[Congressional Record Volume 146, Number 87 (Monday, July 10, 2000)]
[Extensions of Remarks]
[Page E1191]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               QUALITY HEALTH-CARE COALITION ACT OF 2000

                                 ______
                                 

                               speech of

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                        Thursday, June 29, 2000

       The House in Committee of the Whole House on the State of 
     the Union 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:

  Mr. STARK. Mr. Chairman, the fact that we are considering this 
legislation on the House floor today is a testament to the Republican 
leadership's lack of desire to deal with the real problems consumers 
are facing from managed care.
  We passed a bipartisan Patients' Bill of Rights last October, the 
conference was appointed nearly four months ago--but we have made 
precious little progress on that important legislation that is already 
so long overdue.
  That is what we should be debating on the House floor today. We 
should be debating extending patient protections to consumers to ensure 
that health plans cover emergency room care, that women have an 
unfettered right to ob/gyn care, that health plans are required to 
provide their members with access to specialists, that patients be 
guaranteed access to an independent external appeals, and that patients 
could hold health plans liable if their actions caused harm or death.
  Instead, we are faced with a bill that does absolutely nothing to 
protect consumers in managed care--but does wonders to protect doctors' 
incomes.
  I guess we shouldn't be surprised. This Republican Congress has shown 
us time and time again that they are far more interested in helping 
their monied friends and supporters than the general public.
  On its face, this legislation raises numerous concerns. A simple look 
at the exceptions in the bill makes it clear that anti-trust exemptions 
fraught with potential problems.
  It Exempts Federal Health Programs. In order to get the bill out of 
the Judiciary Committee the bill's supporters had to accept an 
amendment to exclude Medicare, Medicaid, the Federal Employees Health 
Benefits Plan, the State Children's Health Insurance Program, Veterans 
Health services, Indian Health Services and all other federal health 
programs from the law.
  The reason for this amendment was that Congressional Budget Office 
analysis showed that the bill would impact federal spending for these 
programs by increasing expenditures by some $11.3 billion over 10 
years.
  Managed care plays a major role in most of these programs today. By 
allowing doctors to collectively bargain with managed care plans, CBO 
estimates that rates will increase by 15 percent. If the law applied to 
federal health programs it would obviously impact federal health 
spending. The supporters of the bill don't want to acknowledge the real 
costs associated with passage of this bill so they exempt federal 
programs from it.
  Even with federal health programs exempted, CBO found that passage of 
the bill would decrease federal tax revenues by some $3.6 billion over 
ten years. Those federal losses come about because employers would 
claim larger deductions for the increased expense of providing health 
benefits (because of the increased bargaining power of doctors). This 
would also result in employees receiving a greater share of 
compensation in tax-sheltered benefits.
  The law sunsets after three years. In another attempt to gain 
support, the bill has a provision that would automatically sunset the 
law after three years. This sunset provision is a direct 
acknowledgement of the concern that granting anti-trust exemptions is a 
dramatic move. The fact is that we don't know exactly how much strength 
doctors would exert through this new found ability to collectively 
bargain. It may be that they would exercise restraint and put the 
quality of care of their patients first. Then again, they might 
exercise united power by refusing to contract with health plans that 
won't meet their demands--whatever those demands might be.
  Should the latter occur, the impact on patient care could be 
devastating. Therefore, the authors are acknowledging that an escape 
hatch might be necessary. I'd rather not open such a risky door in the 
first place.
  After all of these strong statements, I must also acknowledge that I 
understand and empathize with the frustration of America's physicians 
and other health care providers. The growth of managed care has 
significantly altered their professions in ways in which we could not 
have imagined even 10 years ago. And, much of this change has not been 
good for patients or health care providers. Congress can and should 
take action to address those concerns, but this bill isn't the 
solution.
  Instead, I urge Congress to move forward with passage of the 
Patients' Bill of Rights which would limit health plans' abilities to 
use financial incentives, eliminate gag clauses, and finally extend 
liability already faced by doctors and hospitals to the health plans 
that are making many of today's medical decisions.
  Many of my colleagues may not know that I was voted the most fiscally 
conservative Democrat this year by the National Taxpayer's Union. In 
the spirit of maintaining my standing of strong fiscal responsibility--
and on the many additional grounds I've mentioned--I strongly oppose 
H.R. 1304 and urge my colleagues to join with me in opposition to this 
so-called managed care ``solution'' that is fraught with such serious 
flaws.

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