[Congressional Record Volume 147, Number 76 (Tuesday, June 5, 2001)]
[House]
[Pages H2866-H2871]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2001, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, once again this evening, as we are back 
from the Memorial Day break, I would like to take up the issue of 
health care. As my colleagues know, I have been down here with many of 
my Democratic colleagues many times over the last few months since the 
session began and since this new administration began in January, 
basically speaking out on three major health care issues that have not 
been addressed, in my opinion, by the President and the Republican 
leadership in the Congress, and that is the need to reform HMOs and the 
need to pass a Patients' Bill of Rights that would reform HMOs.
  There are so many problems that people now have with their HMO or 
their managed care organization in not having proper access to care, 
not being able to go to the hospital of their choice, not being able 
to, if they have a grievance, have an independent review of the 
decision by the HMO to deny them care; and I will get into this more 
this evening.
  The second issue is the need for a Medicare prescription drug 
benefit. When I go home, and I was home for the last 10 days in New 
Jersey, my seniors and my constituents complained more about the high 
cost of drugs and how they cannot pay for prescription drugs and that 
it should be included in Medicare. I agree, and that needs to be 
addressed.
  The third issue is access for the uninsured. More Americans every day 
have no health insurance. Most of those are working people, and we need 
to find ways to address those concerns and have them insured and 
covered for their health care.
  My point tonight, and I would like to yield now to some of my 
colleagues, but my point tonight is that we really face, I hope, a 
different situation tomorrow here in the Congress, here in Washington, 
because of the change in the other body, in the Senate. I have watched 
over the last 4 or 5 months, and during the course of the campaign, 
President Bush mentioned many times that he was going to pass a 
Patients' Bill of Rights and reform HMOs, that he was going to have a 
prescription drug benefit, that he was going to address the problem of 
people who do not have health insurance. Yet over the last 4 or 5 
months of this administration, these issues have not come to the floor, 
they have not been moved in committee in either House. The Republican 
leadership, in conjunction with the Republican President, have simply 
dropped the ball on these issues.
  I was heartened to find that during the break with the changeover in 
the Senate to Democratic control tomorrow, that the leaders in that 
body, the Democratic leaders in that body have said that the first 
order of business when they come back next week most likely, next week 
is going to be to move the Patients' Bill of Rights in the other body, 
and that that will be followed soon with these other health care 
issues.
  So finally now we may have an opportunity to get legislation passed, 
at least in the other body, on some of these issues by the Democrats 
that will come over here and force the hand, I hope, of the Republican 
leadership here and the Republican President.
  With that, Mr. Speaker, I would like to yield to the gentleman from 
Rhode Island (Mr. Langevin).

                              {time}  1915

  Mr. LANGEVIN. Mr. Speaker, I am pleased to rise and join my 
colleague, the gentleman from New Jersey (Mr. Pallone) on this 
important topic.
  Mr. Speaker, I rise to address in particular the skyrocketing price 
of prescription drugs, which is making this essential component of our 
Nation's health care system inaccessible to those who need it most.
  Older Americans, who make up 13 percent of the U.S. population, 
account for 34 percent of all prescriptions dispensed and 42 cents of 
every dollar spent on prescription drugs. The average Medicare 
beneficiary fills 18 different prescriptions per year.
  Obtaining prescription drugs is a clear necessity for our senior 
citizens. Yet, the annual spending per capita in the Medicare 
population for prescription drugs has jumped from $674 in 1996 to 
$1,539 in the year 2000, and is expected to climb to over $3,700 in 
2010.
  Overall, prescription drug prices rose 306 percent between 1981 and 
1999, while the Consumer Price Index rose just 99 percent during that 
same period. In the year 2000, total spending in the U.S. for 
prescription drugs was $116 billion, more than twice the $51 billion 
spent in 1993. That amount is expected to triple to $366 billion by 
2010. These escalating prices can and must cease.
  For every dollar that a consumer pays for a prescription drug at the 
pharmacy, 74 cents goes to the drug manufacturer, 3 cents goes to the 
wholesale distributor, and 23 cents goes to the pharmacy. In 2000, 
pharmaceutical companies had after-tax median profits of 19 percent, 
compared with 5 percent for all other Fortune 500 companies combined.
  While I recognize the importance of researching and developing 
technological advancements that have helped numerous Americans, and of 
course we all want to see this continue, I know drug manufacturers do 
not need such astronomical profits to ensure continued research.
  Mr. Speaker, let us face facts: most core research for prescription 
drugs is funded through NIH. In addition, pharmaceutical companies 
dedicate more than 18 percent of revenues to profits and 30 percent to 
marketing and administration, compared with just 12 percent to research 
and development. In fact, the 12 drug companies with the highest 
revenues spent three times as much on marketing as on R&D in 2000.
  Mr. Speaker, access to prescription drugs is critical to the survival 
and maintenance of an accessible quality of life for millions of our 
senior citizens. As we know, Medicare does not offer any prescription 
drug program, and most seniors have found that the Medicare+Choice 
program has not provided the kind of opportunities Congress thought it 
would.
  As a result, today at least one in three people in the Medicare 
population have no drug coverage at all in the course of a year, and 
nearly half have no coverage for at least part of an entire year. These 
Medicare beneficiaries spend on average 83 percent more for their 
medications than those with drug coverage. Moreover, almost half of 
Medicare beneficiaries without any form of prescription drug coverage 
have incomes less than 175 percent of the poverty level. That means 
they had incomes of $15,000 in 2001.
  That, Mr. Speaker, is why we need to require drug companies to give 
local pharmacies the best price they give their most favored customers, 
or the average foreign price, and reinstate the requirement for 
reasonable pricing on products that were researched and developed using 
taxpayer money via NIH.
  Moreover, we need to authorize the Federal government to buy drugs in 
bulk and at a discount for Medicare beneficiaries.
  And most of all, we must provide a Medicare prescription drug plan. 
While the administration's budget includes $153 billion over 10 years 
to provide for prescription drug coverage and Medicare reforms, this 
plan falls far short of a comprehensive drug coverage program.
  The 4-year Immediate Helping Hand proposal provides block grants to 
the States to help low-income seniors purchase prescription drugs, and 
then an unspecified Medicare prescription drug

[[Page H2867]]

benefit is to be developed, along with Medicare restructuring.
  According to the administration's own cost estimates, adjusted by 
CBO's projections of drug inflation, covering only the low-income 
population's prescription drugs would cost over $200 billion, almost 
$50 billion more than what has been provided in the budget.
  Furthermore, the Immediate Helping Hand program would deny 
eligibility to about 20 million Medicare beneficiaries, most of whom 
lack affordable, dependable prescription drug coverage.
  For instance, under the administration's plan, an 85-year-old widow 
with an annual income of $17,000 would receive no assistance with her 
prescription drug costs. Now that we have passed what I believe is an 
irresponsible and partisan budget, providing the kind of comprehensive 
and effective drug benefit our seniors need appears to be next to 
impossible.

  Mr. Speaker, I urge my colleagues not to forget our seniors, and to 
not neglect the American public, who is counting on us to follow 
through on a promise that was made by Democrats and Republicans alike 
to provide a quality prescription drug plan for Medicare beneficiaries.
  Mr. PALLONE. Mr. Speaker, I want to thank my colleague, the gentleman 
from Rhode Island, for his statement.
  If I could just mention two things that he brought up, which I think 
are so crucial, the whole issue is affordability. Prescription drug 
affordability is really of the utmost importance to seniors and to 
people with disabilities.
  This is what I have heard back at home the last 10 days, the last 
week or so, that seniors that have major financial problems with 
purchasing their necessary medications, they have to choose between 
paying the rent or buying food, and it is basically because of growing 
out-of-pocket expenses. Even people that have some sort of limited 
coverage because they are in an HMO or because of some kind of benefit 
they received on the job that they get in their retirement are finding 
that the out-of-pocket costs just continue to rise exponentially every 
year.
  We have done a number of studies with the Committee on Government 
Reform with the gentleman from California (Mr. Waxman) in various 
States, in various congressional districts, that have shown that drug 
manufacturers engage in widespread price discrimination, so that 
seniors are paying significantly more for their drugs than they would 
if they were in another country.
  I want to thank our colleague, the gentleman from Rhode Island (Mr. 
Langevin), for what he brought up. I think it is so important.
  I know our colleague, the gentleman from Maine (Mr. Allen), has a 
bill called the Prescription Drug Fairness Act or Fairness for Seniors 
Act that would link the price to the average farm prices in certain 
countries. Maybe he might discuss that.
  I yield to the gentleman from Maine (Mr. Allen) to have him talk 
about that. I know he has other health care issues to bring up as well.
  Mr. ALLEN. Mr. Speaker, I thank the gentleman from New Jersey (Mr. 
Pallone) for yielding to me, and I thank particularly our friend, the 
gentleman from Rhode Island (Mr. Langevin), for coming here tonight and 
speaking on this particular topic.
  We really have built strong support on the Democratic side of the 
aisle for the discount, which would be about 35 percent for all 
Medicare beneficiaries in the cost of their prescription drugs 
reflected in the bill that I have sponsored, the Prescription Drug 
Fairness for Seniors Act. Also, we know that seniors ultimately need a 
Medicare prescription drug benefit, not a private insurance company 
prescription drug benefit. That is really the choice that is presented 
between the Democratic side of the aisle and the Republican side of the 
aisle.
  If I could say a couple of things, I guess I want to go beyond the 
prescription drug issue for a moment and talk about Medicare generally. 
The American public has every reason to feel a bit confused because in 
the last election there was all this talk about prescription drug 
coverage for seniors, and there has been talk for years about Medicare 
reform. The question always is, what is contained in those little words 
``Medicare reform.''
  Well, today there is breaking news, Mr. Speaker, on health care, 
breaking news on Medicare. I guarantee the Members, it will not be on 
the evening news, it will not be covered on the front page of any 
newspaper tomorrow, but still, it is breaking news.
  It comes in a story by Robert Pear in the New York Times this 
morning. The headline is significant: ``Medicare Shift Toward HMOs Is 
Planned.'' So the question is, planned by whom? Well, planned by the 
Bush administration. Now at last we can see a little more clearly what 
this administration is up to when it comes to Medicare.
  There are many people on the Republican side of the aisle who have 
never liked Medicare because, after all, it is a government health care 
program. It takes care of our seniors. It has been there since 1965. It 
was put in place because in 1965 only one-half of all of our seniors 
had any health insurance at all. Medicare stepped in where the private 
insurance industry simply would not provide coverage to our seniors. It 
has been a success. It is there in every State. It is equal. It is 
trusted by our seniors. It is respected by our seniors.
  Well, the President has appointed and the Senate has confirmed a new 
administrator of the Health Care Financing Administration, the 
organization that runs Medicare. His name is Thomas Scully, and he made 
his first speech, significantly, at the United States Chamber of 
Commerce.
  Here is what he said: ``The government is better in the long run when 
it is a buyer of insurance, rather than an insurer.'' What did Mr. 
Scully mean by that? He meant that it would be better for our seniors 
to have private insurance than it would be to be under Medicare, under 
a Federal health care plan.
  Let us look at some of the facts. I am interested in this because the 
program that allows some, about 14 or 15 percent, of our seniors to get 
their Medicare benefits through a private insurance company has a name. 
It is called Medicare+Choice. What that Medicare+Choice refers to is 
coverage that will be obtained through HMOs.
  Now, this is wonderful, I suppose, in a few places in this country, 
particularly in our big cities, because there we may have several 
competing plans that are there to try to provide more choices to 
seniors, and in some big cities in this country it works, with an 
exception which I will note later.
  But in my home State of Maine, we do not have a single, not one, HMO 
providing insurance for our seniors. We did last year. We had one 
company which had about 1,700 beneficiaries. Two of them were my 
parents. But the insurance company decided it could not make money in 
Maine, and so it pulled out. My parents had to go looking for another 
supplementary health care insurance, causing all sorts of confusion and 
upset.

                              {time}  1930

  Well, what is happening across the country? Medicare, I would note, 
Medicare does not pull out of a State when it is not making money, but 
private insurance companies do.
  In fact, in the last 3 years, managed care plans have dropped more 
than 1.6 million Medicare beneficiaries; 1.6 million beneficiaries 
dropped. Why? Because the company could not make money off them, could 
not make money in a particular area, could not make money off some of 
our seniors who are sicker and need more help than others.
  Now, until Mr. Scully was chosen and confirmed as the administrator 
of the Health Care Financing Administration, Medicare officials have 
historically professed to be neutral. They have said we are not taking 
sides between traditional Medicare fee-for-service, which is there for 
about 75 percent of all Medicare beneficiaries, and the 15 percent who 
get their coverage through an HMO. They are trying to, over the last 
few years, the goal has been, under the Clinton-Gore administration, to 
make sure that there was a level playing field.
  But as I said, that has all changed. That has changed because Mr. 
Scully has made it perfectly clear that the government is better in the 
long run when it is a buyer of insurance rather than an insurer. In 
other words, traditional Medicare that Americans have come to rely on 
and respect and depend on because they know the benefits will not 
change every year, they know Medicare will not pack up and leave a

[[Page H2868]]

State when it is not making money, that system is now under attack from 
the administration.
  Because what Mr. Scully wants to do is he wants up to 30 percent of 
elderly patients in managed care by 2005. That means we have to reverse 
this trend of managed care companies simply dropping people. But it is 
far more significant than that.
  Mr. Scully, I suggest, has not done his homework. Why do I say that? 
Because he does not yet understand that these managed care plans cost 
more than traditional fee-for-service Medicare. As Dave Berry says, I 
am not making this up, it is right here. In a GAO report published in 
August of 2000, this is a review of Medicare+Choice plans. This is a 
review of how managed care is working in Medicare. Here is the title, 
``Payments Exceed Cost of Fee-for-Service Benefits, Adding Billions to 
Spending.'' Adding billions to spending.
  What the GAO did was to do a comparison between traditional old fee-
for-service Medicare and these new health maintenance organization 
managed care plans for our seniors. They make the point, the GAO makes 
the point that Medicare+Choice was designed to expand beneficiaries' 
health plan options, and it was supposed to improve Medicare's 
financial posture by better controlling spending growth.
  Well, lately, the industry has been saying over and over again the 
payments that we get that the health insurance industry gets under 
Medicare+Choice plans are too low. We cannot make money. That is why we 
are dropping people in Maine and all across the country.
  Well, the GAO looked at 210 of the 346 Medicare+Choice plans that 
were in operation in 1998. These plans enrolled 87 percent of all 
beneficiaries in Medicare+Choice plans. What did they find? I quote, 
``Medicare+Choice, like its predecessor managed care program, has not 
been successful in achieving Medicare savings. Medicare+Choice plans 
attracted a disproportionate selection of healthier and less-expensive 
beneficiaries relative to traditional'' fee-for-service Medicare, 
``while payment rates largely continued to reflect the . . . costs of 
beneficiaries in average health.''
  Here is the key, this is a quote right out of the GAO: ``Instead of 
paying less for health plan enrollees, we estimate that aggregate 
payments to Medicare+Choice plans in 1998 were about $5.2 billion . . . 
or approximately $1,000 per enrollee, more than if the plans' enrollees 
had received care in the traditional'' fee-for-service program. ``It is 
largely these excess payments, and not managed care efficiencies, that 
enable plans to attract beneficiaries by offering a benefit package 
that is more comprehensive than the one available to FFS,'' fee-for-
service, ``beneficiaries, while charging modest or no premiums.''
  What does that mean? It means that traditional fee-for-service 
Medicare is cheaper, $5.2 billion in 1998 alone for 15 percent of the 
elderly population. Fee-for-service is cheaper than Medicare managed 
care. So those managed care beneficiaries in this country who are 
getting prescription drug benefits are getting it, not because the 
managed care company is saving money, they are getting it because the 
managed care company is getting more money over and above what it would 
get for traditional fee-for-service beneficiaries. It is out of that 
money that the additional benefits are coming.
  We are making a huge mistake in this country because we have devised 
a system through Medicare+Choice which is going to drag the insurance 
industry into Medicare, will provide our seniors with less effective 
and fair and beneficial services at a higher cost to the taxpayer.
  Now we have the Bush administration stepping up and saying, what we 
really need in this country is more health insurance companies taking 
over Medicare. Mr. Scully is wrong. Fee-for-service Medicare, 
traditional Medicare works. What our seniors need is a system that is 
reliable and predictable and stable, something they can count on. They 
do not need insurance companies changing the benefits, reducing 
benefits one year, raising premiums the same year, pulling out of a 
State because they are not making enough money.
  Medicare needs reform, but it does not need to be taken over by HMOs. 
That is what, in his first major speech, Mr. Scully of the Health Care 
Financing Administration is saying is his goal for Medicare, to turn it 
over, to turn more and more of it over to our insurance companies. If 
he succeeds in doing that, our seniors will be worse off than they are 
today. Our taxpayers will be worse off than they are today. But the 
health insurance industry will be making more money and their stocks 
will be higher than they are today. That is what this is all about.
  At the end of the day, what Mr. Scully is suggesting is not the best 
system for our seniors, it is not the best system for consumers, it is 
the best system for the health insurance industry. That is what it is 
about. Those who gave money in the past election campaign will get 
their reward if this administration can succeed in undermining, 
changing our Medicare system that seniors have grown to depend on, and 
turning it over to private industry to make more money, more profits 
than ever before. It is abomination.
  This Congress, if we do nothing else, has got to stop this 
administration from taking Medicare apart and turning it over to the 
private sector.
  I have gone on some period of time. This is an issue I care deeply 
about. I certainly want to thank the gentleman from New Jersey (Mr. 
Pallone) for holding this event this evening and allowing all of us to 
come forward and express our views.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentleman from Maine 
(Mr. Allen) for what he said this evening. I think it is so important. 
I am amazed because I watched the Republican leadership and the 
Republican President, and it just seems sometimes I think that they are 
motivated, as the gentleman said, just because of special interests. In 
other words, the health insurance companies give a lot of money to 
their campaigns, so they want to support them.
  Other times, I think they are just stuck in this sort of right-wing 
antigovernment idealogical cloud of some sort, that they are just not 
thinking about what is practical. They just think anything that the 
government does has to be bad because idealogically they do not believe 
in the government.
  So when we have a good program like Medicare, traditional Medicare 
fee-for-service that works as effective and is actually saving money is 
a bargain, they do not want to use it, they want to tear it down. 
Whether it is their ideology, which I think is very backward, or it is 
the special interest money they are getting from the insurance company, 
the bottom line is they are just not being practical.
  If my colleagues remember last session in the previous Congress, the 
House Republican leadership tried to establish what they call a 
prescription drug-only insurance policy. In other words, rather than 
expanding Medicare and have a guaranteed benefit under Medicare for 
prescription drugs, they wanted to give people money so they can go out 
and buy a prescription drug-only policy which, again, harkens back to 
this ideology that government and Medicare cannot do the job.
  The insurance companies came before the various committees of 
jurisdiction and said, well, we do not want you to do that. We are not 
going to sell you that insurance. We had an example in the State of 
Nevada which basically did that, Republican-controlled legislature, 
that passed a bill and said, we will give you money, you go out and buy 
these drug-only policies, and nobody would sell them. So for the life 
of me, I cannot understand what they are up to.
  The same thing, as the gentleman from Maine said, with the HMOs. The 
HMOs we know are getting out of the Medicare business. They are either 
dropping seniors, or they are increasing out-of-pocket cost for 
prescription drugs so that the prescription drugs are unaffordable even 
for seniors that have the HMO.
  Why in the world would we want to go out and encourage HMOs as the 
way to address the need for prescription drug benefit? Why in the world 
would we want to suggest these insurance policies that only cover 
prescription drugs? I have not heard much about that in this Congress. 
I guess maybe they dropped that; although I am sure there are some out 
there that still want to do that.

  I mean, what the Democrats have been saying is that we want Medicare

[[Page H2869]]

to be expanded to include prescription drugs as a guaranteed benefit, 
universal benefit. When I go and talk to my seniors in New Jersey, they 
are not interested in this low-income benefit because most low-income 
seniors get some kind of drug benefit if they are covered by Medicaid. 
And in a lot of States now, not all, but many States have expanded 
coverage to cover the low income even a little bit above Medicaid, as 
is the case in New Jersey.
  The problem, though, is for the middle class, the middle-class senior 
who does not get Medicaid, is not covered by their State program 
because their income is a little too high or they do not have a State 
program, and at the same time cannot get a decent HMO policy that is 
going to cover their prescription drugs.
  So when the President says that he wants to do this low-income 
benefit, I think he calls it the helping hand, immediate helping hand, 
and it establishes block grants for States to provide for prescription 
coverage for some low-income seniors and some seniors with catastrophic 
drug costs, he would limit full prescription drug coverage to Medicare 
beneficiaries with incomes up to 35 percent above the poverty level, 
which is $11,600 for individuals, $15,700 for couples, and seniors with 
out-of-pocket prescription spending of over $6,000 per year.
  Again, this is not the problem. The middle-income senior falls above 
that $11,000 for individual, $15,000 for couples in most cases, and 
they do not have the out-of-pocket catastrophic expenses of over $6,000 
per year. Most seniors are not going to benefit from this, even if it 
got passed.
  I do not even see any movement on the part of the Republican 
leadership in either House or the President to move this anyway, so I 
do not even know why I am talking about it, because he talks about it 
during the campaign, but I do not even see an effort to move that.
  Hopefully with the Democrats now in the majority starting tomorrow in 
the other body, in the Senate, we will now see a decent prescription 
drug benefit move, get passed in the other body, and come over here 
where we can try to persuade the House Republican leadership to take it 
up.
  Let me just, Mr. Speaker, if I could give a little indication of what 
the Democrats here in the House and in the other body would like to see 
as a prescription drug benefit. We have certain principles that we have 
been espousing.
  First of all, this prescription drug benefit must be part of 
Medicare. Medicare works. It is cost effective. Let us include a 
guaranteed benefit for those who want it under Medicare.
  Secondly, it should be voluntary, just like one opts and pays a 
premium so much per month for one's doctor bills, for one's coverage of 
one's doctor bills, expenses. We would have this be a voluntary program 
where one pays a certain premium and one gets one's prescription drugs.
  Thirdly, the Democrats have been saying that the prescription drug 
benefit for seniors has to be affordable. Obviously, the premium has to 
be fairly low per month. One cannot be expected to pay a significant 
amount of money out of pocket when one goes and gets each individual 
prescription.
  It goes back to what my colleague from Rhode Island was saying about 
affordability for seniors. I also think it is important that this 
benefit be defined. In other words, Medicare beneficiaries, regardless 
of where they live, should be guaranteeing access to a defined drug 
benefit at the same standard premium.

                              {time}  1945

  You know, people have to know that the prescription drugs they need 
are included in the program. This is what the Democrats have been 
talking about.
  And we also want to build into our proposal an end to price 
discrimination. We talked a little before about the bill of my 
colleague, the gentleman from Maine (Mr. Allen); about how he wants to 
link the price more towards that charged in other countries that are 
developed countries like the United States. There are ways of dealing 
with the price discrimination issue, and that is certainly one of them.
  Another is to basically have the government, through benefit 
providers in each region, purchase and negotiate prices for the drugs 
so that we are getting volume discounts. That is certainly another way 
to try to deal with the price issue. This has got to be done.
  I was home again last week, for the last 10 days, and this is what 
our seniors are talking about. We need to take it up. Hopefully, now 
that the Democrats are in the majority in the other body, they will 
send a bill over here; and we will be able to pressure the Republican 
leadership here in the House to take up a prescription drug bill that 
helps all Medicare recipients.
  Now, I wanted to talk, if I could, Mr. Speaker, before I conclude 
this special order this evening, about two other health care issues 
which I mentioned at the beginning of this special order, and one of 
them, because of what is happening in the Senate, in the other body, is 
likely to move even quicker than a prescription drug benefit. And that 
is fine, I would like to see these important health care issues and 
this legislation get over to the House as soon as possible, and that is 
the Patients' Bill of Rights, or HMO reform.
  Again, when I talk to my constituents, regardless of age, about HMOs, 
because many people in New Jersey are in HMOs and they have become very 
concerned because many times they are denied the care that they think 
they need. Either they cannot go to a particular hospital in an 
emergency, they cannot get access to a specialist, or they are denied a 
particular operation or procedure because the insurance company, the 
HMO, says that it is too innovative. What they really mean is it is too 
expensive and they do not want to pay for it.
  The two issues that I think are so important with HMO reform, and 
which are addressed in the Patients' Bill of Rights in sort of a 
general way, is the definition of what is medically necessary; who is 
going to define whether an operation, a procedure, a hospital, a stay 
in a hospital is necessary; is it going to be the insurance company, 
which wants to save money; or is it going to be the patient and the 
physician. Because, after all, you and your physician care about your 
health.
  Basically, what the Patients' Bill of Rights does is to say that in 
general that decision is made by the physician, the health care 
professional, and the patient, not by the insurance company. They are 
the ones that that decide what is medically necessary.
  The second is if someone has been denied care, the HMO says they 
cannot have a particular procedure, they have to leave the hospital, 
what then does that individual do; how do they redress their 
grievances; where do they go. Now, unfortunately, in many cases, they 
can only go to the HMO, who have said, no, we made that decision and 
too bad. We want a procedure which allows an individual to go to an 
independent board outside the HMO that has the power to overturn that 
decision or we want to be able to go to court as a last resort.
  Now, let me just talk about some of the little more specific although 
still general points about the Patients' Bill of Rights and the real 
Patients' Bill of Rights. And I do not want to put him on the spot, but 
I see one of my heroes over here on this issue, the gentleman from Iowa 
(Mr. Ganske), and he along with the gentleman from Michigan (Mr. 
Dingell), a Democrat, and this is really a bipartisan effort because 
there are some Republicans that support this bill, a lot of them 
frankly, but, unfortunately, not the leadership in the Republican 
Party, have put together a bill called the Dingell-Ganske bill, or the 
Ganske-Dingell bill, which is the real Patients' Bill of Rights that I 
would like to see and that most if not all Democrats would like to see 
passed.
  Just to give you an idea of some of the principles that are in here, 
first of all it has to protect all patients with private insurance, not 
just some. Some of the Republican bills only protect certain types of 
people. All patients with private insurance. There has to be the 
ability to hold the plans accountable, which I discussed. There has to 
be a fair definition of medical necessity, which means that it has to 
be up to the physician and the patient to determine that.
  There has to be guaranteed access to specialists, access to out-of-
network providers. If there is not someone available who can handle a 
patient's situation, they can go out of the network.

  There also has to be a prohibition on improper financial incentives. 
The HMO cannot encourage the doctor to deny care or not provide certain 
care

[[Page H2870]]

and get some sort of financial incentive to do so. There has to be 
access to clinical trials. There has to be a prohibition on gag rules. 
In other words, some of the HMOs say that the doctor cannot tell a 
patient if they need a particular treatment in his or her opinion 
because it is not covered. So if it is not covered and he or she thinks 
a patient needs it, they are not allowed to tell because the insurance 
company will not pay for it. That is ridiculous.
  Emergency room access if it is needed. If something happens, an 
individual has a heart attack, they have an accident, that that person 
can go to the nearest emergency room rather than go to one 50 miles 
away and die or become seriously injured on the way. And the list goes 
on.
  What I am fearful of, and I guess I am a little less fearful now that 
the Democrats are in the majority in the other body, is that even 
though President Bush said he would support a Patients' Bill of Rights 
and said in fact that he would support a Patients' Bill of Rights very 
similar to what they have in the State of Texas, he has essentially 
said that he opposes the Dingell-Ganske bill, which in the other body, 
the Senate, is sponsored again on a bipartisan basis by Senator McCain 
and Senator Kennedy. The President has been variously quoted over the 
past few months saying this bill that so many of us support in the 
House and in the other body is too costly and that he would veto it.
  He said his primary objection to these bills currently in the 
Congress is that they do not contain reasonable caps on damage awards 
against health insurance organizations or insurance. He wants to have 
caps, and not very high caps in terms of the amount of money that a 
person can recover if they go to court. And then he has other concerns; 
that he does not like the particular court that should be allowed to 
sue under the Dingell-Ganske bill.
  The point of the matter is, Mr. Speaker, that the President and the 
Republican leadership in both bodies have been fiddling with this issue 
for the past 4 or 5 months. They say they are for a patients' bill of 
rights, but they do not articulate exactly what they want. All they do 
essentially is say they do not like the bill that most of us support, 
the Dingell-Ganske bill. I am hopeful now that the other body becomes 
Democratically controlled tomorrow, that as the new majority leader, 
Mr. Daschle, said, this is going to be on the agenda probably next 
week.
  Now, if and when it passes over in the other body and it comes over 
here, that will allow us to pressure--


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (Mr. Issa). It is not in order in a debate to 
specifically urge the Senate to take certain actions, and the gentleman 
will be aware of that.
  Mr. PALLONE. Mr. Speaker, I was not aware, and I will not cite that 
again.
  The point I am trying to make, though, is that we really need a good 
Patients' Bill of Rights. I suspect I am going to be hearing more about 
it later this evening from my colleague, the gentleman from Iowa (Mr. 
Ganske), and I think I will stop with that particular issue for now.
  I did want to spend a little time tonight, though, talking about the 
problem of the uninsured, the number of people who are uninsured. That 
number continues to grow and needs to be addressed as well here in the 
Congress.
  Mr. Speaker, I see one of my colleagues, who has been very active on 
the health care issue, and who is a member of our health care task 
force on the Democratic side, is here; and I would like to yield to him 
at this point.
  Mr. RODRIGUEZ. First of all, Mr. Speaker, once again let me thank the 
gentleman for his efforts in the area of health care. As the gentleman 
mentioned, the problem that we encounter now is with the uninsured, and 
that number continues to grow. We have over 44 million uninsured.
  I think that one of the dilemmas we face as we look throughout this 
country, there are hardworking people that are not poor enough to 
qualify for Medicaid, not old enough to qualify for Medicare, and yet 
find themselves working for small companies that do not give them an 
opportunity to have access to insurance coverage. And I can attest to 
the gentleman that if someone is not working for government or a major 
corporation, they do not have any access to health care. So that we 
have a real dilemma, because we do provide it for the indigent, we do 
provide it for the elderly to some extent, but when it comes to those 
working Americans out there trying to make ends meet, we have a 
difficulty in terms of providing access to health care.
  There is a real need for us to come to grips with that issue. We have 
not done that in the past, unfortunately, and we need to do so. We are 
hoping that the administration can start moving in this direction as 
they dialogued about the issue of health care during the campaign. We 
hope they will come up to meet those promises that they made on health 
care and the uninsured, not to mention those that are insured but who 
are what we call the underinsured, the ones that have access to some 
degree but yet do not have full coverage, such as prescription 
coverage.
  I know that the gentleman has covered the issue of prescription 
coverage, but I just want to keep mentioning it because we need to keep 
that issue on the forefront. It is an issue that continues to be one of 
the key issues in America and it is one of the problems that we were 
elected to respond to and we have not yet done so. We are hoping that 
we will begin to cover that.
  When we look at prescription coverage under Medicare, there is no 
doubt that when we devised Medicare, from the very beginning, that at 
that point they did not see the importance of prescription coverage. We 
know now that prescription coverage is key for access to good quality 
care. We know the importance of that, and so we need to look at that 
issue. And the responses that we have before us from the administration 
have not been adequate.
  There is only one State that has tried it, and it has not been that 
successful, and that is because our seniors are the ones that utilize 
prescriptions the most. That is where the private sector will make the 
less amount of profit in any area, and so it is an area where we all 
need to participate and make sure that we can help out when it comes to 
prescription coverage. It does not make any sense for us to make the 
diagnosis, to find out that they are in need, when we do not provide 
them the prescriptions that are needed to be able to cover some of 
those needs.
  The other thing that just does not make any sense is that we provide 
prescription coverage for Medicaid, for the indigent, yet we do not 
provide it for our seniors. So there is a real need for us to kind of 
come to grips on that issue of not only prescription coverage but the 
uninsured. I know there are a couple of proposals out there, and we are 
hoping that we can begin to go throughout the country to dialogue about 
the importance of health care in this country. The fact is, we still 
have a long way to go. We have not come to grips with these issues, and 
we need to get more pressure on the politicians up here to make some 
things happen.
  The only reason we had the Patients' Bill of Rights the last time, as 
the gentleman well knows, is because we decided to do a discharge 
petition that forced the Congress to have to deal with it. Because of 
that, I think we were able to make that happen, and we did pass a good 
bill. Unfortunately, it was killed during conference and so that did 
not materialize. So what is important now is that we have a new 
session, and we need to move forward in that area.
  So I just wanted to take this opportunity now to thank the gentleman 
for what he has been doing on health care. I will be talking later on 
on the issue of AIDS, and I look forward to the gentleman's 
participation in that area.
  Mr. PALLONE. Mr. Speaker, I want to thank my colleague from Texas. 
And I do appreciate the fact that the gentleman is going to spend the 
hour later this evening talking about AIDS and what we need to do 
further. There has been a lot of attention paid to the fact, and during 
the break over the last week I read a number of articles, about the 
increased incidence of AIDS, particularly amongst African American gay 
men; that there was just an incredible increase in the incidence of 
AIDS and HIV. People think that the crisis has subdued somewhat in the 
United States but it is still out there, and in many communities it is 
actually getting worse.

[[Page H2871]]

                              {time}  2000

  The other thing if I could, I am so glad the gentleman mentioned the 
uninsured, and I know that the gentleman has mentioned it many times 
and the need to address that issue.
  Once again, I want to point out that even though the President talked 
about this problem during the campaign, I do not see any effort on the 
part of President Bush or the Republican leadership to address the 
issue.
  One of the things that the President talked about was this idea of a 
tax credit. The basic design of the Bush plan was an individual credit 
of $1,000 for those with an annual income up to $15,000. That phases 
down to zero at $30,000, and a family credit of $2,000 with income up 
to $30,000 that phases down to zero. That sounds good in theory to get 
a $1,000 credit toward health care insurance, but it will not solve the 
problem of the uninsured.
  First, I do not see the President trying to accomplish this. He 
talked about it during the campaign, but there is nothing happening. We 
do not see it moving in committee or any effort being made.
  Beyond that, it is available only to those not enrolled in employer-
sponsored insurance or Medicaid policy and available only to those who 
purchase nongroup insurance.
  Basically we are talking about an individual who has to be able to 
afford to buy insurance in the private individual market, and that 
individual is going to get $1,000 tax credit. That is not going to 
solve the problem.
  Mr. Speaker, people who do not have health insurance, it could cost 
them $5,000 or $6,000 a year to buy a policy; and they are not able to 
shell $4,000 or $5,000 out of pocket because they are going to get a 
$1,000 tax credit when their income is somewhere under $30,000 a year, 
basically under 15, and it phases down to 30. It is not going to 
happen.
  This policy will not accomplish something. I do not want to be 
critical of something that is being proposed, I wish it would move; but 
what needs to be done is to expand the number of people that can get 
health insurance through some of the government programs.
  Mr. Speaker, we looked at the problem of the uninsured in our task 
force, and the biggest group were children and the second group was 
near elderly, people over 65 but not eligible yet for Medicare. We 
tried to adjust the problem of the children through the CHIP program, 
and that basically provides health insurance at government expense and 
it has been great. It has enrolled millions of kids around the country 
that did not have health insurance.
  Now you have to expand that program to the adults. In other words to 
households, to the adult parents, if you will, of those children, to 
other people in those lower-income brackets that are working but are 
not eligible for Medicaid regardless if they have children. That is the 
type of thing that should be done: expand on the CHIP program to 
include the parents, and even include single people who cannot afford 
to buy health insurance in the private individual market and are not 
going to be able to do it with a $1,000 tax credit. That is what the 
Democrats have been proposing. I do not see any movement in that 
respect.
  The other thing that the Democrats have said, with regard to the near 
elderly, the people between 55 and 65, is that they be able to buy into 
Medicare for a standard premium every month or every year. That is 
another way of trying to address that problem.
  But if we keep getting hung up on the ideology that the Republicans 
and the President have that everything the government does is not good, 
and the only answer is to throw a tax credit here or there, we are not 
going to cover any more of the uninsured. That is my fear right now.
  I know that we have other things to get to tonight, and certainly the 
AIDS issue is super-important.
  Mr. Speaker, I do want to say in conclusion, these health care 
issues, we as Democrats are going to continue to bring up frequently 
over the next few weeks because we do want to see action, and we are 
not seeing it on the part of the Republican leadership or the 
President.

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