[Congressional Record Volume 147, Number 33 (Tuesday, March 13, 2001)]
[House]
[Pages H870-H874]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     PATIENTS' BILL OF RIGHTS, PATIENT PROTECTIONS, AND HMO REFORM

  The SPEAKER pro tempore (Mrs. Capito). Under the Speaker's announced 
policy of January 3, 2001, the gentleman from Iowa (Mr. Ganske) is 
recognized for 60 minutes.
  Mr. GANSKE. Madam Speaker, I appreciate the fervor and emotion that 
my colleague just spoke about, especially in dealing with the death tax 
situation, because we have many people back in my home State of Iowa 
that need this type of relief if, in fact, they are going to pass on 
their family farms to their children. The way that that tax is 
calculated and who the benefit goes to can be done many ways. One can 
say the benefit goes to the person who dies, and that person may have 
some considerable assets; but in actuality, it is the person who 
inherits that has to pay the tax, and if we look at who these people 
are, very, very frequently, they do not have assets. They are not rich, 
and then they end up having to sell off half of the farm in order to 
pay the Federal taxes. I think that needs to be fixed.
  Madam Speaker, I want to speak tonight on an issue that I find 
emotional too, and that has to do with the Patients' Bill of Rights and 
patient protections as it relates to HMOs.
  Madam Speaker, about a week ago I was in my apartment here in 
Washington watching C-SPAN; and there was a panel on, a panel of former 
Members of Congress, and they were being interviewed and giving 
comments about what they thought would happen this year in the 
legislative arena. And these pundits were giving their opinions on tax 
cuts and prescription drug benefits and other things, and then one of 
the panelists said something. He said, ``You know, I think this deal 
about patient protection doesn't need to be done. You know, I really 
don't know anyone who has been harmed by HMOs.'' Madam Speaker, I 
nearly fell off my sofa. I nearly fell off my sofa when this pundit, 
this former Member of Congress said, ``You know, who needs patient 
protection, HMO reform because, after all, nobody is being hurt.'' I 
thought to myself, what world is that man living in? What world is that 
man living in?
  I thought, does he not read the newspapers? Does he not see stories 
like this: ``What his parents didn't know about HMOs may have killed 
this baby.'' Maybe this former Member of Congress, who I happen to 
know; he is a friend, he is a fine man, but I am thinking to myself, 
how could he make this comment?
  Does he not see newspapers like this: ``HMOs' cruel rules leave her 
dying for the doc she needs.'' Where has he been?
  Madam Speaker, before coming to Congress, I was a reconstructive 
surgeon. I took care of lots of babies that were born with congenital 
defects like this cleft lip and cleft palate. Fifty percent of the 
reconstructive surgeons in the country in the last 2 years have had 
cases like this denied by HMOs as not being medically necessary. What 
world does that man live in? I thought to myself, well, maybe he does 
not read the national news magazines. Maybe he did not see the cover on 
Time Magazine that featured this family with this little girl, this 
little boy, a husband, a mother that documented how the mother died 
because the HMO inappropriately denied care. Maybe he does not live in 
that world. Maybe he does not read Time Magazine.
  I thought to myself, maybe he does not read The Washington Post. Most 
people in Washington do, especially former Members, but maybe he does 
not. Maybe he did not see the cover story in the Washington Post about 
this young lady who was hiking 40 miles west of here, fell off a cliff, 
broke her arm, her pelvis, stunned, fractured her skull, laying there 
at the bottom of the cliff. Her boyfriend phones in the air flight. 
They take her to the emergency room. She is treated, and then the HMO 
does not pay her bill because she did not phone ahead for prior 
authorization. I thought to myself, what world does this man live in?
  I thought to myself, maybe this former Member of Congress has not 
been watching any of the debates on the floor of Congress. Maybe he has 
not been following the Patients' Bill of Rights, the debate that we 
had. Maybe he did not bother to watch the debate we had on the floor 
when sitting right in that chair was this little boy a few years 
afterwards. This little boy when he was about 6 had a high fever one 
night, like about 104 or 105, so his mother phones the HMO, she is told 
to take him to this one hospital, the only one that is authorized, 
about 70 miles away, he has a cardiac arrest on the way, he ends up 
with gangrene in both hands and both feet, and this is what happens 
when you have gangrene in both hands and both feet. They have to be 
amputated. I thought, maybe that man had not watched our debate here on 
the floor. What world is he living in?
  But I will tell my colleagues this: this little boy who, when he came 
to the floor for that debate, was now about 6 or 7, pulls on his leg 
prostheses with his arm stumps. But do my colleagues know what? This 
little boy is real; and if he had a finger, Madam Speaker, and we could 
prick it, he would bleed. And if he had a hand, some day he would be 
able to caress the cheek of the woman that he loves, and maybe he would 
be able to play basketball. But do my colleagues know what? According 
to this pundit, this former Member of Congress sitting on this panel, 
after all, there is not anyone being injured by HMOs; it is just 
baloney.

                              {time}  2115

  Madam Speaker, I beg to differ. People come up to me all the time 
here in Washington and back home in Iowa. They tell me about stories 
like this, how it is affecting them or their family.
  Just a few days ago, about a 48-year-old woman came up to me. She had 
had a mastectomy for cancer. She had been going through chemotherapy. 
Her physician had recommended that she have an important test to see 
whether the tumor had returned. Her HMO denied it. She came up to me in 
tears in Des Moines, Iowa. She battled that HMO through an internal 
review and finally they said yes. Then, when she was going to go for 
her test, they pulled the rug from underneath her and they said no.
  She said, Greg, I had to do something I have never done before. I had 
to ask my husband to carry on for me on this fight, because that HMO 
has just worn me out. I asked my husband to carry on this fight because 
I didn't have the energy. I don't have the energy anymore to fight that 
HMO.
  Do Members know what? If that woman dies because she has not gotten 
her test, what is the HMO out? Nothing, because she is dead. That is 
not fair and that is not justice. I beg the pardon of that pundit who 
was on that panel, that man who I like but who does not seem to 
understand or has been insulated in some way from what has gone on 
everywhere else in this country.
  Why do Members think the biggest line in the movie As Good as It Gets 
was when Helen Hunt tells Jack Nicholson, ``You know, that HMO is just 
preventing my son with asthma from getting the care that he needs.'' 
Then she went into a long string of expletives.
  My wife and I were in the theater that night. We saw something we had

[[Page H871]]

never seen before: People stood up and clapped. What world is that man 
living in?
  Well, Mr. Speaker, Members on both sides of the aisle in both Houses 
who have been fighting for 5 or 6 years now to get a strong Patients' 
Bill of Rights passed, they will not give up, because we know that this 
is affecting millions of people every day on decisions that some HMOs 
are making.
  We need to fix that. We need to fix that here in Washington, because 
this problem was started by Washington. It was started right here in 
1974, when Congress passed a law which took that oversight of insurance 
plans away from the States, for heaven's sake, where it had been for 
200 years, took it away from the States under a bill called the 
Employee Retirement Income Security Act, ERISA; they took it away from 
the States and put nothing in its place, and basically gave immunity to 
health plans, employer health plans, from the consequences of their 
decisions, an immunity that no other industry in this country has.
  Madam Speaker, I sit on the Committee on Commerce. Last year we heard 
testimony on the tire problem, where tires were blowing out. At last 
count, there were about 118 people killed from that. Madam Speaker, 
what do Members think would happen if Congress passed a law that gave 
legal immunity to tire makers? Why, we would be run out of Washington 
on a rail.
  Yet, we are dealing with today a law that gives an HMO that makes 
this kind of decision that results in this kind of injury for somebody 
who gets their insurance from their employer a free ride. It needs to 
be fixed. It needs to be fixed.
  It is a pretty difficult fight. The HMO industry, their business 
allies, and some in Congress have fought this tooth and nail. They have 
spent $100 million at least trying to prevent the Patients' Bill of 
Rights from actually becoming law.
  Our first victory, though, came in 1999 when the House overwhelmingly 
passed the bipartisan bill that I and my colleague, a conservative 
Republican, the gentleman from Georgia (Mr. Norwood), and a Democrat, 
the gentleman from Michigan (Mr. Dingell), wrote. We passed that bill 
by a vote of 275 to 151 in the face of very stiff HMO industry 
opposition.
  For the last 6 months, the gentleman from Michigan (Mr. Dingell), the 
gentleman from Georgia (Mr. Norwood), and I rewrote our bill. We 
negotiated with Senator McCain to bring him into this fight. On 
February 6, we introduced our bill, H.R. 526, the Bipartisan Patient 
Protection Act of 2001, and Senators McCain, Edwards and Kennedy 
introduced a companion bill in the Senate.
  Madam Speaker, this bill represents a meaningful bipartisan 
compromise on patient's rights issues such as scope, who does the bill 
cover; plan accountability; employer liability.
  I want to go into some more detail. My bill, the Ganske-Dingell bill, 
includes the basic protections that need to be addressed in this 
debate, such as the right to choose one's own doctor; protections 
against one's doctor being gagged by HMOs, not being able to tell us 
the whole story; access to specialists, such as pediatricians and 
obstetrician-gynecologists; access to emergency care; access to plan 
information, so we know what is going on in the plan.
  My bill covers all 190 million Americans in private insurance, 
including ERISA plans, non-Federal government plans, and plans in the 
individual market. The bill addresses the concerns of those who want to 
protect States' rights by allowing States to demonstrate that their 
insurance laws are at least substantially equivalent to the new Federal 
standards, thereby leaving in place equivalent or stronger State laws. 
States can continue to enforce their patient protection laws under our 
bill.
  Under our bipartisan bill, patients would be assured that doctors can 
make medical decisions involving the medical care. When a plan denies 
coverage, a patient would have the ability to pursue an independent 
review of the plan's decision by a panel of medical experts, 
independent of the health plan. That decision would be binding on the 
plan.
  Our bill outlines a new compromise on liability, a new compromise on 
liability that provides for meaningful accountability for injured 
patients. We took the lead from the Supreme Court in its case Pegram v. 
Hedrich, and addressed the desire of multistate employer plans for 
uniformity of benefit decisions.
  The new bill creates a bifurcated Federal and State liability system. 
Injured patients can hold health plans accountable in State court for 
disputes involving the quality of medical care, those involving medical 
necessity decisions. However, patients who were injured by a plan's 
administrative nonmedical decision to deny benefits or coverage would 
proceed to Federal court, and additionally, punitive damages are 
prohibited in State court unless the plan shows a willful or a wanton 
disregard for patients' rights or safety.
  Our bill also addresses other concerns raised by the bill that passed 
the House in 1999. For instance, our new bill says, ``Employers may not 
be held liable unless they `directly participate' in a decision to deny 
benefits that result in injury or death.''
  Madam Speaker, I have talked to business groups all across the State 
of Iowa, employers who run small businesses. I asked them, I say, 
``When you hire an HMO to provide a health plan for your family and for 
your employees, do you as an employer ever get involved in the medical 
decision-making?'' And they say, ``Not on your life. Number one, it is 
a privacy issue. We do not want to know what is happening to our 
employees in their private medical life. We do not want them to know 
what is going on in our family, either. But we do not get involved in 
that.''
  Under our bill, Madam Speaker, that employer cannot be held liable. 
In recent months, the debate on patient protection has focused on 
whether or not and to what extent we should hold HMOs accountable when 
they make medical decisions that harm patients, or even cause them to 
die.
  In recent weeks, congressional offices have been inundated, as I am 
sure the gentlewoman's office has, Madam Speaker, with messages 
opposing a strong patient protection bill of rights like our Bipartisan 
Patient Protection Act of 2001.
  I feel, Madam Speaker, that our colleagues need to hear the truth 
about the liability provisions in our bill, and why I have included 
those liability provisions in our bill.
  Madam Speaker, many opponents to liability provisions in patient 
protection bills such as the Ganske-Dingell bill say, Why do we need 
them in the first place? Well, the goal of the liability provision is 
to ensure that patients receive the proper health care when they need 
it, and that a patient has a right to redress when the plan makes a 
medical decision to deny a claim for benefits and causes injury or 
death.
  Under current law, as I said, the patient has access to an internal 
review process. If there is still a dispute upon conclusion of the 
plan's internal process, the patient may only seek the value of the 
benefit in Federal court under section 502 of ERISA. There is no 
provision under current law for consequential damages caused by the 
failure to provide the benefit, whether or not there was an injury.
  Some States, however, have passed provisions that would allow the 
patient to hold some health plans accountable in State court for 
failing to provide adequate care.
  Madam Speaker, under our new liability provision, when a patient is 
denied a benefit, he or she will have access to a swift internal review 
process and a strong independent external review process to help settle 
disputes, and that, in the vast majority of times, will get the patient 
appropriate care.
  If the patient feels he or she is owed a benefit under the review 
process, they will have access to existing 502 ERISA remedies in 
Federal court to seek the benefit, but not other damages. In those rare 
cases when a patient suffers harm or death as a result of the plan's 
action, a patient will have access to Federal court under ERISA section 
502 if the dispute was a purely administrative contractual decision. In 
order to prevail and recover limited damages, the patient would need to 
show that the plan acted negligently in making the decision, and that 
the decision caused the patient's injury or death.

[[Page H872]]

  But, Madam Speaker, if the dispute involves a medically-reviewable 
decision, the patient will be able to seek redress in State court under 
applicable State law. Generally, our bill prohibits punitive damages if 
the health plan follows the review process and follows the 
determination of the external review entity.
  In our new bifurcated Federal-State liability, this is a significant 
compromise. It is a significant move from the State cause of action in 
the original bill that passed the House, the Norwood-Dingell-Ganske 
bill, in 1999. Our original language did not change the existing remedy 
in section 502 of ERISA. Rather, it simply clarified that State causes 
of action were not preempted under section 514.
  The business and insurance industry raised concerns that this 
approach would inhibit their ability to administer a multistate 
employee health benefit plan.

                              {time}  2130

  Madam Speaker, we made the step towards the business community. Our 
new bill answers that concern by leaving suits involving benefit 
administration in Federal court under section 502, thereby allowing 
employers and insurers to have uniformity in administering their health 
plans across State lines.
  The first part of the liability section in our bill adds to that 
existing Federal remedy under section 502. Under this new Federal cause 
of action, a plaintiff may seek both economic and noneconomic damages. 
By excluding medically reviewable decisions from the Federal remedy, 
group health plans will only be subject to liability under section 502 
for benefit administrative decisions. That includes decisions such as 
whether a patient is eligible for coverage, whether a benefit is part 
of the plan or other purely administrative contract decisions.
  Punitive damages are not allowed under the Federal cause of action. A 
civil assessment can be awarded upon showing clear and convincing 
evidence that the plan acted in bad faith. That standard carries a high 
burden of proof and is consistent with State statutes for the award of 
damages. That standard ensures a health plan will not be subject to 
these damages for simply making a wrong decision.
  The patient would have to show that the plan has demonstrated 
flagrant disregard for health and safety in order for the plan to be 
liable. Madam Speaker, before exercising that legal remedy, the patient 
would have to exhaust both internal and external appeals processes.
  If the patient suffers irreparable harm or death prior to completion 
of the process, the patient or the plan can continue the review process 
and the court can consider the outcome.
  The second part of the liability section in the Ganske-Dingell bill 
amends ERISA section 514 to allow cause of actions in State court for a 
denial of a claim for benefits involving a medically reviewable 
decision, a medically reviewable decision that causes harm or death to 
a patient.
  In our bill, punitive damages are prohibited in cases where the plan 
follows the requirements of the appeal processes. That provision 
protects plans and businesses when they follow the decision of the 
external review panel.
  But I ask, Madam Speaker, if an industry exhibited a willful and 
wanton disregard for safety, would you grant them immunity? Under 
current ERISA law, they have it. We simply say in this section that if 
they exhibit willful and wanton disregard for safety that they would be 
liable if it results in an injury.
  The Ganske-Dingell bill removes the preemption of State law in ERISA 
514. That allows injured patients to bring a cause of action in State 
court for injuries by a medical decision.
  That new provision is a significant compromise, because it limits the 
scope of actions that can be filed in State court to those involving a 
medically reviewable decision, whereas the bill that we passed here in 
1999, the industry said that you could take contractual decisions into 
State court. We did not think our bill did that, but we were willing to 
clarify that, and that what is what we have done.
  In addition, we think that our current bill's bifurcated liability 
provision is consistent with the current direction of the courts in 
interpreting ERISA law.
  Recent Supreme Court decisions and the 5th Circuit decision involving 
Texas' health plan liability law would allow the continued development 
of State case laws. The health plan liabilities laws that have passed 
in nine States, Arizona, California, Georgia, Louisiana, Maine, 
Oklahoma, Tennessee, Texas and Washington, would not be preempted in 
our new liability provision. It would be under other bills that are 
currently being developed, and it would have been under past efforts to 
create an exclusive, and this is important, Madam Speaker, under an 
exclusive Federal remedy. All of those preempt State law.
  Our new bill further clarifies that employers are protected from 
liability in either Federal or State court, unless they directly 
participate in a denial that causes death or harm.
  Madam Speaker, that ``direct participation'' standard was developed 
by the gentleman from Tennessee (Mr. Hilleary) and later used in the 
Coburn-Shadegg substitute. The business and the insurance communities 
said the previous Norwood-Dingell language was too broad because it 
held employers harmless unless they exercised discretionary authority 
to make a decision on a particular claim.
  In a spirit of bipartisan compromise, we rewrote the section. We 
moved towards our critics. But what did they do? They took a step away. 
They trashed our bill again. Talk about a moving goal post.
  In addition to the direct participation protection, our bill 
specifically lists decisions that are not considered direct 
participation. Those specific actions include the employer selection of 
the group health plan, which plan they choose, the health insurance 
issuer, third-party administrator or other agent, employers are 
protected in any cost benefit analysis undertaken by the selection of 
the plan.

  They are protected for any participation in the process of creating, 
continuing, modifying or terminating the plan or any benefit, and they 
are protected for any participation in the design of any benefit under 
the plan. There are additional protections for employers who advocate, 
who advocate on behalf of an employee in the appeals process.
  Furthermore, our bill clarifies existing ERISA law to make certain 
that a group health plan can purchase insurance to cover losses 
incurred from suits under this title, just as any medical health 
professional would do when they know that they are responsible for 
making medical decisions.
  Madam Speaker, recently President Bush sent a letter to Congress 
outlining his principles for patient protection legislation. And while 
the President's principles were in nature general, I was pleased to 
note that our bill met almost all of the President's stated goals, and 
those goals included providing comprehensive patient protections, 
applying those protections to all Americans. That is a significant 
improvement over what we saw in the Senate last time, a review process 
where doctors make medical decisions and patients receive care in a 
timely fashion and protections for employers, but the President calls 
for only allowing Federal lawsuits.
  Madam Speaker, such an action would preempt State patient protection 
laws, including those in Texas, and would treat HMOs differently than 
all other businesses that could hurt people.
  Madam Speaker, I do not know how you can move everything into Federal 
court and then say at the same time that you are preserving State law. 
How do you stand, Madam Speaker, in two places at the same time?
  As with the President's stated goals, our Ganske-Dingell Bipartisan 
Patient Protection Act provides patient protections for all Americans, 
as I said. In addition, our bill empowers governors to certify their 
State's patient protections provisions as being equivalent to the 
Federal floor through a process similar to the one for participation in 
the State children's health insurance program, so that States can 
continue to enforce their own laws for their citizens.
  In addition, our bill has every one of the patients protections 
listed in the President's statement of principles, emergency room care, 
OB/GYNs for

[[Page H873]]

women, prescription drug coverage, clinical trials, pediatricians, 
stopping gag clauses, health plan information choices and continuity of 
care.
  Our bill provides for a quick internal, independent external review 
process modeled after the strong Texas medical care review process, 
because getting prompt medical care is the goal of our bill. Our bill 
requires exhaustion of the review process. Only if a patient dies or is 
irreparably harmed can a family go to court before the review is 
completed.
  Madam Speaker, it has never been clear to me how you can write a 
provision that says you have to go through an appeals process before 
you can go to court when the initial decision can result in an injury 
in a result such as this.
  This mother and father did not have a chance to go through an 
internal or an external appeal process before their little boy had his 
cardiac arrest en route to the hospital and developed gangrene and had 
to have both hands and both feet amputated. But under our bill, because 
he suffered irreparable harm, that HMO would be accountable, and it 
should be accountable.
  Anyone who tries to pass a law that gives a free skate to a health 
plan on a case like this I would say is ignoring the scales of justice.
  Madam Speaker, I look forward to working with President Bush and my 
colleagues to ensure swift passage of the Patient Protection Act so 
that the President can sign into law patient protection legislation as 
he so frequently talked about during his Presidential campaign.
  The HMO industry has made alot of allegations. One of the things that 
they have talked about is that employers would be subject to a 
multitude of frivolous lawsuits. We have already spoken alot about 
that.
  As I have said, our bill would allow employers to be liable only, 
only if they have entered into the decision-making.
  Another HMO allegation is that with a strong appeals process there is 
no need for legal accountability for managed care. Madam Speaker, who 
are they kidding?
  Look, they have legal accountability in Texas, and they need it. 
There is a case in Texas where a man was suicidal in the hospital. His 
doctor said that he needed to stay in the hospital. His HMO said, no, 
he does not; he can stay if his family wants to pay for it, but we are 
discharging him. So the family took him home, and that night he drank 
half a gallon of antifreeze, and he died.
  It is important that Texas has that accountability, that legal, that 
liability provision. Because the way that their appeals process is 
supposed to work is that if there is a dispute between the treating 
doctor and the health plan and it is in a case like this where 
something bad could happen immediately, then it goes to an expedited 
review before the HMO can kick out the patient, but the HMO just 
ignored it.
  The HMO just ignored Texas law. And in that situation, that is why 
you need at the end of the day accountability and liability for a 
health plan that makes that kind of decision that results in a man 
going home and drinking half a gallon of antifreeze and dying.
  These are real cases. How about a patient who sustained injuries to 
his neck and spine from a motorcycle accident? After which, he was 
taken to the hospital. The hospital's physicians recommended immediate 
surgery, but the health plan refused to certify. The surgery had to be 
canceled. Soon afterwards, the insurer did agree to pay, but by then 
the patient was paralyzed.
  Are you going to tell me that that patient who is going to spend the 
rest of his life paralyzed does not have his right to a day in court 
because he did not have the time to go through an external appeals 
process?

                              {time}  2145

  How about the patient who was admitted to the emergency room of his 
community hospital complaining of paralysis and numbness of his 
extremities. The treating emergency room physician concluded that the 
gravity of the patient's neurological condition necessitated his 
immediate transfer to an academic hospital and made the arrangements. 
The health plan denied the authorization and recommended others.
  By the time the physician was able to have the patient transferred, 
the patient had sustained permanent quadriplegia, could not move both 
arms or his legs, paralyzed from the neck down.
  Now, that patient did not have a chance to go through an internal and 
an external appeals process, but he sure as heck did suffer irreparable 
harm. Our bill handles that situation. The opposition's do not.
  Another HMO industry allegation is that the Ganske-Dingell bill 
liability provision would significantly increase the cost of health 
insurance. The truth of that allegation is blown way out of proportion. 
They always say, yes, if the cost goes up so much, then so many people 
are going to lose their insurance.
  The Congressional Budget Office scored other liability provisions 
such as that contained in the Norwood-Dingell bill that passed in the 
106th Congress, showing that premiums would rise about 4.1 percent over 
5 years. Critics of our bill pounced on that, that costs were going to 
skyrocket. But they were wrong.
  The part of the bill that costs the most was not the liability 
provision. It was the section designed to prevent the lawsuits that is 
common to all of the patient legislation plans that we have seen, and 
that was the internal and external review sections.
  In addition, the HMO industry failed to note that the total CBO 
projection was spread over 5 years with virtually no cost in the first 
year and about 1 percent per year after that up to 4 percent total. 
Now, compare that with the average 7 percent annual increases in recent 
years by the HMO industry itself.
  Opponents have cited an ever-changing and ridiculously wide range of 
job loss figures for every 1 percent increase in cost. First, the 
opponents of legal accountability cite the figures that 400,000 
individuals would lose their health coverage for every 1 percent 
increase in premiums. When the GAO challenged that figure, saying that 
it was based on outdated information and did not account for all the 
relevant factors, opponents lowered the job loss figure to 300,000 for 
every 1 percent.
  Again, the GAO looked at this and caused opponents to lower their 
estimate a second time to 200,000. However, none of those predictions 
have come to pass. For example, between 1988 and 1996 the number of 
workers offered coverage actually increased despite premium increases 
each year.
  Now, the next allegation I will answer is that consumer support for 
patient protection evaporates when they learn that it will cost them 
some additional premiums. This is another one of the HMO industry's 
distortions. Patients want a real enforceable patient protection Bill 
of Rights, and they are willing to pay something for it.
  A 1998 nationwide survey by Penn, Schoen & Berland showed that 86 
percent of the public support a bill that would give patients' health 
plan legal accountability, access to specialists, emergency services, 
and point of service coverage. When asked if they would support a bill 
if their premiums increased between $1 and $4 a month, 78 percent 
supported the bill.
  Madam Speaker, the House-passed bill, the Norwood-Dingell-Ganske 
bill, would have raised insurance premiums an average of 4.1 percent. 
That would have meant increases in employee premiums of about $1.36 per 
month for an individual and $3.75 a month for a family member.
  Finally, I want to dispel the allegation that patients are satisfied 
with the quality of care being provided by HMOs. HMOs frequently do 
these surveys of their membership, and they come up with some figure 
like 80 percent of the enrollees are happy with their care or 
satisfied. What they fail to point out is that these are all the 
healthy people in their plan who are not utilizing the plan.
  I mean, does anyone think, when they saw that movie ``As Good As It 
Gets'' and saw the response to Helen Hunt's descriptor of her HMO that 
the public is not aware of this?
  A recent public opinion survey found that most Americans believed 
problems with managed care have not improved, 74 percent. Most think 
that legislative action is either more urgent or equally as urgent as 
when this debate

[[Page H874]]

began, 88 percent. A 1999 survey of physicians and nurses reported that 
72 percent of physicians and 78 percent of nurses believed that managed 
care has decreased the quality of care for people who are sick.
  In addition, Republican pollster, Linda Divall, did a post-election 
poll right after this last election of issues that the new President 
and the newly elected Congress should work together on to accomplish 
for the good of the country. In every group, men, stay-at-home moms, 
working women, a Patients' Bill of Rights was at the top of the list.
  Madam Speaker, the American public wants and deserves a strong 
patient Bill of Rights now, this year. It is time for us to put on the 
President's desk a bill like the Ganske-Dingell bill or the McCain-
Edwards bill. We need to get it signed into law, Madam Speaker.
  Millions of people are having decisions that HMOs are making today. 
To go back to what I started about at the beginning of the speech, for 
anyone to say that people are not having any problems with HMO, I would 
just have to say, what world are they living in?

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