary, the bill would ensure that Congress could address any
potential concerns that may arise before the legislation is re-
authorized. Adding unneeded language would only harm patients by
delaying passage and ultimately destroying the bill.
Mr. Chairman, this legislation is clear and I press upon my
colleagues the need to oppose all amendments at this point and to
support the passage H.R. 1304 so the American people may begin to
receive the best health care possible.
Mr. CONYERS. Mr. Chairman, I yield myself the remaining time.
The Cox amendment is nothing less than a last-minute attack on the
rights of health care professionals and patients in particular. Now,
notice, this is a nongermane amendment that had the rule prescribed
that all points of order had not been waived would not even be in
order. It is a last-grasp effort on the part of the opponents of the
bill to change the subject matter of the bill and turn pro-labor
Members against the measure.
The practical impact of the amendment would be devastating to the
ability of health care professionals to collectively bargain and
protect patients' rights. Let us not pass tonight inadvertently the
first Federal right-to-work law in our country's history.
American Federation of Labor and Congress of Industrial
Organizations,
Washington, DC, June 29, 2000.
Hon. John Conyers, Jr.,
House of Representatives, Washington, DC.
Dear Congressman Conyers: The AFL-CIO opposes the Cox
amendment to H.R. 1304, Quality Health Care Coalition Act.
This amendment is clearly an attempt at passing
[[Page H5643]]
a federal ``right to work'' law for doctors and health
professionals.
We strenuously oppose this amendment and urge Members to
vote against it.
Sincerely,
Peggy Taylor,
Director, Department of Legislation.
The CHAIRMAN. The question is on the amendment offered by the
gentleman from California (Mr. Cox).
The question was taken; and the Chairman announced that the ayes
appeared to have it.
Mr. CONYERS. Mr. Chairman, I demand a recorded vote.
The CHAIRMAN. Pursuant to House Resolution 542, further proceedings
on the amendment offered by the gentleman from California (Mr. Cox)
will be postponed.
It is now in order to consider Amendment No. 4 printed in House
report 106-709.
Amendment No. 4 Offered by Mr. Terry
Mr. TERRY. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 4 offered by Mr. Terry:
Page 4, after line 20, insert the following:
(3) No negotiation over fees.--The exemption provided in
subsection (a) shall not apply to negotiations over fees.
{time} 0010
The CHAIRMAN. Pursuant to the order of the House of today, the
gentleman from Nebraska (Mr. Terry) and a Member opposed each will
control 5 minutes.
The Chair recognizes the gentleman from Nebraska (Mr. Terry).
Mr. TERRY. Mr. Chairman, I yield myself 2 minutes.
(Mr. TERRY asked and was given permission to revise and extend his
remarks.)
Mr. TERRY. Mr. Chairman, this amendment is really rather simple. This
Terry-Coburn amendment states rather simply that this broad antitrust
exemption should be provided, not for fees, but only for the protection
of patients.
The AMA in our discussions has assured me that this bill that they
support and want is not about money. In fact, they sent around a flier
today to all of us saying it is about the patient, not dollars. So, in
theory, they should support this type of an amendment that still
protects their rights to negotiate the quality of patients' care, but
not to collaborate on fees and increase the cost.
I have met with several of the doctors back in my home district. They
have shared with me that they want the ability to communicate and
balance the table, to talk to the insurance companies about the quality
of care, that they are concerned about being gagged in what they can
and cannot talk to their patients about, or gatekeeper provisions, or
medical necessity definitions. These are the types of things they would
like to sit down and negotiate.
I think we should allow them that type of opportunity, because that
does go to the heart of the quality of patient care. So why are they
against this amendment? Maybe it is about the money. Providing quality
care should never take a back seat to cost or treatment. This amendment
will assure that this bill remains focused on what we all want, and
that is quality of care, and is not simply increasing the cost of that
care.
I urge my colleagues to vote for this simple solution that splits the
difference.
Mr. CAMPBELL. Mr. Chairman, I rise in opposition.
The CHAIRMAN. The gentleman from California (Mr. Campbell) is
recognized for 5 minutes.
Mr. CAMPBELL. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Iowa (Mr. Ganske).
Mr. GANSKE. Mr. Chairman, I urge my colleagues on both sides of the
aisle to reject this amendment. Here is why: The Terry amendment would
prevent negotiations over quality of care. It addresses costs.
Let me give an example of how costs can affect quality of care. As a
reconstructive surgeon, if somebody has their hand cut off, I can take
that patient to the operating room and under microsurgical repair sew
back all the tendons, the blood vessels, put the nerves back together.
That is probably a 10-hour operation, an 8- to 10-hour operation.
That HMO that I may be contracted with can determine that the payment
to the surgeon for that procedure would be $200, or maybe $150. By
their pricing, they can effectively, despite their promises to their
patients, prevent those patients from getting the services paid for,
covered by their plans, by simply making it impossible for that patient
to get that type of care that they need. They can price a product, a
health care product, so low that we effectively are not providing the
service.
Yes, if that patient comes in, under medical ethics I would take the
patient to the operating room and fix their hand, but I would be
essentially doing it for free.
Mr. CAMPBELL. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Florida (Mr. Weldon).
Mr. WELDON of Florida. Mr. Chairman, I rise in opposition to the
amendment offered by the gentleman from Nebraska. I have the utmost
respect for him, but happen to disagree with him on this issue.
I think the gentleman from Iowa (Mr. Ganske) was fairly eloquent on
this issue. He presupposes that there is no correlation between
reimbursement and quality. When I talk to a lot of the physicians in my
community about their experiences on this issue, many of them share
with me the same thing, that the lower and lower the reimbursement
schemes that the insurance companies are essentially ramming down their
throats, the way they cope is they see more and more patients in a
given amount of time.
There has been some very good research out of Canada to show that
physicians spend very little time seeing patients because the
reimbursement is so bad that patients have to go to a doctor two,
three, or four times before they finally get properly diagnosed, and
the essential problem is the doctors are not spending any time with the
patients.
While this bill passed with the gentleman's exception would be better
than no bill, I think the gentleman's amendment does serious injury to
the fundamental issue.
There are 220 cosponsors of the underlying bill. I would encourage
all of them to vote no on the Terry amendment.
Mr. TERRY. Mr. Chairman, I yield 3 minutes to the gentleman from
Oklahoma (Mr. Coburn).
Mr. COBURN. Mr. Chairman, this is an ironic twist that I am against
my doctor friends in the House. I do so not without risk to myself. I
was castigated at the AMA when they had the House of Delegates because
I opposed the bill.
I voted for the Patients' Bill of Rights. I have worked hard to try
to see that we get a bill for patients. I understand the motivation,
severely, behind this bill. I think the motivation is pure.
But I do think that our obligation, and as the gentleman from Iowa
(Mr. Ganske) said, if a patient came to him, he would do it whether he
got paid or not. How is it we have a health care system where we have
to make a consideration about whether we get paid or not, whether or
not there is a question about adequate remuneration?
The fact is that this is about money, unfortunately. To say it is
about patient care is really not true, because everything I have heard
from the doctors that I have talked about has been about money. Money
is associated with patient care.
The question has been raised about low monthly payments for patients
in an HMO, but the only way an HMO can force a doctor to accept $10 a
month for pediatric care is if there are way too many doctors in that
market. So although the goals and the desires of my friends from the
AMA are good, what they want to do is continue to perpetrate the
maldistribution of physicians in this country.
The other thing to think about is if this bill becomes law and
Members live in a rural district, half of their doctors will no longer
be in the rural district because we will have set up a system where
they can come to the urban areas, where many of them would rather be,
and get the same treatment because we can negotiate the fees higher. So
we are going to disrupt further the distribution of physicians in the
country.
I am with my brothers and sisters in the medicine field. I believe
this is the
[[Page H5644]]
wrong way to solve our problem. The right way to solve our problem is
the Patients' Bill of Rights. If this amendment is accepted and my
amendment is accepted, I will be voting for this bill.
Mr. CAMPBELL. Mr. Chairman, I yield the balance of our time to the
gentleman from Georgia (Mr. Norwood).
Mr. NORWOOD. Mr. Chairman, I thank the gentleman for yielding time to
me.
I want to say to my dear friend, and I mean that, the gentleman from
Oklahoma (Mr. Coburn), I simply do not agree with him. I think we ought
to vote this amendment down.
Is this about money? Of course it is about money. People who are
going broke are concerned about that. I have been involved in managed
care a few years. I can tell the Members right now it is a lot easier
to stay home and go fishing than go broke, because their choice is to
go broke or give bad care. That is the choices they give us.
I have always wanted to tell this story. I hate to tell it when
nobody is awake. It is a story basically about what this is all about.
It has occurred since I have been in Congress.
In 1996, Concordia Dental Insurance Company won the bid from the
United States government to care for all the dependent personnel for
our military across the country, a $1 billion contract. There is a
little town in eastern North Carolina called Jacksonville, North
Carolina. One hundred thousand people live there. Thirty thousand are
civilians, 70,000 belong to the Marines.
{time} 0020
Now, there are only 30 dentists there, and Concordia comes to town
and says, Guys, we are going to take two-thirds of your practice. We
are go to cut everything that you are paid in half, your fees are cut
in half. You do not have to take this contract. The gentleman from
Oklahoma (Mr. Coburn) says they could just walk away. How can they walk
away? They are taking two-thirds of their practice.
They are simply saying, We want you to treat these people with
quality care as long as you can. You may be out of business in a year,
you may even last 2 years. These people said, No. We are not going to
do this. These 30 dentists said, No, we cannot do this. We will go
broke. We cannot feed our families or take care of our children's
education.
What do my colleagues think happened to these people? The next thing
they get is the big arm of the Federal Government from the Federal
Trade Commission slamming down on their door saying, We know you are in
collusion. You have got to be, because none of you will come to work
for this insurance company and go broke. Something has got to be wrong.
You are talking to each other. Sure you are. We are going to prosecute
you.
Do my colleagues know what happened? A classmate from Harvard who was
a lawyer from Concordia just happened to know a classmate of his at the
Federal Trade Commission and he calls him up and he says, John, I
cannot get these people to work for nothing. You need to help me do
something about that. So our great Federal Trade Commission puts all of
these 30 people under the threat of jail because they will not work for
nothing.
Mr. Chairman, I urge my colleagues, do not pass this amendment.
The CHAIRMAN. The question is on the amendment offered by the
gentleman from Nebraska (Mr. Terry).
The question was taken; and the Chairman announced that the noes
appeared to have it.
Mr. TERRY. Mr. Chairman, I demand a recorded vote.
The CHAIRMAN. Pursuant to House Resolution 542, further proceedings
on the amendment offered by the gentleman from Nebraska (Mr. Terry)
will be postponed.
It is now in order to consider amendment No. 5 printed in House
Report 106-709.
Amendment No. 5 Offered by Mr. Coburn
Mr. COBURN. Mr. Chairman, I offer an amendment.
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 5 offered by Mr. Coburn:
Page 6, after line 10, insert the following new subsection
(and redesignate the succeeding subsections accordingly):
(h) Exemption of Abortion and Abortion Services.--Nothing
in this section shall apply to negotiations specifically
relating to requiring a health plan to cover abortion or
abortion services.
The CHAIRMAN. Pursuant to the order of the House of today, the
gentleman from Oklahoma (Mr. Coburn) and a Member opposed each will
control 7\1/2\ minutes.
The Chair recognizes the gentleman from Oklahoma (Mr. Coburn).
Mr. COBURN. Mr. Chairman, I yield 2 minutes to the gentleman from New
Jersey (Mr. Smith).
Mr. SMITH of New Jersey. Mr. Chairman, first of all let me begin by
saying that the gentlewoman from Texas (Ms. Jackson-Lee), my friend and
colleague, misstated--was in error--when she suggested that any
amendment to H.R. 1304, constituted a poison pill crafted by the
insurance industry to destroy the bill.
As a strong and longstanding cosponsor of the Campbell bill, and as
one speaking in favor of the pro-life Coburn amendment, nothing could
be further from the truth. Our only intent in proposing this amendment
is to protect innocent babies and their mothers from the violence of
abortion. Abortion isn't health care--it is the dismembering and
poisoning of fragile children.
Mr. Chairman, let us make no mistake about it, pro-abortion groups
have long had as their goal complete assimilation of abortion into the
Nation's health care system. It is clear that absent Coburn abortion
providers could certainly use the exemption created by H.R. 1304 to
pressure private group health plans to cover abortion. It is
appropriate then, and I think it is a vital duty of this Congress, to
adopt the Coburn abortion-neutral amendment if we are going to grant
physicians the significant leverage in negotiations over benefits and
other important issues permitted under the legislation. But we
certainly should not, however unwittingly or inadvertently, permit more
abortions as a consequence of this measure.
The Coburn amendment, which would simply maintain the status quo,
would only exclude negotiations over abortions. That is all it would
do. In other words, current antitrust law would remain in place if
organizations and health care providers tried to leverage expansive
abortion coverage from insurers.
Opposition to the Coburn amendment could only come from those who
want abortion advocates to use this special antitrust exemption granted
by H.R. 1304 to expand coverage of abortion. That is why the National
Right to Life is in favor of Coburn. That is why NARAL and other pro-
abortion organizations are against it. It could not be clearer.
Mr. Chairman, I strongly urge a positive vote in favor of the Coburn
amendment.
Mr. CONYERS. Mr. Chairman, I rise in opposition to the amendment.
The CHAIRMAN. The gentleman is recognized for 7\1/2\ minutes.
Mr. CONYERS. Mr. Chairman, I yield myself 45 seconds.
Mr. Chairman, this is another example of the kind of gamesmanship
that we have been subjected to. The bill says nothing about abortion.
This anti-choice gag rule is a poison pill designed only to kill
another bill to provide quality health care to all Americans.
How many Members have told me on the floor tonight if this amendment
passes, they will vote against the bill? It is very simple. It is very
obvious. To talk about leaving a rape victim without medical guidance.
Mr. Chairman, I reserve the balance of my time.
Mr. COBURN. Mr. Chairman, I yield 30 seconds to the gentleman from
Arizona (Mr. Shadegg).
Mr. SHADEGG. Mr. Chairman, the gentleman from Michigan (Mr. Conyers),
my colleague on the other side, said point blank that the bill says
nothing about abortion. He is simply wrong. The language of the bill
clearly provides that physicians cannot negotiate in order to preclude
people from providing abortion, but in fact they can negotiate to force
them.
The language of the bill is right here. I invite the gentleman to
read it. It simply says if a doctor is licensed to perform an abortion,
negotiations may not be held to preclude him from performing abortions,
in plain language of the bill. I invite the gentleman to read it.
[[Page H5645]]
Mr. CONYERS. Mr. Chairman, I yield 2 minutes to the distinguished
gentlewoman from New York (Mrs. Lowey).
Mrs. LOWEY. Mr. Chairman, I have been a cosponsor of this bill for
nearly a year. But the amendment before us strips physicians of their
right to speak about their medical, religious, and moral beliefs; and
it says doctors can collectively bargain on any subject except those
related to abortion and abortion services.
Every single time the anti-choice majority in this House can
interfere with a women's right to access family planning or choose a
legal abortion, they do. It is never enough. This bill contains no
mention of any specific health service. It offers no directive about
specific benefits or services that must be covered. But here we are
debating women's reproductive health care once again.
We need not fear that it will be covered because this amendment would
ensure it cannot even be discussed. I hope that Americans who are
watching this debate will think carefully about the kind of Congress
they want to elect in November. We can have a Congress that encourages
responsible decision-making and access to quality reproductive health
care. We can have a Congress that works to prevent the need for
abortion by increasing access to effective family planning methods. Or
we can continue to have a Congress like this where nearly every day it
seems there is another amendment, another bill to make the right to
choose obsolete.
This is what it is all about. We are gagging our doctors. We are not
giving them the right to negotiate.
Mr. Chairman, I urge my colleagues to fight for quality health care
for their constituents and oppose this amendment.
Mr. COBURN. Mr. Chairman, I yield myself 2 minutes.
Mr. Chairman, let me quote from the bill:
Nothing in this section shall exempt from the application
of the antitrust laws any agreement or otherwise unlawful
conspiracy that excludes, limits, the participation or
reimbursement or other otherwise limits the scope of services
to be provided by any health care professional, or group of
health care professionals, with respect to the performance of
services that are within their scope of practice as defined
by permitted relevant law or regulation.
Well, let me tell my colleagues what that very slickly says. What
that says is that health care providers have the right to retain
services, but no right to exemption from antitrust laws to reduce
services. So if a group, if a Catholic hospital buys a hospital that is
presently performing abortions and under their conscience do not
additionally want to offer that service, then in fact they will not be
able to do that.
{time} 0030
So that is not the intention of this author, and I understand that.
That was never his intention. But that is the result and the effect is
that those hospitals in this country who consciously object to the
taking of unborn life can in fact be forced to perform that.
Mr. Chairman, I reserve the balance of my time.
Mr. CONYERS. Mr. Chairman, I am pleased to yield 45 seconds to the
distinguished gentlewoman from Maryland (Mrs. Morella).
Mrs. MORELLA. Mr. Chairman, actually, I am sure that what I will say
has already been said, but it needs to be repeated.
Actually, first of all, I am very pleased that this bill is coming to
the floor. It is a good bill. It is supported by 220 Members of
Congress and a myriad of associations and organizations. With the ever
increasing consolidation within managed care, it is essential.
Actually, the bill does not mandate any benefit of service, nor does
it force insurance companies to provide abortion coverage. So I am
dismayed that the very distinguished gentleman from Oklahoma (Mr.
Coburn) has offered this amendment because it drags the abortion issue
into this discussion.
But what is happening with this amendment is we are dragging the
abortion issue into this discussion when our debate should pivot on
whether or not giving doctors the right to collectively bargain will
have a beneficial or adverse consequence on the health care industry.
This should not be a discussion on the specific conscience of a
doctor or a health care, but the Coburn amendment would do just that.
And so, I urge defeat of the amendment.
Mr. COBURN. Mr. Chairman, I reserve the balance of my time.
Mr. CONYERS. Mr. Chairman, I yield 45 seconds to the gentleman from
Pennsylvania (Mr. Greenwood).
Mr. GREENWOOD. Mr. Chairman, I thank the gentleman for yielding me
the time.
Mr. Chairman, those of my colleagues who are supporters of this
measure really have to vote against the Coburn amendment, and they have
to do it for a reason of substance and a reason of process.
The substantive reason is that if they argue that this is all about
freeing doctors, freeing doctors to use their individual liberty to go
and negotiate with their plans, then they cannot have it both ways,
they cannot say except in this one instance and be consistent.
Secondly, if they are for the bill, they cannot vote for the Coburn
amendment. Because if we look at the people who voted for the rule to
allow this to happen at all, nearly half of them are pro-choice Members
and they will kill the bill with the Coburn amendment.
So to be consistent and support the right of doctors to individually
and collectively argue for good care for their patients and to be
consistent and say they want the bill to pass, they must vote against
the Coburn amendment unless they are going to go home to their doctors
and let them know they tried to have it both ways.
Mr. COBURN. Mr. Chairman, I yield myself 1 minute just to answer the
gentleman from Pennsylvania (Mr. Greenwood).
Mr. Chairman, what the bill says is that they can negotiate for
abortion rights but they cannot negotiate for life. That is the
ultimate result of this language. And in fact, it puts in jeopardy
every Catholic hospital in this country.
What it also does, to say that this is not happening is the
California Medical Association has already tried to introduce this law.
It is through the State of California to mandate that every health care
provider and every health care organization offer abortion services.
Mr. Chairman, I reserve the balance of my time.
Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentleman from New
York (Mr. Nadler).
Mr. NADLER. Mr. Chairman, I was going to use my minute to talk about
how this is a total red herring and this debate should not be about
abortion because the bill does not talk about abortions.
Then the amendment that I wrote and negotiated over a period of 6
months with doctors and nurses is cited by the gentleman on the other
side as an abortion amendment. It has nothing to do with abortion.
The purpose of section (e) is to say that a group of doctors cannot
negotiate with the HMO an agreement that says they may not pay nurses
more than x dollars an hour. It is to prevent one group of
professionals, doctors generally, from saying that nurses may not do
certain things that the law says they may do.
That fear was expressed by the nurses, the physical therapists, the
chiropractors; and we carefully negotiated language in this section
with the doctors, the nurses, the chiropractors and the physical
therapists to prevent the bill from being used by one group of health
care practitioners to exclude or limit the reimbursement of another
group of health care practitioners.
It has nothing whatsoever to do with abortion, period. It is just
completely irrelevant to it. This bill says nothing about abortion pro
or con.
Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, if, in fact, the gentleman is correct, then there is
nothing wrong with my amendment. If, in fact, he is incorrect, and I
believe he is, that the unintended consequence is exactly as I
described, we will, in fact, have the situation as I described.
Mr. CONYERS. Mr. Chairman, I am pleased to yield 1 minute to the
gentlewoman from Texas (Ms. Jackson-Lee).
Ms. JACKSON-LEE of Texas. Mr. Chairman, I respect the differences
that my friends have who are against abortion. I do again reaffirm that
the Supreme Court has said the right to choose is the law of the land.
[[Page H5646]]
The Coburn amendment makes this bill more difficult and untenable
than it is or may be. By preventing any negotiations between health
care plans and doctors about abortion, the Coburn amendment could leave
an incest victim stranded on an island of despair. Even her own
psychiatrist could be prevented by an HMO to referring her to an
obstetrician to exercise her constitutional protected right to choose.
It could also leave a rape victim without any medical guidance, or an
emergency room doctor could be forbidden from ensuring that a health
plan allows a referral to an appropriate reproductive health clinic.
By preventing any negotiations between health care plans and doctors
about any abortion-related service, this extreme anti-choice amendment
could prevent a physician from ensuring that an HMO provides ultrasound
to mothers. It is not in this bill.
We should not vote for this amendment. We should allow the right to
choose to stand on its own.
Mr. Chairman, I rise in opposition to this amendment offered by
Representative Coburn to exclude ``negotiations specifically relating
to requiring a health plan to cover abortion or abortion services.''
H.R. 1304, the Quality Health Care Coalition Act is about controlling
health costs and quality and access to health care, not about limiting
health care services because of a mention of abortion. It does so by
amending the antitrust laws to allow health care professionals to
jointly negotiate the terms of their contracts with health care plans.
This bill is not about abortion rights. That debate has already been
decided in the Supreme Court in 1973 in the landmark ruling of Roe v.
Wade. Furthermore, just yesterday, once again the Supreme Court upheld
a woman's right to choose whether or not an abortion is right for her,
without the State enacting undue restrictions. By ruling the Nebraska
``partial-birth'' ban unconstitutional, the Court reiterated that Roe
v. Wade is still the law of the land and cannot be undermined with
ambiguous anti-abortion language.
Under the Coburn amendment, providers could not negotiate against any
oppressive restrictions that appear in their contracts concerning
abortion services. Such restrictions could include a ban on referring
clients for abortions elsewhere, or from discussing abortion as a
medically appropriate and legal option with patients.
The amendment runs counter to the spirit of the underlying
legislation--the goal of which is to empower health-care providers in
their negotiations with large health plans. This amendment is merely
another attempt to stigmatize abortion by separating it from other
medical care.
Contrary to what the amendment sponsors will argue, H.R. 1304 would
not force insurance companies to provide abortion coverage. In fact,
specific benefits are not usually outlined in contracts between health
plans and providers. Rather, they are contained in contracts between
health plans and patients or groups of patients or employers on their
behalf.
H.R. 1304 would not alter this practice. The Coburn amendment,
however, would silence physicians and other providers. Those 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.
Physicians would be precluded from negotiating on their patient's
behalf with hospitals to provide abortions in cases of medical
emergency, or even mentioning that an abortion does not meet an
adequate standard of care. Although today's Coburn amendment is limited
to abortion or abortion services, it is very likely that those who seek
to gag doctors from discussing abortion with their patients would soon
target other reproductive health services, such as tubal ligations,
sterilization, or contraception!
H.R. 1304 gives health care professionals the power to jointly
negotiate contract terms to promote quality health care for their
patients. H.R. 1304 would provide guarantees that patients are
protected from bureaucratic abuses and help pave the way for such
assurances.
Mr. Chairman, this amendment is strongly opposed by the American
College of Obstetricians and Gynecologists and the American Medical
Women's Association because this is an inappropriate amendment designed
to kill support for this bill.
Personalized attention is what most Americans desire from their
doctors, social workers and other care providers. H.R. 1304 encourages
doctors to focus on the care they give to their patients. It allows us
to return to an era when physicians were able to act on behalf of their
patients and not for the benefit of the bottom line for an insurance
company.
I ask my colleagues not to support such outlandish tactics and to
rise above this so that we might approve this most significant piece of
legislation.
Mr. COBURN. Mr. Chairman, I yield myself the balance of the time.
Mr. Chairman, my point is said by this chart, is that, in fact, the
rule of the land is that they do not provide good health care unless
they are willing to terminate an unborn child. That is NARAL's
position. That is where we are headed with the language as it is
written in this bill.
This bill has great intention. The authors never intended this quirk
of availability to be there. That was not the intention of the
gentleman from California (Mr. Campbell). But it is there. And unless
it is fixed, what will happen is NARAL's position that they are not
providing health care unless they are terminating unborn children in
every health plan, every Catholic hospital in this country that are on
health insurance or extended facility will be at the mercy of NARAL.
Seventy-five percent of the people in this country, the latest poll,
believes it is murder to kill an unborn child. Twenty-five percent of
the people in this country are wrong. They are wrong.
There is a God in heaven, and we will pay a price for what we are
doing to unborn children.
Do not let this bill go out of this House without this amendment. My
colleagues will doom not only those organizations that are there for
life, but they will doom some of the best health care organizations in
the country.
Mr. Chairman, I yield back the balance of my time.
Mr. CONYERS. Mr. Chairman, I yield the balance of the time to the
gentlewoman from New York (Mrs. Maloney).
Mrs. MALONEY of New York. Mr. Chairman, I yield to the gentleman from
Michigan (Mr. Conyers).
Mr. CONYERS. Mr. Chairman, the word ``abortion'' does not appear. I
wrote this with the gentleman from California (Mr. Campbell). We can
assure our colleagues that in no place does the word ``abortion''
appear.
I just want to emphasize that.
{time} 0040
Mrs. MALONEY of New York. Mr. Chairman, I thank the gentleman for his
leadership.
Mr. Chairman, I rise against the amendment of the gentleman from
Oklahoma (Mr. Coburn). No HMO has ever required a doctor to perform an
abortion. They have never required a doctor to perform an abortion.
This amendment is totally unnecessary. Come on, we all know what this
is about.
The Campbell-Conyers amendment, the underlying bill, is not about
abortion. The Coburn amendment is irrelevant, deceptive, and
transparent. Its goal has nothing to do with abortion. Its goal is to
try to undermine a very thoughtful and important bill. I urge a no vote
on the Coburn amendment and a yes vote for Campbell-Conyers.
Mr. Chairman, I yield to the gentlewoman from New York (Mrs. Lowey),
my good friend.
Mrs. LOWEY. Mr. Chairman, I would like to clarify the statement from
my good friend, the gentleman from Oklahoma (Mr. Coburn), who said that
unless someone is willing to terminate an unborn child they cannot
practice medicine. Look at what the Greenwood amendment says, that the
Committee on Rules and the gentleman would not accept. It clearly says
and provides for a religious exception.
The CHAIRMAN. The question is on the amendment offered by the
gentleman from Oklahoma (Mr. Coburn).
The question was taken; and the Chairman announced that the noes
appeared to have it.
Mr. COBURN. Mr. Chairman, I demand a recorded vote, and pending that,
I make the point of order that a quorum is not present.
The CHAIRMAN. Pursuant to House Resolution 542, further proceedings
on the amendment offered by the gentleman from Oklahoma (Mr. Coburn)
will be postponed.
The point of no quorum is considered withdrawn.
It is now in order to consider amendment No. 6 printed in House
Report 106-709.
Amendment No. 6 Offered by Mr. Davis of Illinois
Mr. DAVIS of Illinois. Mr. Chairman, I offer an amendment.
[[Page H5647]]
The CHAIRMAN. The Clerk will designate the amendment.
The text of the amendment is as follows:
Amendment No. 6 offered by Mr. Davis of Illinois:
Add at the end the following new subsection:
(j) Sense of Congress.--It is the sense of Congress that
decisions regarding medical care and treatment should be made
by the physician or health care professional in consultation
with the patient.
The CHAIRMAN. Pursuant to the order of the House today, the gentleman
from Illinois (Mr. Davis) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentleman from Illinois (Mr. Davis).
Parliamentary Inquiry
Mr. CAMPBELL. Mr. Chairman, I have a parliamentary inquiry.
The CHAIRMAN. The gentleman from California (Mr. Campbell) may
inquire.
Mr. CAMPBELL. In the absence of anyone opposed, may I claim the time
for additional speakers on our side?
The CHAIRMAN. The gentleman from California (Mr. Campbell) may claim
the time in opposition, by unanimous consent.
Mr. CAMPBELL. Mr. Chairman, I ask unanimous consent to claim the time
in opposition to the amendment, that I like and support.
The CHAIRMAN. Is there objection to the unanimous consent request of
the gentleman from California?
Mr. DICKS. Mr. Chairman, I object.
The CHAIRMAN. Objection is heard.
The gentleman from Illinois (Mr. Davis) is recognized for 5 minutes.
Mr. DAVIS of Illinois. Mr. Chairman, I yield myself such time as I
may consume.
Mr. Chairman, first of all, I want to commend and congratulate the
gentleman from California (Mr. Campbell) and the gentleman from
Michigan (Mr. Conyers) on the introduction of a necessity whose time
has come, that is, the Quality Health-Care Coalition Act.
I also want to thank the Committee on Rules for making my amendment
in order. The amendment that I offer today enhances the underlying bill
by expressing a sense of Congress relative to decisions regarding
medical care and treatment. This amendment simply states that it is the
sense of this body that decisions regarding medical care and treatment
should be made primarily by the physician or health care professional
in consultation with the patient.
In my congressional district I have 22 hospitals and a vast a array
of other health and medical research institutions and many residents
with serious health and medical needs. Oftentimes health providers and
patients will agree on a course of action, a course of treatment, that
they consider best.
However, the HMO or insurer will have, in some cases, drafted
guidelines and rules that will not allow payment for the suggested
treatment prescribed by the doctor.
That leads to a situation where the doctor may have to forego his or
her prescribed recommendation in order to get the patient's bill paid.
In some instances, this has led to tragic consequences for patients.
Quality health care is not only found in providing access. It is also
found in the ability of doctors and other health providers to find
remedies that may be outside the box. In other words, clinicians
working for HMOs who draw guidelines to suggest that one size fits all,
limit medical potential and the use of modern medical technology and
does not allow for unique individual differences that patients may
have.
The power of insurers to determine coverage potentially gives them
the power to dictate professional standards of care for all but the
wealthiest of patients. That is not appropriate. It is not good care,
and it is not right.
Too many patients are suffering because HMOs have put profits ahead
of patient care. This House cannot stand silently by while insurance
company decisions are superseding the recommendations of health experts
and doctors.
It is time that we strengthen the doctor-patient relationship.
Therefore, I would urge support for this important amendment and urge
its passage. I would also suggest that on the eve of July 4, I believe
that it is time that we pass a declaration of independence for this
Nation's doctors, nurses and other health care providers who along with
their patients ought to be able to determine the best and most
appropriate course of action.
Mr. Chairman, I reserve the balance of my time.
Parliamentary Inquiry
Mr. OSE. Mr. Chairman, parliamentary inquiry.
The CHAIRMAN. The gentleman will state his parliamentary inquiry.
Mr. OSE. Mr. Chairman, wishing to speak in favor of the gentleman's
amendment, how would I go about requesting time?
The CHAIRMAN. The gentleman would proceed by asking unanimous consent
for additional time, which would be granted on both sides.
Mr. OSE. Mr. Chairman, I ask unanimous consent to address the House
for 2 minutes in favor of the amendment.
The CHAIRMAN. Is there objection to the request of the gentleman from
California? Objection is heard.
Is any Member in the Chamber seeking to control time in opposition?
Mr. DAVIS of Illinois. Mr. Chairman, could I inquire of the Chair how
much time I have left?
The CHAIRMAN. The gentleman from Illinois (Mr. Davis) has 1 minute
remaining.
Mr. DAVIS of Illinois. Mr. Chairman, then I would be pleased to yield
the 1 minute that I have remaining to the gentleman from California
(Mr. Ose).
Mr. OSE. Mr. Chairman, I thank the gentleman from Illinois (Mr.
Davis) for his very cordial provision of time.
Mr. Chairman, I rise in support of the gentleman's amendment, and I
just wish to relate the impact in my district of the lack of available
physician or health care professional assistance within the Medicare
HMO sector of the health care market. The consequence that I am
referring to is HCFA's interpretive nature on reimbursement rates that
are allowed to Medicare HMOs and the like, and the consequence on
doctors for providing service.
I saw a study today that estimates that HCFA has exacted over $50
billion over congressional intent by virtue of BBA-97. To the extent
that we can return control of these decisions to a doctor and the
patient, this is a step in the right direction, and I heartily endorse
it.
The CHAIRMAN. Is there any Member seeking time in opposition?
Mr. THOMAS. Mr. Chairman, I seek the time in opposition.
The CHAIRMAN. The gentleman from California (Mr. Thomas) is
recognized for 5 minutes.
Mr. THOMAS. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, I do so to enter into a colloquy with my colleague, the
gentleman from Illinois (Mr. Davis), only for clarification purposes.
I do believe that the sense of this resolution is to make sure that
medical decisions are made by the medical professionals, but I do have
some concern about the wording because it says that it is the sense of
Congress that decisions regarding medical care and treatment should be
made by the physician or, and here is my concern, health care
professional. We had heard some discussion earlier on another amendment
that this legislation was not just about physicians; that it was about
other health care professionals as well.
{time} 0050
I am concerned about the class that would be covered by the term
health care professional, because it is possible that some of those
categories may, in fact, be jobs that we would not want to have the
decision making and treatment recommendation in their hands. So was the
intent of the gentleman from Illinois (Mr. Davis) in terms of expanding
beyond physicians the decision-making capability regarding medical care
and treatment?
Mr. DAVIS of Illinois. Mr. Chairman, will the gentleman yield?
Mr. THOMAS. I yield to the gentleman from Illinois.
Mr. DAVIS of Illinois. Mr. Chairman, the intent is oftentimes medical
providers work as a team. The physician is generally the lead person on
the team, and so the language is not restricted to a physician in a
situation where only he or she is working alone, but also as they work
as members of a team who might be working on a particular problem.
Mr. THOMAS. Reclaiming my time, I thank the gentleman for the
clarification. I still have difficulty with the
[[Page H5648]]
language, because the word between physician and health care
professional is not ``and,'' it is ``or.'' So that it could be the
physician or the health care professional, and the health care
professional, depending on the way we define it, could be the candy
striper in the hospital, and the candy striper in the hospital is the
health care professional, and they make decisions regarding medical
care and treatment.
Does Congress want to go on record that it is the sense of Congress
that the orderly, that the cook, that the person who is doing menial
tasks but is classified as the health care professional is going to
make decisions regarding medical care and treatment. Is that what we
are doing it?
Mr. DAVIS of Illinois. If the gentleman would continue to yield, the
definition of health care professional reads in the bill: The term
health care professional means an individual who provides health care
items or services, treatment, assistance with activities of daily
living or medications to patients and who to the extent required by
State or Federal law possesses specialized training that confers
expertise in the provision of such items or services, treatment,
assistance, or medications.
Mr. THOMAS. Reclaiming my time, Mr. Chairman, that means that
somebody who is trained in giving someone a bath, because they are
incapable of doing that is one of the activities of daily living that
would be classified as the health care professional and, therefore,
Congress believes that they should make medical care and treatment
decisions; that is what the sense of Congress says.
I think it is fairly early in the morning, and we are getting a
little carried away in terms of what we want to do. If we want to say
as a Congress, people who give people baths ought to be able to make
medical decisions about their care and treatment, vote yes on this
sense of Congress.
Mr. GANSKE. Mr. Chairman, will the gentleman yield?
Mr. THOMAS. I yield to the gentleman from Iowa.
Mr. GANSKE. I say to the gentleman from California (Mr. Thomas) maybe
one way to resolve this at this late hour is simply that it sounds as
if basically these people, health professionals, this is covered within
the extent of the duties that are described generally within their job.
Mr. THOMAS. Reclaiming my time, Mr. Chairman, I think the gentleman
from Iowa (Mr. Ganske) will find that is about the all-inclusive
description of health care professionals I have heard, including people
who give people baths.
Mr. GANSKE. If the gentleman will continue to yield. Again, I would
not have a problem with a person whose job it is to give a patient a
bath, if that is the only thing we are talking about.
Mr. THOMAS. I understand that, but this says the sense of Congress is
that decisions regarding medical care and treatment, it does not say
how we take a bath.
The CHAIRMAN. All time has expired.
The question is on the amendment offered by the gentleman from
Illinois (Mr. Davis).
The amendment was agreed to.
Mr. THOMAS. No, no, I was on my feet.
The CHAIRMAN. The gentleman will suspend.
Mr. THOMAS. I was on my feet.
The CHAIRMAN. The gentleman from California (Mr. Thomas) did not call
for a recorded vote. The Chair moved the further proceedings.
Sequential Votes Postponed in Committee Of the Whole
The CHAIRMAN. Pursuant to House Resolution 542, proceedings will now
resume on those amendments on which further proceedings were postponed
in the following order:
Amendment No. 1 by Mr. Ballenger of North Carolina;
Amendment No. 2 by Mr. Stearns of Florida;
Amendment No. 3 by Mr. Cox of California;
Amendment No. 4 by Mr. Terry of Nebraska; and,
Amendment No. 5 by Mr. Coburn of Oklahoma.
The Chair will reduce to 5 minutes the time for any electronic vote
after the first vote in this series.
Amendment No. 1 Offered by Mr. Ballenger
The CHAIRMAN. The pending business is the demand for a recorded vote
on Amendment No. 1 offered by the gentleman from North Carolina (Mr.
Ballenger) on which further proceedings were postponed and on which the
noes prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The CHAIRMAN. A recorded vote has been demanded.
A recorded vote was ordered.
The vote was taken by electronic device, and there were--ayes 71,
noes 345, not voting 19, as follows:
[Roll No. 367]
AYES--71
Armey
Ballenger
Bartlett
Barton
Bass
Bateman
Bereuter
Biggert
Bliley
Blunt
Boehner
Bonilla
Bono
Burton
Buyer
Cannon
Castle
Chabot
Coble
Coburn
Combest
Cunningham
DeLay
DeMint
Dreier
Dunn
Ewing
Gekas
Goodling
Goss
Gutknecht
Hastert
Hayworth
Hoekstra
Hostettler
Houghton
Hulshof
Johnson (CT)
Kingston
Knollenberg
Kolbe
LaHood
Largent
Lewis (KY)
Linder
McCrery
McKeon
Miller, Gary
Myrick
Nussle
Packard
Pease
Pitts
Pomeroy
Pryce (OH)
Radanovich
Ramstad
Rogers
Ryan (WI)
Ryun (KS)
Sanford
Schaffer
Sensenbrenner
Shadegg
Stump
Sununu
Terry
Thomas
Tiahrt
Watkins
Watt (NC)
NOES--345
Abercrombie
Ackerman
Aderholt
Allen
Andrews
Baca
Bachus
Baird
Baker
Baldacci
Baldwin
Barcia
Barr
Barrett (NE)
Barrett (WI)
Becerra
Bentsen
Berkley
Berman
Berry
Bilbray
Bilirakis
Bishop
Blagojevich
Blumenauer
Boehlert
Bonior
Borski
Boswell
Boucher
Boyd
Brady (PA)
Brady (TX)
Brown (FL)
Brown (OH)
Bryant
Burr
Callahan
Calvert
Camp
Campbell
Canady
Capps
Capuano
Cardin
Carson
Chambliss
Chenoweth-Hage
Clayton
Clement
Clyburn
Collins
Condit
Conyers
Cooksey
Costello
Cox
Coyne
Cramer
Crane
Crowley
Cubin
Cummings
Danner
Davis (FL)
Davis (IL)
Davis (VA)
Deal
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Diaz-Balart
Dickey
Dicks
Dingell
Dixon
Doggett
Dooley
Doolittle
Doyle
Duncan
Edwards
Ehlers
Ehrlich
Emerson
Engel
English
Eshoo
Etheridge
Evans
Everett
Farr
Fattah
Fletcher
Foley
Forbes
Ford
Fossella
Frank (MA)
Franks (NJ)
Frelinghuysen
Frost
Gallegly
Ganske
Gejdenson
Gephardt
Gibbons
Gilchrest
Gillmor
Gilman
Gonzalez
Goode
Goodlatte
Gordon
Graham
Granger
Green (TX)
Green (WI)
Greenwood
Gutierrez
Hall (OH)
Hall (TX)
Hansen
Hastings (FL)
Hayes
Hefley
Herger
Hill (IN)
Hill (MT)
Hilleary
Hilliard
Hinchey
Hinojosa
Hobson
Hoeffel
Holden
Holt
Hooley
Horn
Hoyer
Hunter
Hutchinson
Hyde
Inslee
Isakson
Istook
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Jenkins
John
Johnson, E. B.
Jones (NC)
Jones (OH)
Kanjorski
Kaptur
Kasich
Kelly
Kennedy
Kildee
Kilpatrick
Kind (WI)
King (NY)
Kleczka
Kucinich
Kuykendall
LaFalce
Lampson
Lantos
Larson
Latham
LaTourette
Lazio
Leach
Lee
Levin
Lewis (CA)
Lewis (GA)
Lipinski
LoBiondo
Lofgren
Lowey
Lucas (KY)
Lucas (OK)
Luther
Maloney (CT)
Maloney (NY)
Manzullo
Mascara
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McHugh
McInnis
McIntyre
McKinney
Meehan
Menendez
Metcalf
Mica
Millender-McDonald
Miller (FL)
Miller, George
Minge
Mink
Moakley
Mollohan
Moore
Moran (KS)
Moran (VA)
Morella
Murtha
Nadler
Napolitano
Neal
Nethercutt
Ney
Northup
Norwood
Oberstar
Obey
Olver
Ortiz
Ose
Owens
Oxley
Pallone
Pascrell
Pastor
Paul
Payne
Pelosi
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pickett
Pombo
Porter
Portman
Price (NC)
Quinn
Rahall
Rangel
Regula
Reyes
Reynolds
Riley
Rivers
Rodriguez
Roemer
Rogan
Rohrabacher
Ros-Lehtinen
Rothman
Roukema
Roybal-Allard
Royce
Rush
Sabo
Salmon
Sanchez
Sanders
Sandlin
Sawyer
Saxton
Scarborough
Schakowsky
Scott
Serrano
Sessions
Shaw
Shays
Sherman
Sherwood
Shimkus
Shows
Simpson
Sisisky
Skeen
Skelton
Slaughter
Smith (MI)
Smith (NJ)
Smith (TX)
Smith (WA)
[[Page H5649]]
Snyder
Souder
Spence
Spratt
Stabenow
Stearns
Stenholm
Strickland
Stupak
Sweeney
Talent
Tancredo
Tanner
Tauscher
Tauzin
Taylor (MS)
Thompson (CA)
Thompson (MS)
Thornberry
Thune
Thurman
Tierney
Toomey
Towns
Traficant
Turner
Udall (CO)
Udall (NM)
Upton
Velazquez
Visclosky
Vitter
Walden
Walsh
Wamp
Waters
Watts (OK)
Waxman
Weiner
Weldon (FL)
Weldon (PA)
Weller
Wexler
Weygand
Whitfield
Wicker
Wilson
Wise
Wolf
Woolsey
Wu
Wynn
Young (AK)
NOT VOTING--19
Archer
Clay
Cook
Filner
Fowler
Hastings (WA)
Johnson, Sam
Klink
Markey
Martinez
McIntosh
McNulty
Meek (FL)
Meeks (NY)
Shuster
Stark
Taylor (NC)
Vento
Young (FL)
{time} 0113
Messrs. LARSEN, BARCIA, GOODLATTE, GREEN of Wisconsin, LATHAM, and
SHAYS changed their vote from ``aye'' to ``no.''
Mr. HOEKSTRA and Mr. LINDER changed their vote from ``no'' to
``aye.''
So the amendment was rejected.
The result of the vote was announced as above recorded.
Announcement by the Chairman
The CHAIRMAN. Pursuant to House Resolution 542, the Chair announces
that he will reduce to a minimum of 5 minutes the period of time within
which a vote by electronic device will be taken on each amendment on
which the Chair has postponed further proceedings.
Amendment No. 2 Offered by Mr. Stearns
The CHAIRMAN. The pending business is the demand for a recorded vote
on amendment No. 2 offered by the gentleman from Florida (Mr. Stearns)
on which further proceedings were postponed and on which the noes
prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The CHAIRMAN. A recorded vote has been demanded.
A recorded vote was ordered.
The CHAIRMAN. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 94,
noes 320, not voting 21, as follows:
[Roll No. 368]
AYES--94
Armey
Ballenger
Barton
Bass
Bereuter
Biggert
Bilirakis
Bliley
Blunt
Boehner
Bonilla
Bono
Brady (TX)
Burton
Buyer
Cannon
Castle
Chabot
Coble
Coburn
Combest
Crane
Cunningham
Davis (FL)
DeLay
DeMint
Dooley
Dreier
Ehlers
Ehrlich
Gekas
Goodlatte
Goodling
Goss
Green (WI)
Hansen
Hastert
Hayworth
Hefley
Herger
Hill (IN)
Hoekstra
Hostettler
Hulshof
Hutchinson
Johnson (CT)
Kingston
Knollenberg
Kolbe
Largent
Larson
Latham
Lewis (KY)
Lucas (OK)
Luther
McCrery
McInnis
McKeon
Mica
Miller, Gary
Mink
Moran (KS)
Myrick
Northup
Nussle
Oxley
Packard
Pease
Pitts
Pombo
Pomeroy
Portman
Pryce (OH)
Radanovich
Ramstad
Ryan (WI)
Ryun (KS)
Salmon
Sanford
Sensenbrenner
Shadegg
Shays
Souder
Spence
Stearns
Stump
Sununu
Terry
Thomas
Tiahrt
Toomey
Watkins
Wicker
Young (AK)
NOES--320
Abercrombie
Ackerman
Aderholt
Allen
Andrews
Baca
Bachus
Baird
Baker
Baldacci
Baldwin
Barcia
Barr
Barrett (NE)
Barrett (WI)
Bartlett
Bateman
Becerra
Bentsen
Berkley
Berman
Berry
Bilbray
Bishop
Blagojevich
Blumenauer
Boehlert
Bonior
Borski
Boswell
Boucher
Boyd
Brady (PA)
Brown (FL)
Brown (OH)
Bryant
Burr
Callahan
Calvert
Camp
Campbell
Canady
Capps
Capuano
Cardin
Carson
Chambliss
Chenoweth-Hage
Clayton
Clement
Clyburn
Collins
Condit
Conyers
Cooksey
Costello
Cox
Coyne
Cramer
Crowley
Cubin
Cummings
Danner
Davis (IL)
Davis (VA)
Deal
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Diaz-Balart
Dickey
Dicks
Dingell
Dixon
Doggett
Doolittle
Doyle
Duncan
Dunn
Edwards
Emerson
Engel
English
Eshoo
Etheridge
Evans
Everett
Ewing
Farr
Fattah
Fletcher
Foley
Forbes
Ford
Fossella
Frank (MA)
Franks (NJ)
Frelinghuysen
Frost
Gallegly
Ganske
Gejdenson
Gephardt
Gibbons
Gilchrest
Gillmor
Gilman
Gonzalez
Goode
Gordon
Graham
Granger
Green (TX)
Greenwood
Gutierrez
Gutknecht
Hall (OH)
Hall (TX)
Hastings (FL)
Hayes
Hill (MT)
Hilleary
Hilliard
Hinchey
Hinojosa
Hobson
Hoeffel
Holden
Holt
Hooley
Horn
Hoyer
Hunter
Hyde
Inslee
Isakson
Istook
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Jenkins
John
Johnson, E. B.
Jones (NC)
Jones (OH)
Kanjorski
Kaptur
Kasich
Kelly
Kennedy
Kildee
Kilpatrick
Kind (WI)
King (NY)
Kleczka
Kucinich
Kuykendall
LaFalce
LaHood
Lampson
Lantos
LaTourette
Lazio
Leach
Levin
Lewis (CA)
Lewis (GA)
Linder
Lipinski
LoBiondo
Lofgren
Lowey
Lucas (KY)
Maloney (CT)
Maloney (NY)
Manzullo
Mascara
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McHugh
McIntyre
McKinney
Meehan
Meeks (NY)
Menendez
Metcalf
Millender-McDonald
Miller (FL)
Miller, George
Minge
Moakley
Mollohan
Moore
Moran (VA)
Morella
Murtha
Nadler
Napolitano
Neal
Nethercutt
Ney
Norwood
Oberstar
Obey
Olver
Ortiz
Ose
Owens
Pallone
Pascrell
Pastor
Paul
Payne
Pelosi
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pickett
Porter
Price (NC)
Quinn
Rahall
Rangel
Regula
Reyes
Reynolds
Riley
Rivers
Rodriguez
Roemer
Rogan
Rogers
Rohrabacher
Ros-Lehtinen
Rothman
Roukema
Roybal-Allard
Royce
Rush
Sabo
Sanchez
Sanders
Sandlin
Sawyer
Saxton
Schaffer
Schakowsky
Scott
Serrano
Sessions
Shaw
Sherman
Sherwood
Shimkus
Shows
Simpson
Sisisky
Skeen
Skelton
Slaughter
Smith (MI)
Smith (NJ)
Smith (TX)
Smith (WA)
Snyder
Spratt
Stabenow
Stenholm
Strickland
Stupak
Sweeney
Talent
Tancredo
Tanner
Tauscher
Tauzin
Taylor (MS)
Thompson (CA)
Thompson (MS)
Thornberry
Thune
Thurman
Tierney
Towns
Traficant
Turner
Udall (CO)
Udall (NM)
Upton
Velazquez
Visclosky
Vitter
Walden
Walsh
Wamp
Waters
Watt (NC)
Watts (OK)
Waxman
Weiner
Weldon (FL)
Weldon (PA)
Weller
Wexler
Weygand
Whitfield
Wilson
Wise
Wolf
Woolsey
Wu
Wynn
NOT VOTING--21
Archer
Clay
Cook
Filner
Fowler
Hastings (WA)
Houghton
Johnson, Sam
Klink
Lee
Markey
Martinez
McIntosh
McNulty
Meek (FL)
Scarborough
Shuster
Stark
Taylor (NC)
Vento
Young (FL)
{time} 0120
Mr. ROGAN changed his vote from ``aye'' to ``no.''
So the amendment was rejected.
The result of the vote was announced as above recorded.
Amendment No. 3 Offered by Mr. Cox
The CHAIRMAN. The pending business is the demand for a recorded vote
on the amendment offered by the gentleman from California (Mr. Cox) on
which further proceedings were postponed and on which the ayes
prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The CHAIRMAN. A recorded vote has been demanded.
A recorded vote was ordered.
The CHAIRMAN. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 201,
noes 214, not voting 20, as follows:
[Roll No. 369]
AYES--201
Aderholt
Armey
Bachus
Baker
Ballenger
Barr
Barrett (NE)
Bartlett
Barton
Bass
Bateman
Bereuter
Biggert
Bilbray
Bilirakis
Bliley
Blunt
Boehner
Bonilla
Bono
Boyd
Brady (TX)
Bryant
Burr
Burton
Buyer
Callahan
Calvert
Camp
Campbell
Canady
Cannon
Castle
Chabot
Chambliss
Chenoweth-Hage
Clement
Coble
Coburn
Collins
Combest
Cooksey
Cox
Crane
Cubin
Cunningham
Davis (VA)
Deal
DeLay
DeMint
Dickey
Doolittle
Dreier
Duncan
Dunn
Edwards
Ehlers
Ehrlich
Etheridge
Everett
Ewing
Fletcher
Foley
Fossella
Frelinghuysen
Gallegly
[[Page H5650]]
Ganske
Gekas
Gibbons
Gilchrest
Gillmor
Goode
Goodlatte
Goodling
Goss
Graham
Granger
Greenwood
Gutknecht
Hall (TX)
Hansen
Hastert
Hayes
Hayworth
Hefley
Herger
Hill (MT)
Hilleary
Hobson
Hoekstra
Hostettler
Hulshof
Hunter
Hutchinson
Hyde
Isakson
Istook
Jenkins
John
Johnson (CT)
Jones (NC)
Kasich
Kingston
Knollenberg
Kolbe
Kuykendall
LaHood
Largent
Latham
Lazio
Leach
Lewis (CA)
Lewis (KY)
Lucas (OK)
Manzullo
McCollum
McCrery
McInnis
McKeon
Metcalf
Mica
Miller (FL)
Miller, Gary
Moore
Moran (KS)
Moran (VA)
Myrick
Nethercutt
Northup
Norwood
Nussle
Ose
Oxley
Packard
Pease
Peterson (PA)
Petri
Pickering
Pickett
Pitts
Pombo
Porter
Portman
Price (NC)
Pryce (OH)
Radanovich
Ramstad
Reynolds
Riley
Rogan
Rogers
Rohrabacher
Ros-Lehtinen
Roukema
Royce
Ryan (WI)
Ryun (KS)
Salmon
Sanford
Scarborough
Schaffer
Sensenbrenner
Sessions
Shadegg
Shaw
Shimkus
Simpson
Sisisky
Skeen
Smith (MI)
Smith (TX)
Souder
Spence
Spratt
Stearns
Stenholm
Stump
Sununu
Talent
Tancredo
Tanner
Tauzin
Taylor (MS)
Terry
Thomas
Thornberry
Thune
Tiahrt
Toomey
Upton
Vitter
Walsh
Wamp
Watkins
Watts (OK)
Weldon (FL)
Whitfield
Wicker
Wilson
Wolf
Young (AK)
NOES--214
Abercrombie
Ackerman
Allen
Andrews
Baca
Baird
Baldacci
Baldwin
Barcia
Barrett (WI)
Becerra
Bentsen
Berkley
Berman
Berry
Bishop
Blagojevich
Blumenauer
Boehlert
Bonior
Borski
Boswell
Boucher
Brady (PA)
Brown (FL)
Brown (OH)
Capps
Capuano
Cardin
Carson
Clayton
Clyburn
Condit
Conyers
Costello
Coyne
Cramer
Crowley
Cummings
Danner
Davis (FL)
Davis (IL)
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Diaz-Balart
Dicks
Dingell
Dixon
Doggett
Dooley
Doyle
Emerson
Engel
English
Eshoo
Evans
Farr
Fattah
Forbes
Ford
Frank (MA)
Franks (NJ)
Frost
Gejdenson
Gephardt
Gilman
Gonzalez
Gordon
Green (TX)
Green (WI)
Gutierrez
Hall (OH)
Hastings (FL)
Hill (IN)
Hilliard
Hinchey
Hinojosa
Hoeffel
Holden
Holt
Hooley
Horn
Houghton
Hoyer
Inslee
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson, E. B.
Jones (OH)
Kanjorski
Kaptur
Kelly
Kennedy
Kildee
Kilpatrick
Kind (WI)
King (NY)
Kleczka
Kucinich
LaFalce
Lampson
Lantos
Larson
LaTourette
Lee
Levin
Lewis (GA)
Lipinski
LoBiondo
Lofgren
Lowey
Lucas (KY)
Luther
Maloney (CT)
Maloney (NY)
Mascara
Matsui
McCarthy (MO)
McCarthy (NY)
McDermott
McGovern
McHugh
McIntyre
McKinney
Meehan
Meeks (NY)
Menendez
Millender-McDonald
Miller, George
Minge
Mink
Moakley
Mollohan
Morella
Murtha
Nadler
Napolitano
Neal
Ney
Oberstar
Obey
Olver
Ortiz
Owens
Pallone
Pascrell
Pastor
Paul
Payne
Pelosi
Peterson (MN)
Phelps
Pomeroy
Quinn
Rahall
Rangel
Regula
Reyes
Rivers
Rodriguez
Roemer
Rothman
Roybal-Allard
Sabo
Sanchez
Sanders
Sandlin
Sawyer
Saxton
Schakowsky
Scott
Serrano
Shays
Sherman
Sherwood
Shows
Skelton
Slaughter
Smith (NJ)
Smith (WA)
Snyder
Stabenow
Strickland
Stupak
Sweeney
Tauscher
Thompson (CA)
Thompson (MS)
Thurman
Tierney
Towns
Traficant
Turner
Udall (CO)
Udall (NM)
Velazquez
Visclosky
Walden
Waters
Watt (NC)
Waxman
Weiner
Weldon (PA)
Weller
Wexler
Weygand
Wise
Woolsey
Wu
Wynn
NOT VOTING--20
Archer
Clay
Cook
Filner
Fowler
Hastings (WA)
Johnson, Sam
Klink
Linder
Markey
Martinez
McIntosh
McNulty
Meek (FL)
Rush
Shuster
Stark
Taylor (NC)
Vento
Young (FL)
{time} 0126
Mr. TANNER and Mr. MORAN of Virginia changed their vote from ``no''
to ``aye.''
So the amendment was rejected.
The result of the vote was announced as above recorded.
Amendment No. 4 Offered by Mr. Terry
The CHAIRMAN. The pending business is the demand for a recorded vote
on amendment No. 4 offered by the gentleman from Nebraska (Mr. Terry)
on which further proceedings were postponed and on which the noes
prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The CHAIRMAN. A recorded vote has been demanded.
A recorded vote was ordered.
The CHAIRMAN. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 78,
noes 338, not voting 19, as follows:
[Roll No. 370]
AYES--78
Armey
Ballenger
Barrett (NE)
Barrett (WI)
Bartlett
Barton
Bass
Bereuter
Biggert
Bilirakis
Bliley
Blunt
Boehner
Bonilla
Bono
Burton
Buyer
Cannon
Castle
Chabot
Coble
Coburn
Combest
Cox
Crane
DeLay
DeMint
Dreier
Dunn
Ewing
Gekas
Goodlatte
Goodling
Goss
Green (WI)
Hastert
Hayworth
Hoekstra
Hostettler
Hulshof
Johnson (CT)
Kingston
Knollenberg
Kolbe
Largent
Latham
Lewis (KY)
McCrery
McKeon
Miller, Gary
Myrick
Nussle
Oxley
Packard
Pease
Pitts
Pomeroy
Pryce (OH)
Radanovich
Ramstad
Rogers
Ryan (WI)
Ryun (KS)
Sanford
Schaffer
Sensenbrenner
Shadegg
Skeen
Souder
Stump
Sununu
Tancredo
Terry
Thomas
Tiahrt
Toomey
Walden
Watkins
NOES--338
Abercrombie
Ackerman
Aderholt
Allen
Andrews
Baca
Bachus
Baird
Baker
Baldacci
Baldwin
Barcia
Barr
Bateman
Becerra
Bentsen
Berkley
Berman
Berry
Bilbray
Bishop
Blagojevich
Blumenauer
Boehlert
Bonior
Borski
Boswell
Boucher
Boyd
Brady (PA)
Brady (TX)
Brown (FL)
Brown (OH)
Bryant
Burr
Callahan
Calvert
Camp
Campbell
Canady
Capps
Capuano
Cardin
Carson
Chambliss
Chenoweth-Hage
Clayton
Clement
Clyburn
Collins
Condit
Conyers
Cooksey
Costello
Coyne
Cramer
Crowley
Cubin
Cummings
Cunningham
Danner
Davis (FL)
Davis (IL)
Davis (VA)
Deal
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Diaz-Balart
Dickey
Dicks
Dingell
Dixon
Doggett
Dooley
Doolittle
Doyle
Duncan
Edwards
Ehlers
Ehrlich
Emerson
Engel
English
Eshoo
Etheridge
Evans
Everett
Farr
Fattah
Fletcher
Foley
Forbes
Ford
Fossella
Frank (MA)
Franks (NJ)
Frelinghuysen
Frost
Gallegly
Ganske
Gejdenson
Gephardt
Gibbons
Gilchrest
Gillmor
Gilman
Gonzalez
Goode
Gordon
Graham
Granger
Green (TX)
Greenwood
Gutierrez
Gutknecht
Hall (OH)
Hall (TX)
Hansen
Hastings (FL)
Hayes
Hefley
Herger
Hill (IN)
Hill (MT)
Hilleary
Hilliard
Hinchey
Hinojosa
Hobson
Hoeffel
Holden
Holt
Hooley
Horn
Houghton
Hoyer
Hunter
Hutchinson
Hyde
Inslee
Isakson
Istook
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Jenkins
John
Johnson, E. B.
Jones (NC)
Jones (OH)
Kanjorski
Kaptur
Kasich
Kelly
Kennedy
Kildee
Kilpatrick
Kind (WI)
King (NY)
Kleczka
Kucinich
Kuykendall
LaFalce
LaHood
Lampson
Lantos
Larson
LaTourette
Lazio
Leach
Lee
Levin
Lewis (CA)
Lewis (GA)
Lipinski
LoBiondo
Lofgren
Lowey
Lucas (KY)
Lucas (OK)
Luther
Maloney (CT)
Maloney (NY)
Manzullo
Mascara
Matsui
McCarthy (MO)
McCarthy (NY)
McCollum
McDermott
McGovern
McHugh
McInnis
McIntyre
McKinney
Meehan
Meeks (NY)
Menendez
Metcalf
Mica
Millender-McDonald
Miller (FL)
Miller, George
Minge
Mink
Moakley
Mollohan
Moore
Moran (KS)
Moran (VA)
Morella
Murtha
Nadler
Napolitano
Neal
Nethercutt
Ney
Northup
Norwood
Oberstar
Obey
Olver
Ortiz
Ose
Owens
Pallone
Pascrell
Pastor
Paul
Payne
Pelosi
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pickett
Pombo
Porter
Portman
Price (NC)
Quinn
Rahall
Rangel
Regula
Reyes
Reynolds
Riley
Rivers
Rodriguez
Roemer
Rogan
Rohrabacher
Ros-Lehtinen
Rothman
Roukema
Roybal-Allard
Royce
Rush
Sabo
Salmon
Sanchez
Sanders
Sandlin
Sawyer
Saxton
Scarborough
Schakowsky
Scott
Serrano
Sessions
Shaw
Shays
Sherman
Sherwood
Shimkus
Shows
Simpson
Sisisky
Skelton
Slaughter
Smith (MI)
Smith (NJ)
Smith (TX)
Smith (WA)
Snyder
Spence
Spratt
Stabenow
[[Page H5651]]
Stearns
Stenholm
Strickland
Stupak
Sweeney
Talent
Tanner
Tauscher
Tauzin
Taylor (MS)
Thompson (CA)
Thompson (MS)
Thornberry
Thune
Thurman
Tierney
Towns
Traficant
Turner
Udall (CO)
Udall (NM)
Upton
Velazquez
Visclosky
Vitter
Walsh
Wamp
Waters
Watt (NC)
Watts (OK)
Waxman
Weiner
Weldon (FL)
Weldon (PA)
Weller
Wexler
Weygand
Whitfield
Wicker
Wilson
Wise
Wolf
Woolsey
Wu
Wynn
Young (AK)
NOT VOTING--19
Archer
Clay
Cook
Filner
Fowler
Hastings (WA)
Johnson, Sam
Klink
Linder
Markey
Martinez
McIntosh
McNulty
Meek (FL)
Shuster
Stark
Taylor (NC)
Vento
Young (FL)
{time} 0133
So the amendment was rejected.
The result of the vote was announced as above recorded.
Amendment No. 5 Offered by Mr. Coburn
The CHAIRMAN. The pending business is the demand for a recorded vote
on amendment No. 5 offered by the gentleman from Oklahoma (Mr. Coburn)
on which further proceedings were postponed and on which the noes
prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The CHAIRMAN. A recorded vote has been demanded.
A recorded vote was ordered.
The CHAIRMAN. This will be a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 213,
noes 202, answered ``present'' 1, not voting 19, as follows:
[Roll No. 371]
AYES--213
Aderholt
Armey
Bachus
Baker
Ballenger
Barcia
Barr
Barrett (NE)
Bartlett
Barton
Bateman
Bereuter
Berry
Bilirakis
Bliley
Blunt
Boehner
Bonilla
Borski
Brady (TX)
Bryant
Burr
Burton
Buyer
Callahan
Calvert
Camp
Canady
Cannon
Chabot
Chambliss
Chenoweth-Hage
Coble
Coburn
Collins
Combest
Costello
Cox
Crane
Cubin
Cunningham
Danner
Davis (VA)
Deal
DeLay
DeMint
Diaz-Balart
Dickey
Doolittle
Doyle
Dreier
Duncan
Dunn
Ehlers
Ehrlich
Emerson
English
Everett
Ewing
Fletcher
Forbes
Fossella
Gallegly
Gekas
Gillmor
Goode
Goodlatte
Goodling
Goss
Graham
Green (WI)
Gutknecht
Hall (OH)
Hall (TX)
Hansen
Hastert
Hayes
Hayworth
Hefley
Herger
Hill (MT)
Hilleary
Hobson
Hoekstra
Holden
Hostettler
Hulshof
Hunter
Hutchinson
Hyde
Isakson
Istook
Jenkins
John
Jones (NC)
Kanjorski
Kasich
Kildee
King (NY)
Kingston
Knollenberg
Kucinich
LaFalce
LaHood
Largent
Latham
LaTourette
Leach
Lewis (CA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Lucas (KY)
Lucas (OK)
Manzullo
Mascara
McCollum
McCrery
McHugh
McInnis
McIntyre
McKeon
Metcalf
Mica
Miller, Gary
Moakley
Mollohan
Moran (KS)
Murtha
Myrick
Nethercutt
Ney
Northup
Norwood
Nussle
Oberstar
Ortiz
Oxley
Packard
Pease
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pitts
Pombo
Portman
Quinn
Radanovich
Rahall
Regula
Reynolds
Riley
Roemer
Rogan
Rogers
Rohrabacher
Ros-Lehtinen
Royce
Ryan (WI)
Ryun (KS)
Salmon
Sanford
Saxton
Scarborough
Schaffer
Sensenbrenner
Sessions
Shadegg
Sherwood
Shimkus
Shows
Simpson
Skeen
Skelton
Smith (MI)
Smith (NJ)
Smith (TX)
Souder
Spence
Stearns
Stenholm
Stump
Stupak
Sununu
Talent
Tancredo
Tauzin
Taylor (MS)
Terry
Thomas
Thornberry
Thune
Tiahrt
Toomey
Traficant
Upton
Vitter
Walsh
Wamp
Watkins
Watts (OK)
Weldon (FL)
Weldon (PA)
Weller
Weygand
Whitfield
Wicker
Wilson
Wolf
Young (AK)
NOES--202
Abercrombie
Ackerman
Allen
Andrews
Baca
Baird
Baldacci
Baldwin
Barrett (WI)
Bass
Becerra
Bentsen
Berkley
Berman
Biggert
Bilbray
Bishop
Blagojevich
Blumenauer
Boehlert
Bonior
Bono
Boswell
Boucher
Boyd
Brady (PA)
Brown (FL)
Brown (OH)
Campbell
Capps
Capuano
Cardin
Carson
Castle
Clayton
Clement
Clyburn
Condit
Conyers
Cooksey
Coyne
Cramer
Crowley
Cummings
Davis (FL)
Davis (IL)
DeFazio
DeGette
Delahunt
DeLauro
Deutsch
Dicks
Dingell
Dixon
Doggett
Dooley
Edwards
Engel
Eshoo
Etheridge
Evans
Farr
Fattah
Foley
Ford
Frank (MA)
Franks (NJ)
Frelinghuysen
Frost
Gejdenson
Gephardt
Gibbons
Gilchrest
Gilman
Gonzalez
Gordon
Granger
Green (TX)
Greenwood
Gutierrez
Hastings (FL)
Hill (IN)
Hilliard
Hinchey
Hinojosa
Hoeffel
Holt
Hooley
Horn
Houghton
Hoyer
Inslee
Jackson (IL)
Jackson-Lee (TX)
Jefferson
Johnson (CT)
Johnson, E.B.
Jones (OH)
Kaptur
Kelly
Kennedy
Kilpatrick
Kind (WI)
Kleczka
Kolbe
Kuykendall
Lampson
Lantos
Larson
Lazio
Lee
Levin
Lewis (GA)
Lofgren
Lowey
Luther
Maloney (CT)
Maloney (NY)
Matsui
McCarthy (MO)
McCarthy (NY)
McDermott
McGovern
McKinney
Meehan
Meeks (NY)
Menendez
Millender-McDonald
Miller (FL)
Miller, George
Minge
Mink
Moore
Moran (VA)
Morella
Nadler
Napolitano
Neal
Obey
Olver
Ose
Owens
Pallone
Pascrell
Pastor
Payne
Pelosi
Pickett
Pomeroy
Porter
Price (NC)
Pryce (OH)
Ramstad
Rangel
Reyes
Rivers
Rodriguez
Rothman
Roukema
Roybal-Allard
Rush
Sabo
Sanchez
Sanders
Sandlin
Sawyer
Schakowsky
Scott
Serrano
Shaw
Shays
Sherman
Sisisky
Slaughter
Smith (WA)
Snyder
Spratt
Stabenow
Strickland
Sweeney
Tanner
Tauscher
Thompson (CA)
Thompson (MS)
Thurman
Tierney
Towns
Turner
Udall (CO)
Udall (NM)
Velazquez
Visclosky
Walden
Waters
Watt (NC)
Waxman
Weiner
Wexler
Wise
Woolsey
Wu
Wynn
ANSWERED ``PRESENT''--1
Paul
NOT VOTING--19
Archer
Clay
Cook
Filner
Fowler
Ganske
Hastings (WA)
Johnson, Sam
Klink
Markey
Martinez
McIntosh
McNulty
Meek (FL)
Shuster
Stark
Taylor (NC)
Vento
Young (FL)
{time} 0139
So the amendment was agreed to.
The result of the vote was announced as above recorded.
Mr. CONYERS. Mr. Chairman, I will not offer a motion to recommit. As
the lead cosponsor of the bill, I wish that the Coburn amendment had
been defeated but notwithstanding its adoption I am asking everyone to
vote aye on final passage.
This vote is not being scored by the pro choice community.
The CHAIRMAN. The question is on the committee amendment in the
nature of a substitute, as amended.
The committee amendment in the nature of a substitute, as amended,
was agreed to.
The CHAIRMAN. Under the rule, the Committee rises.
Accordingly, the Committee rose; and the Speaker pro tempore (Mr.
Pease) having assumed the chair, Mr. Shimkus, Chairman of the Committee
of the Whole House on the State of the Union, reported that that
Committee, having had under consideration 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, pursuant to House
Resolution 542, he reported the bill back to the House with an
amendment adopted by the Committee of the Whole.
The SPEAKER pro tempore. Under the rule, the previous question is
ordered.
Is a separate vote demanded on any amendment to the committee
amendment in the nature of a substitute adopted by the Committee of the
Whole? If not, the question is on the amendment.
The amendment was agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Recorded Vote
Mr. CONYERS. Mr. Speaker, I demand a recorded vote.
[[Page H5652]]
A recorded vote was ordered.
The vote was taken by electronic device, and there were--ayes 276,
noes 136, answered ``present'' 2, not voting 20, as follows:
[Roll No. 372]
AYES--276
Abercrombie
Ackerman
Aderholt
Allen
Andrews
Baca
Bachus
Baker
Baldacci
Barcia
Barr
Bartlett
Bentsen
Berry
Bilbray
Bishop
Blagojevich
Blumenauer
Boehlert
Bonior
Borski
Boswell
Boucher
Boyd
Brady (PA)
Brown (FL)
Brown (OH)
Bryant
Burr
Callahan
Calvert
Camp
Campbell
Canady
Capuano
Cardin
Carson
Chambliss
Chenoweth-Hage
Clayton
Clement
Clyburn
Collins
Condit
Conyers
Cooksey
Costello
Coyne
Cramer
Crowley
Cubin
Cummings
Danner
Davis (FL)
Davis (IL)
Davis (VA)
Deal
DeFazio
Delahunt
DeLauro
Diaz-Balart
Dickey
Dicks
Dingell
Doolittle
Doyle
Duncan
Edwards
Ehrlich
Emerson
Engel
English
Etheridge
Evans
Everett
Farr
Fattah
Fletcher
Foley
Forbes
Ford
Fossella
Frank (MA)
Franks (NJ)
Frelinghuysen
Frost
Gallegly
Ganske
Gejdenson
Gephardt
Gibbons
Gilchrest
Gillmor
Gilman
Gonzalez
Goode
Goodlatte
Gordon
Graham
Granger
Green (TX)
Green (WI)
Greenwood
Hall (OH)
Hall (TX)
Hansen
Hayes
Hefley
Hill (IN)
Hill (MT)
Hilleary
Hilliard
Hinchey
Hinojosa
Hoeffel
Holden
Hooley
Horn
Hoyer
Hulshof
Hunter
Hutchinson
Hyde
Isakson
Istook
Jackson-Lee (TX)
Jefferson
Jenkins
John
Johnson, E. B.
Jones (NC)
Kanjorski
Kaptur
Kasich
Kelly
Kennedy
Kildee
Kind (WI)
King (NY)
Kleczka
Kolbe
Kucinich
Kuykendall
LaFalce
Lampson
Lantos
LaTourette
Lazio
Leach
Levin
Lewis (CA)
Lewis (KY)
Linder
Lipinski
LoBiondo
Lucas (KY)
Lucas (OK)
Maloney (CT)
Maloney (NY)
Manzullo
Mascara
Matsui
McCarthy (NY)
McCollum
McDermott
McGovern
McIntyre
McKinney
Meehan
Menendez
Mica
Miller (FL)
Moakley
Mollohan
Moore
Moran (KS)
Moran (VA)
Morella
Murtha
Nadler
Napolitano
Neal
Nethercutt
Ney
Norwood
Oberstar
Obey
Olver
Ortiz
Ose
Pallone
Pascrell
Pastor
Paul
Payne
Peterson (MN)
Peterson (PA)
Petri
Phelps
Pickering
Pickett
Pombo
Porter
Price (NC)
Rahall
Regula
Reyes
Reynolds
Riley
Rivers
Rodriguez
Roemer
Rogan
Rohrabacher
Ros-Lehtinen
Rothman
Roukema
Royce
Rush
Ryan (WI)
Salmon
Sanders
Sandlin
Sawyer
Saxton
Scarborough
Scott
Serrano
Sessions
Shaw
Shimkus
Shows
Simpson
Sisisky
Skelton
Slaughter
Smith (MI)
Smith (NJ)
Smith (TX)
Snyder
Souder
Spratt
Stabenow
Stenholm
Strickland
Stupak
Sweeney
Talent
Tancredo
Tanner
Tauscher
Tauzin
Taylor (MS)
Thompson (CA)
Thompson (MS)
Thornberry
Thune
Tierney
Traficant
Turner
Udall (CO)
Udall (NM)
Upton
Vitter
Wamp
Weiner
Weldon (FL)
Weller
Weygand
Whitfield
Wicker
Wilson
Wise
Wolf
Wu
Wynn
NOES--136
Armey
Baird
Baldwin
Ballenger
Barrett (NE)
Barrett (WI)
Barton
Bass
Bateman
Bereuter
Berkley
Berman
Biggert
Bilirakis
Bliley
Blunt
Boehner
Bonilla
Bono
Brady (TX)
Burton
Buyer
Cannon
Capps
Castle
Chabot
Coble
Coburn
Combest
Cox
Crane
Cunningham
DeGette
DeLay
DeMint
Deutsch
Dixon
Doggett
Dooley
Dreier
Dunn
Ehlers
Eshoo
Ewing
Gekas
Goodling
Goss
Gutierrez
Gutknecht
Hastings (FL)
Hayworth
Herger
Hobson
Hoekstra
Holt
Hostettler
Houghton
Inslee
Jackson (IL)
Johnson (CT)
Jones (OH)
Kilpatrick
Kingston
Knollenberg
LaHood
Largent
Larson
Latham
Lee
Lewis (GA)
Lofgren
Lowey
Luther
McCarthy (MO)
McCrery
McHugh
McInnis
McKeon
Meeks (NY)
Millender-McDonald
Miller, Gary
Miller, George
Minge
Mink
Myrick
Northup
Nussle
Oxley
Packard
Pease
Pelosi
Pitts
Pomeroy
Portman
Pryce (OH)
Quinn
Radanovich
Ramstad
Rangel
Rogers
Roybal-Allard
Ryun (KS)
Sabo
Sanchez
Sanford
Schaffer
Schakowsky
Sensenbrenner
Shadegg
Shays
Sherman
Sherwood
Skeen
Smith (WA)
Stearns
Stump
Sununu
Terry
Thomas
Thurman
Tiahrt
Toomey
Towns
Velazquez
Visclosky
Walden
Walsh
Waters
Watkins
Watt (NC)
Watts (OK)
Waxman
Weldon (PA)
Wexler
Woolsey
Young (AK)
ANSWERED ``PRESENT''--2
Becerra
Owens
NOT VOTING--20
Archer
Clay
Cook
Filner
Fowler
Hastings (WA)
Johnson, Sam
Klink
Markey
Martinez
McIntosh
McNulty
Meek (FL)
Metcalf
Shuster
Spence
Stark
Taylor (NC)
Vento
Young (FL)
{time} 0157
Mr. THOMAS changed his vote from ``aye'' to ``no.''
Mr. ROYCE and Mr. PORTER changed their vote from ``no'' to ``aye.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________