[Congressional Record Volume 147, Number 85 (Tuesday, June 19, 2001)]
[House]
[Pages H3238-H3244]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PATIENTS' BILL OF RIGHTS

  The SPEAKER pro tempore (Mr. Johnson of Illinois). Under the 
Speaker's announced policy of January 3, 2001, the gentleman from Texas 
(Mr. Rodriguez) is recognized for 60 minutes as the designee of the 
minority leader.
  Mr. RODRIGUEZ. Mr. Speaker, I rise tonight to highlight the health 
care needs of our communities throughout this country. I am deeply 
concerned with the lack of attention that the House leadership and the 
administration has paid, not just to managed-care reform, but to health 
care as a whole.
  Every day, millions of Americans suffer from diseases that we could 
prevent, diseases we could treat, diseases that we could cure. But we 
have not made the commitment to take care of that.
  We must not let them down. In this Special Order tonight, we look at 
the Patients' Bill of Rights, as well as the issue of health care.
  It is time for us to also consider the fact that there are a lot of 
individuals out there who are sick and that need our assistance, and we 
must not forget them.
  We hear so much about values, and the greatest value I know is 
helping those who need the assistance. And who needs the assistance 
more than those afflicted with the diseases of the body and of the 
mind?
  There is no doubt that this particular issue is an issue that 
continues to haunt us and is an issue that as a country we need to come 
to grips with. The Patients' Bill of Rights is an important piece of 
legislation. Not only does it make sense, but it also is the right 
thing to do.
  The Ganske-Dingell bill accomplishes the critical goals of managed-
care reform. First, one of the things that it does, it gives every 
American the right to choose their own doctor. That makes every sense 
in the world. That is the fact that each one of us should have, the 
right to choose our own doctor.
  Secondly, the bill covers all Americans with employer-based health 
insurance, as well as other bills that, remarkably, exclude individuals 
such as firefighters, church employees, and teachers.
  Thirdly, this bill ensures that we extend external reviews of medical 
decisions that are conducted by independent and qualified physicians. 
We should not be allowing insurance accountants and people who are 
going to be looking at the all-mighty dollar when deciding the 
decisions of health care of those people that are ensured.
  Fourthly, it holds a plan accountable when the plan makes a bad 
decision that harms and kills someone. If the insurance and managed-
care system decides not to provide access to care to someone, then we 
need to look at that seriously; and that is occurring throughout the 
country.
  Finally, it guarantees that health care decisions are made based on 
the medical, not the financial, considerations. Managed-care companies 
must put health care first, and the Patients' Bill of Rights creates 
the incentives to make sure that that occurs.
  Tonight, I am also joined here with the gentleman from Texas (Mr. 
Lampson). I am glad that he is here.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Lampson)
  Mr. LAMPSON. Mr. Speaker, I thank the gentleman from Texas (Mr. 
Rodriguez) for yielding to me.
  I wanted to come here tonight, Mr. Speaker, to speak on the Patients' 
Bill of Rights, which is currently being debated in Congress, and 
primarily to join my other friend from Texas here and talk specifically 
about some of the applicability of issues facing the Hispanic community 
in Texas and across the Nation.
  But as I listened to the gentleman talk, I wanted to make another 
comment before I get into these particular remarks, because as the 
gentleman talked about the accessibility, about a person who might want 
to be treated for an illness that they know there is a cure for but to 
which they have no access, it reminds me of a friend of mine in 
Nederland, Texas, right by Beaumont in the heart of the 9th 
Congressional District, who is a school teacher, Regina Cowles; and 
Regina contracted breast cancer just a couple of years ago, and she 
found a treatment for that cancer in Houston. But because her insurance 
company made the decision

[[Page H3239]]

that this was not an appropriate treatment for her, they refused to 
make a payment.
  And consequently, she did not have access to the treatment. We worked 
with that insurance company and ultimately got them to relent. They 
made the treatment available. And she went to Houston, and she got the 
treatment. Unfortunately, it was started much, much too late and she 
died.
  Those are the kinds of things about which the gentleman is speaking; 
that is what we are concerned with, with people across the United 
States of America. And we hear these stories over and over again about 
someone other than a physician making a decision about treatment for a 
person's health care problem.
  Soon after I came to the United States House of Representatives, I 
was asked by Dr. Joe DeLeon, a cardiologist in Port Arthur, Texas, for 
me to come and do one of my worker-for-a-day program, and I went to Dr. 
DeLeon's office; and I did a number of things with him during the 
course of the several hours that I spent there, but at one point in 
time, he asked me to go with one of his nurses and pre-certify the 
patients that were on his list, so that he could get permission from 
the insurance company to be able to see them.
  I did that. I sat down and made 10 or 12 telephone calls and, 
interestingly enough, a large number of the people with whom I was 
speaking at those insurance companies were not health care-trained 
professionals. They were making decisions based on lists of information 
that were put there. More a part of it was the bottom line of that 
insurance company than was the health of the people who were wanting to 
see the doctors.

  Mr. Speaker, that is what has to change, I say to my colleagues in 
the House of Representatives. We have to make sure that our effort to 
produce legislation is going to reach those persons whose lives can be 
affected by the work that we are doing and make sure that we make 
policy that will reach those people, because they choose to have and 
want to have and deserve to have the quality of life that they can have 
in the United States of America.
  While I said that I came to talk about those issues affecting the 
Hispanic community particularly, as far as we have come as a Nation, 
obstacles to equality still exist; and we continue pushing forward to 
provide opportunities for all.
  Currently in Texas, more than 1 million children lack health 
insurance, Hispanics representing a disproportionate number of that 
number of children. A restrictive enrollment to the interview and an 
interview process, coupled with a burdensome application process has 
helped to produce this disparity. A lack of access particularly with 
Spanish-speaking providers and services has caused difficulty in what 
has become a cumbersome and bureaucratic managed-care system.
  Nationwide, Hispanics constitute 35.3 percent of the total uninsured 
population. This is a disparity which is rapidly reaching epidemic 
proportions. Much of the problem can be attributed to lack of funding 
for prevention and education initiatives, absence of culturally-
competent information available for Hispanic communities to make 
educated health care decisions, and inadequate representation of 
Latinos in the health care professions.
  This is a trend which absolutely must be curtailed. And as we begin 
to, again, debate the Patients' Bill of Rights, we must be mindful of 
the issues facing all of our communities and work toward a bill that 
will provide protections for every citizen. The time for political 
posturing has passed, and now it is time to deliver on a Patients' Bill 
of Rights.
  I support the Dingell-Ganske Patients' Bill of Rights as a 
comprehensive approach that provides enforceable protections to all 
Americans and ensures health care decisions that are made by patients 
and doctors and not those insurance companies about which we were 
talking.
  Mr. Speaker, I thank the gentleman for allowing me to come and join 
him, and I thank him for the good work that the gentleman is doing in 
helping us get the word out on this bill and make sure that we come up 
with provisions that will indeed make a difference in all Americans' 
lives.
  Mr. RODRIGUEZ. Mr. Speaker, I know that when the gentleman talked 
about that specific story, we all have stories; and we all have had 
calls and letters that we have received.
  Mr. Speaker, I had a family that recently sent me a letter 
complaining about the fact that she had Lupus and had received some 
contact from the particular company, and it is unfortunate in terms of 
the difficulty that some of these people are having.
  There is no doubt that when you are healthy and young, they are 
willing to have you onboard. As soon as you get sick and serious, then 
you begin to have some problems with those managed-care systems.
  Mr. LAMPSON. If the gentleman will yield, those who are making those 
decisions need to be held accountable for those decisions, and that is 
what is going to change the complexion of health care in this country.
  Mr. RODRIGUEZ. I also want to thank the gentleman. The gentleman 
mentioned the disparities that exist in the area of access to health 
care. We know that one of the biggest disparities that exists is the 
number of uninsured.
  The gentleman talked about Hispanics. We have some data to show that 
in Texas it is over 33 percent; but throughout the country, we continue 
to have almost 25 percent, that lack access to healthcare insurance.
  I want to share that with my colleagues a little bit, in terms of the 
discussion, a particular call that I had from one of my constituents. I 
recently received a letter from this constituent, who is not only 
battling Lupus, but also battling her managed-care company.

                              {time}  1945

  Lupus is a chronic disease that causes the immune system to attack 
the body's own tissue. Patients often need access to several 
specialists because the disease can affect many different organ 
systems. When individuals need those several specialists, they find 
difficulty in dealing with the managed care system and difficulty in 
them responding.
  I want to quote from a letter that a person received. It says, 
``People with lupus enrolled in managed care health plans should have 
immediate access to specialists and the specialty care they need even 
if those specialties are outside of the provider network. Because lupus 
can quickly become life-threatening, people with lupus should be able 
to seek emergency care when they reasonably believe that their health 
is in danger. They should not have to go through the lengthy 
complicated appeals process for receiving special care.''
  Mr. Speaker, this story speaks well to the importance of a strong 
patient bill of rights. It is important to ensure that those who have 
private health coverage also have meaningful health care coverage that 
they can depend on when they are in need. I am a strong supporter of 
this, and I think it is important for us to continue to be supportive 
of this effort that when an individual is ill they have to be able to 
have access to those specialists, especially in specific cases such as 
lupus and many others. Unfortunately, people that find themselves in 
this bind also are having to battle the managed care systems throughout 
our country.
  I also want to mention that it is unfortunate that both 
administratively and legislatively recently we decided to look at the 
tax cut as the number one priority before we begin to look at the 
issues that confront us. It was unfortunate that we went forward on 
this tax cut without looking at the resources that were going to be 
needed, not only in all aspects of health care but all the other issues 
that confront us. It leaves too many Americans with diminished hopes in 
the area of health care. We are following the wrong path. We should 
first meet our needs and our priorities, which must include access to 
health care, before helping those individuals on the tax cuts.
  We face two great health care obstacles before us. First, too many 
Americans do not have the basic health care coverage that is needed. 
Secondly, even those who do often find themselves subject to a 
bureaucracy that they can neither understand nor navigate, a 
bureaucracy that is not responsive, a bureaucracy that needs to be 
pushed into doing the right thing. I am not referring to government, I 
am referring to

[[Page H3240]]

the private sector and the managed care systems. We can no longer put 
off addressing these two great health care issues, the issue of access 
and managed care reform.
  The problem of access to care is not a small problem. More than 42 
million persons, and the number is growing in this United States, lack 
access to good health care insurance. The burden falls 
disproportionately on a lot of the poor and minorities throughout this 
country. So many places of employment do not provide coverage. And let 
me add that those working in a small company, if it is not a major 
corporation, probably do not have access to insurance. Those not 
working for government, whether it be local government or Federal 
Government, probably do not have access to health insurance. So people 
find themselves in a real serious problem. Individuals not over 65 do 
not have Medicare; individuals who are not indigent, they do not have 
Medicaid. So here we have working Americans finding themselves in a 
real bind.
  In America, the rural populations face special challenges to access 
care. For example, nearly one-fourth, or 25 percent, of the uninsured 
in the United States are Hispanic, as indicated earlier. That is twice 
the proportion based on population. So we can see the disproportionate 
numbers. In addition, African Americans also lack insurance, 25 percent 
of them, when they only represent half of that amount of the 
population. So we can see the disparity in these communities. The rest 
are people that are poor and that do not have access to insurance but 
who are out there working trying to make ends meet.
  Roughly 20 percent of the uninsured live in rural areas. I have the 
distinction of having both not only an urban area in San Antonio but 
also 13 other counties of rural Texas, and I find myself that a lot of 
the rural counties have a great amount of difficulty with managed care 
systems, partly because of the reimbursement rates, partly because of 
the problem that a lot of the managed care systems choose not to go 
into rural America, and also because of the difficulties in terms of 
providing access to the ones that are really in need.
  According to recent studies by the Kaiser Family Foundation, the 
rural populations tend to be older, they tend to be poorer and they 
tend to be less healthy compared to the people living in urban areas. 
So here we find ourselves with a very vulnerable population and a real 
need for us to reach out. When we look at the statistics of the 
uninsured, our children, the numbers are staggering. Nearly 11 million 
children under 19 do not have access to insurance. We have tried some 
efforts in that area, but a lot more needs to occur and we hopefully 
will continue to move forward in those directions.
  In places like my hometown of San Antonio I am ashamed to say one-
third, or 33 percent, of our children do not have coverage for health 
insurance. The burden falls not only on the children and not only on 
the families but also on the local governments. The reason why that is, 
for example, in the State of Texas we hold each county obligated up to 
10 percent of their budgets to make sure they provide for the health 
care of their constituency. Yet those rural counties in south Texas, 
along the border, are expending up to 30 percent of their budgets for 
the poor. The rich counties have less poor and so do not have to expend 
as much, but a poor county, where individuals are paying property 
taxes, and in some cases in Texas for the hospital districts they are 
having to pay more to take care of these individuals, because the 
children's access to care is at the most expensive point, the emergency 
room.

  We need to make every effort to make sure that we take care of those 
kids before the emergency room; that we take care of those people 
before the emergency room. The cost rises as local governments are 
forced to raise taxes. So it is important for us to look at health care 
as a major issue that confronts this country and an issue that we have 
been unwilling to deal with not only as elected officials but as a 
community as a whole. Everyone pays and everyone pays too much because 
we do not offer the proper care up front.
  We need to look at the preventive care that is so very critical and 
very important and that can help prevent a lot of the diseases. The 
beauty of it now is that we can tell when youngsters are prone to have 
diabetes, type 2 diabetes, but what do we do with that information? 
Unless we do something to help prevent that diabetes as that youngster 
grows up, then we are defeating ourselves.
  My colleagues will also hear me speak time and time again on the need 
for improving access for the uninsured, especially with regard to the 
health status of the most underserved population, the poor, the rural 
population, the children, and minority of this country. The current 
debate on patients' rights illustrates the access to service that does 
not necessarily guarantee quality of service.
  We tend to associate barriers to care only with the uninsured, but 
even the insured in this country have a barrier to service. Those who 
have health insurance also, as my colleagues well know, face those 
barriers, and we need to make sure that those people at least have 
access. After all, they have been paying for that insurance, and when 
they get sick, it should be there for them.
  Let me be clear. Managed care companies provide a valuable service 
for millions of Americans. Health care must be affordable and it must 
be available. HMOs do work hard to reach those goals, but there are 
excesses. There are situations where individuals lose out and there are 
situations where HMOs have not been responsive. For many, health care 
coverage has not been there when it is needed.
  I recall a story that was told of LBJ, when he looked at establishing 
Medicare and Medicaid in this country back in the 1960s, and the story 
is that when he was having difficulty with the insurance companies who 
continued to bring obstacles on Medicare and Medicaid, he brought them 
into a room and he basically told them, and it is a very similar 
situation that we find ourselves in now, where he said, look, we all 
know that you are willing to take care of individuals when they are 
young and healthy, but as soon as they get old and sick, you are 
unwilling to expend what needs to be expended.
  As the story goes, LBJ got those people there into that room that 
were part of the insurance companies of this country and he told them, 
look, I am willing to help you by taking and being able to support and 
establish a Medicare and taking care of the senior citizens. After all, 
the statistics and the data showed that a lot of the companies were 
basically dumping our seniors after they got sick, very similar to what 
we find now in a lot of areas.
  So LBJ was able to convince them to support him on establishing 
Medicare for our seniors because, after all, those are the ones that 
are the most ill, those are the ones where the private sector is less 
likely to make a profit from, and they knew that they needed some help 
in that area.
  For the same reason, for the indigent, who did not have the resources 
to buy the insurance, he asked them to allow him the opportunity to 
establish Medicaid for the indigent so that these people that do not 
have those resources to buy insurance that they can be able to have 
access.
  So now we find a dilemma that in this country we somewhat take care 
of our seniors with Medicare and somewhat take care of our indigent 
with Medicaid, but in middle America we find people who are working 
hard, who are trying to make ends meet, in a bind, and yet not having 
access to good quality care. In fact, we have the largest number of 
uninsured in this country, over 42 million and growing.
  So many of us have experienced the frustration of having also changed 
doctors because they are no longer a part of our plan. The patient bill 
of rights addresses this issue, where individuals should have the right 
to see the doctor of their choice. It does not make any sense for them 
to force an individual to see someone that they do not want to see, 
especially if they have their own doctor.
  It also is troubling not being referred to specialists when a doctor 
says a person needs to see a specialist. That opportunity needs to be 
there and that opportunity is not there now with the private sector, 
some HMOs, who are giving individuals a rough time and giving those 
people who do pay their monthly premiums and should be able to have 
access to good quality care and to the specialists that they need. Such 
is the case with my constituent with

[[Page H3241]]

lupus who had difficulty getting access to good care.
  We continue to hear these stories throughout the country. The passage 
of a Patient's Bill of Rights is important for all Americans and for 
members of the various communities that make up this Nation. As chair 
of the Congressional Hispanic Caucus, on the Task Force on Health Care, 
I would also like to highlight briefly how a Patient's Bill of Rights 
would help the Hispanic community in particular.
  The needs of managed care reform is especially important for 
Hispanics. Fully two-thirds of privately insured Hispanics are enrolled 
in managed care while only about one-half of privately insured whites 
are in managed care. This is based on a study done by a medical 
expenditures panel survey. In addition, the health care system is 
complicated enough, but for Hispanics and populations with limited 
English proficiency, the task of dealing with managed care is even more 
difficult. We need access to good culturally competent, linguistically 
sensitive providers that serve our communities.
  I want to share an example when we talk about culturally competent. 
This was a story that I continue to tell because it is a true story, a 
devastating story, of a woman who was told that she was positive for 
AIDS.

                              {time}  2000

  In Spanish when you say positive, just like in English, it is 
``positivo.'' If you do not explain what that means, the lady when she 
was told she was positive, she felt everything was great, not realizing 
that she was positive for AIDS, and she had a child that contracted 
AIDS. So the issue of cultural competency and linguistic understanding 
is very important.
  Hispanics, because they are more likely to be in managed care, are 
also more likely to have limited providers' options and limited 
treatment options. By having the right to choose doctors, patients can 
seek a doctor who speaks the same language. Managed care may be less 
likely to provide treatment and diagnosis that most affect these 
populations.
  Mr. Speaker, I am joined tonight by my colleague, the gentlewoman 
from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, let me thank the gentleman for 
his leadership on the question of health care, both as a Member of 
Congress as well as a member of the State legislature in Texas. I think 
this is an important enough topic to give a chronological history.
  As I was listening to this debate in my office, I thought it was 
important to explain that people should not be frightened about this 
compromise. I am excited by the Senate bill and the compromise in the 
bill in the House, the Ganske-Dingell bill. I see no reason why this 
bill cannot pass from the House into the Senate and receive the 
signature of President Bush.
  As the gentleman from Texas knows, Texas passed a similar initiative; 
and to my knowledge, we have not suffered in the loss of good health 
care. I am sure that we can work to even improve the concept of 
reasonable balance between patients and physicians. That is all we are 
talking about, is giving the American people the right to be able to 
make decisions about their health care along with their physicians, 
simply plain and straight to the point.
  I am reminded of this debate, and I have been engaged in this debate 
it seems to be three sessions. I remember when we had a number of 
hearings about tragic situations which have occurred. I would like to 
bring back one in particular, and I think this young man if I recall, I 
do not want to add to the story, but I believe he was an amputee, at 
least two legs, I am not sure, I think he lost two hands as well. He 
was a youngster under the age of 12. He was an example of a youngster 
who had been picnicking with his relatives and had fallen and had 
gotten onto some dirty nails. His family was rushing him to an 
emergency room, but because of their insurance, their insurance was not 
accepted at that particular emergency room. Therefore, they had to 
travel miles away. It was a rural community. Just that distance caused 
the young man to be put in dire condition and therefore became an 
amputee on that basis because he could not be treated by the immediate 
emergency room. That is what the Patient Bill of Rights is attempting 
to do, to be able to ensure that the Hispanic woman who spoke Spanish, 
who understood everything is okay from the word ``positive'' versus 
that you are positive with HIV, that kind of lack of sensitivity would 
be no more.
  That the idea of being turned away from an emergency room simply 
because you are in the wrong location simply has to stop. This is a 
powerful country, and although health care is not in the constitution, 
it certainly should be a right and privilege of Americans.
  This particular bill as I understand it allows for the extra 
protection, I do not call it the right for a lawsuit, the extra 
protection to be able to, if you will, challenge and hold responsible 
any culprit, any particular entity that divides health care between 
patient and physician.
  If the HMO tells the loved one while the patient is needing care I am 
sorry they cannot get it because your insurance does not cover or you 
have not paid enough, or we do not want you to have that because the 
doctor says you should have it, it is extra and something tragic 
happens, I believe that the American public deserves the right to hold 
that entity accountable. That is all we are asking for, is to ensure 
that those privileges are had and the Patient Bill of Rights 
reestablishes the privileges of the patient and reestablishes the right 
for medication and dialysis, reestablishes the right treatment for 
diabetes as opposed to being denied that right; and so many of my 
constituents have had that experience.
  Mr. Speaker, elderly are living longer and the HMO is saying, I am 
sorry, they are at that limit, we are not going to approve it.
  In closing, I had that experience with my father. Of course we do not 
come to the floor of the House to generate personal stories of our 
personal dilemmas or personal frustrations, but it is always good for 
people to know that we walk in their shoes. There is no special 
treatment and should be no special treatment for Members of Congress, 
and we do not want any special treatment. I want every American who has 
health insurance to feel the confidence that you can go in and assure 
that that physician is going to be the one between yourself and if it 
is a loved one, deciding the best health care, having the ability of 
the physician to be able to expand on health care or procedures, not 
frivolous procedures, we do not want that. We have been in a process of 
efficiency and management. I believe in that. I believe in bringing 
down the costs.

  But, Mr. Speaker, I also believe that this bill is long overdue, that 
physicians can sit down and say I think he or she can try this 
treatment or I think you need this surgery and I have researched it and 
they need to have it.
  Mr. Speaker, to see a patient on the phone lines trying to argue with 
the insurance companies is a frustrating process to watch; and I 
encountered that through the long illness of my father, talking in the 
hospital, in a phone booth, trying to talk to the insurance company to 
provide a certain coverage of someone who had paid insurance and was 
covered by insurance, and trying to make the argument that this is a 
kind of treatment that was needed or a transport that was needed 
because insurance companies pay for transportation from one hospital to 
the next.
  I do not think that Americans should be subjected to that, and 
particularly those who adequately provide coverage for them or their 
loved ones. This is an important effort that we are engaging in. I hope 
this bill that is being debated in the Senate will quickly come to the 
House and we will find a way in our consciences and also in our 
representation of the American people to finally give them a Patient's 
Bill of Rights which balances patients, physicians, loved ones, and 
insurance companies.
  I say to the industry of insurers that sometimes it looks frightening 
when you see something on the horizon, but it is interesting enough 
that a number of States, including the State of Texas, has now for at 
least 4 years had the kind of Patient Bill of Rights that we are trying 
to give to the American people.
  I do want to refute the point that insurance costs are going up. We 
have already documented that corporations can find a way that they do 
not pass

[[Page H3242]]

those fees or suggested costs on to the insured, on to the employees. 
It can be done. It did not happen in Texas as we understand it; and, 
therefore, I do not think it will happen on a national level.
  I thank the distinguished Member for having this time to talk about 
this important issue. I hope that our colleagues will move this bill 
quickly because I think it is an important step for America in 
improving the health care delivery system that is so much needed.
  Mr. RODRIGUEZ. Mr. Speaker, I thank the gentlewoman for her 
participation. I know the gentlewoman mentioned specifically about the 
fact that there are people making decisions, and as we well know, 
sometimes it is the accountant making a decision whether the patient 
should have a specialist or not. The ones making the decision should be 
the physicians. They are the ones that know best. They should be 
deciding whether a patient should have access to a specialist or not, 
and it should not be based upon economics. As the gentlewoman knows, 
this bill will make sure that occurs.
  As the gentlewoman stated, we want to see the doctors of our choice. 
It is a basic right that a patient should see a doctor that they want 
to see and that just makes all of the sense in the world. We want to 
make sure the patient feels comfortable. The gentlewoman mentioned the 
importance in terms of making sure that the language barriers and the 
competency is there. Nothing is worse than a patient being sent to 
someone that they do not feel comfortable with, that they do not feel 
secure with. That the patient feels maybe they are not making the right 
decisions. Maybe a patient has someone that they have been seeing all 
this time that they want to continue to see.
  I have always had my own doctor, and I have continued to see him 
despite the fact that my insurance does not cover those visits, but I 
continue to see him because I want to see him.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, if the gentleman would yield, 
that is a vital point. That is the continuum of care. Over the last 5-
10 years, we have seen the patient moved around like a shopping cart 
being moved around at the grocery store. One time you are in one aisle 
looking at cereal boxes. Another time canned meats, another time fruit 
juices, meaning that the patient cannot have that physician that they 
have a trust in that they have had for 10 or 15 years. We used to keep 
our physicians for a period of time. When the insurance came in and 
said I am sorry, you have to move on to Doctor So-and-so because your 
long-standing doctor is not on the list. Continuum of care is a vital 
part of health care in America.
  Mr. RODRIGUEZ. Mr. Speaker, the gentlewoman has hit the nail right on 
the head. That is one issue that all Americans agree we need to push 
for. The Patient Bill of Rights allows us to have the doctor of our 
choice.
  When we look at that and when we look at lawsuits, we have not seen 
that many lawsuits, but I will attest that if an accountant makes a 
decision whether you should see a specialist or not and that person 
dies, and that decision was made not for a medical reason but in terms 
of financing, then they have every right to be sued for malpractice. It 
is unfortunate that that is occurring in this country. We need to put a 
stop to that. I thank the gentlewoman for being here with us.
  Mr. Speaker, I want to take this opportunity to stress a little more 
in terms of the language barriers that exist, both to services and to 
health care that we encounter. The experiences that a lot of people 
have, if they do not speak the language, it becomes very difficult. We 
need to continue to move forward on that.
  Mr. Speaker, tonight I am joined by the gentleman from New Mexico 
(Mr. Udall). I know the gentleman has been active on health care and 
has serious concerns about access to health care, and I thank the 
gentleman for joining me tonight.
  Mr. UDALL of New Mexico. Mr. Speaker, I thank the gentleman from 
Texas. It is nice to be here with the gentleman this evening. Let me 
first say that the leadership of the Hispanic Caucus on the health care 
issues and on the Patient's Bill of Rights has been very impressive. I 
have a district in New Mexico that is 38 percent Hispanic, close to 20 
percent Native American, and the leadership that the Hispanic Caucus 
has shown in terms of educating us on these issues has been very, very 
helpful to me.
  The gentleman mentioned an issue that I wanted to say something 
about, until I go on to continue with the Patient Bill of Rights, and 
that issue is this issue of why we are giving patients the right to sue 
an HMO.
  Mr. Speaker, we have two States which have passed laws very similar 
to the bills we are considering now. California and Texas have passed 
Patient Bill of Rights laws. To listen to the other side argue and to 
listen to the HMO community, the managed care community argue, one 
would think that we were going to have runaway lawsuits. You would 
think that juries are going to go crazy and award massive awards. In 
fact, those two laws which have been in place now a number of months, 
one of them in Texas, went through and was put in. President Bush did 
not sign it, but he could have prevented it and he allowed it to become 
law. I believe only a half dozen people have even filed a claim under 
that law.

                              {time}  2015

  And so the one thing that we have got to get the word out on is that 
this is not a situation that is going to jeopardize these companies. 
This is not a situation that is going to end up in runaway jury 
verdicts. This is a situation where we just give a patient an 
opportunity to have their day in court is really what we are talking 
about, if they are seriously injured, if someone is killed as a result 
of a medical decision, that they have that kind of opportunity. That is 
a very important point.
  I think the same thing is true, as the gentleman knows in California. 
Only about a handful of individuals have filed. It has not been a 
situation that has fostered lawsuits. The important thing here is to 
protect the civil justice system.
  A couple of words on the Patients' Bill of Rights. I believe that 
this is a very, very good bill because it protects patients and all of 
their various options. There is nothing more frustrating as a patient 
to have care denied and not understand why. There is nothing more 
frustrating as a patient to have an expert be turned down to look at 
your particular case. What we are talking about here is very simple, 
common-sense rules that make the HMOs produce quality care.
  I will never forget as State attorney general when I heard this whole 
idea of managed care coming in, as the gentleman from Texas (Mr. 
Rodriguez) knows, they sold it to us that it was going to be cost 
effective, which they have cut a lot of costs, there is no doubt about 
that; but they said the quality of care is going to go up. In fact, 
that has not happened. The quality of care has gone down, people have 
been denied care, patients find themselves dealing with these large 
bureaucracies, and they do not have any idea how to get through them. 
That is a big, big problem.
  Let me just sum up by saying, the Hispanic Caucus has been a real 
leader on this issue. They have taught me a lot, the gentleman and the 
other members. It is a real pleasure to carry on this colloquy today 
with the gentleman about these issues.
  Mr. Speaker, I rise today to address an issue that is important to 
and affects many people throughout the country, particularly many of my 
constituents who live in the 3rd Congressional District of New Mexico. 
As our colleagues in the Senate begin to take up the very important 
issue of a Patients Bill of Rights, it is important that we highlight 
the various and unique obstacles that Hispanics in the United States 
face when it comes to managed care.
  Many Hispanics who belong to managed care programs often face 
obstacles that others do not. One obstacle is language barriers. At 
times, language barriers adversely affect not only their access to 
health care, but that of their children, as well. A recent report by 
the Agency for Healthcare Research and Quality showed that the 
inability of many Hispanic children to access care is a result of their 
parents' inability to speak English well enough to interact fully with 
the health care system. Furthermore, pamphlets and written information 
are sometimes available only in English, which presents another set of 
challenges for many Hispanics in the United States.
  Moreover, the difficulty of navigating through the bureaucratic 
managed care system is often complex and burdensome. This can

[[Page H3243]]

often present a challenge to anybody, but can be compounded by 
unfamiliarity with the managed care system and difficulty with the 
English language.
  In addition to these specific problems faced directly by some 
Hispanics accessing and obtaining managed care, there is also a general 
lack of data that outlines the specific Hispanic needs pertaining to 
managed care programs.
  While these issues I just mentioned are faced by Hispanics on an 
individual basis, there is another more systemic problem, that being 
the lack of Hispanic representation at the administrative level. It is 
important that more Hispanics are able to participate in the decision-
making processes in managed care. There are many reasons why this is 
important, one of which is that individual's from similar backgrounds 
can better related to the challenges faced at the individual level.
  As this Congress takes up a Patient's Bill of Rights and help 
guarantee the safety and care of patients, it is important that we not 
forget the unique challenges that Hispanics face when dealing with 
managed care. The issues that have been discussed tonight must be 
addressed in order to insure that Hispanics are able to receive the 
care they need and deserve.
  Mr. RODRIGUEZ. I want to thank the gentleman from New Mexico (Mr. 
Udall) for his service. I know he has been working real hard in this 
area, too. He mentioned the lawsuits. He is right and correct in the 
fact that we have not seen those lawsuits in Texas. It just gives that 
right. They know that the decision should be made by the medical 
profession and not by the accountants. In addition, he also represents 
a State that has a lot of rural community, a lot of Hispanics also that 
are uninsured. I know he has worked hard in representing them. I want 
to thank him for what he has done in that area. And also the fact that 
rural America, such as rural New Mexico and Texas, find themselves 
without access to health care. A lot of the managed-care systems are 
not operating in rural America. We have a great deal of difficulty in 
getting access to managed care in those areas. It has created a lot of 
problems for us. I want to thank the gentleman personally for what he 
has done on behalf of New Mexico and everyone in New Mexico including 
the Hispanics there.
  Mr. UDALL of New Mexico. The rural part of this, as the gentleman 
knows, is a huge issue. Rural America does not have the opportunity to 
take the benefits that managed care provides, and we are especially 
seeing that in my district and in rural New Mexico in regard to 
Hispanics. I thank the gentleman once again for his leadership. I see 
we have another of our distinguished colleagues here that I know he is 
going to talk about, a real champion of health care issues for 
Hispanics.
  Mr. RODRIGUEZ. I thank the gentleman from New Mexico for joining us 
tonight. I thank him for coming out. I know it is kind of late.
  We are also joined tonight by the gentlewoman from California (Ms. 
Sanchez). I want to thank her for coming out here tonight. I know it is 
kind of late. She was also working on an issue today on the House 
floor. I thank her for coming back and joining me.
  Ms. SANCHEZ. I thank my colleague from Texas very much. This is such 
an important issue. I want to take the opportunity to thank him as a 
Hispanic sitting on the Hispanic Caucus, which is the nonpartisan 
official working group of this House of Representatives that talks to 
the issues that in particular affect Hispanics. Of course the gentleman 
and I both know that health and health care is one of the largest 
problem areas for our population for a lot of reasons, lack of 
knowledge in particular. And so when we look at something like a 
Patients' Bill of Rights, when we look at the effect that policy can 
have on giving right information, giving all the information, 
explaining better the information to a potential patient becomes very 
important for Hispanics in particular. Or just the convenience factor. 
Most of us, we run around and we think it would be difficult to 
schedule different appointments with different doctors. For someone in 
the working class, it is very difficult to take time off from work in 
order to go and see their doctor, and so to make multiple visits 
becomes a very difficult thing.
  I just want to take the opportunity to thank the gentleman for the 
type of work he has been doing, heading up the health care task force 
within the Hispanic Caucus.
  Mr. RODRIGUEZ. I thank the gentlewoman for joining me tonight. She 
has worked hard in the caucus on various task forces. I know she is 
interested in health also, and I know she is very interested in the 
Patients' Bill of Rights. We have talked tonight about the importance 
of seeing the doctor of our choice, the importance of making sure that 
physicians make the decisions and not accountants, the importance of 
making sure that we hold the managed-care system accountable when that 
person needs a specialist and the physician says that they need a 
specialist, then that person should be allotted that specialist.
  We have a variety of cases that have been brought, I know, to her 
office. The gentlewoman has had letters from people who have had 
difficulty with managed-care systems. I shared with the public a 
particular person who had had lupus, a disease that required a variety 
of specialists and had not only had to fight with her illness but also 
had to fight with our managed-care system.
  Ms. SANCHEZ. And in particular with respect to diseases, it is really 
troublesome when we see that the Hispanic population in particular in 
the United States is having such a problem. They are one of the 
largest, fastest-growing segments of the population with respect to 
HIV. Not enough testing gets done there. They have the highest, 
probably three or four times out of the general population, ability or 
propensity to get diabetes.
  We not only see that they need to see doctors but why it becomes so 
important to see the doctor of your choice. In some cases, there can be 
language barriers, not getting exactly the right communication going 
between doctor and patient. Think about how we feel. Once we find a 
doctor that we are comfortable with, it is almost like we do not want 
our insurance ever to change because we want to be able to have always 
the same doctor. You feel comfortable going to that doctor. Imagine how 
somebody feels who may not completely and totally understand the 
English language as well as a natural-born citizen here. I think of my 
own parents. My mother has a master's degree in Spanish and English. 
She is a teacher. Yet she always feels more comfortable hearing, 
especially difficult things, complicated things, complex things, in her 
native language of Spanish than she does in English.

  Think about if you have ever been to the doctor, and they come out to 
tell you something, most of the time these doctors do not even know how 
to tell you in layman's terms what the heck is wrong with you and they 
are talking English. Imagine if you have the barrier of a language, it 
becomes even more important for people to have choice of doctor, to 
have portability if they go to a different job, of taking that 
insurance. And also a lot has been said about, oh, my God, this 
Patients' Bill of Rights is just about lawyers who make lots of money 
being able to sue HMOs.
  That is not the case. First of all, if you are working class or lower 
income, even if you are middle class, actually, and you have a problem 
and you go to do these types of suits, you go to do a type of suit like 
this, it is a very long and expensive process. And so these contingent 
fees, if this goes nowhere, those lawyers, they lose all the expense 
money and all their time and effort. They do not get paid one dime on 
that. I think those who saw ``Erin Brockovich,'' for example, 
understood that comment, that these people really only take a case if 
they think that there is something there most of the time. And so for 
someone, especially in the Hispanic population, a majority of the 
people who are Hispanics, we fall in that category. We do not have a 
lawyer on retainer. How do we know what to do?
  Mr. RODRIGUEZ. The gentlewoman is right. I think one of the realities 
is that we need to make sure that everyone has the right to have access 
to health care. In so doing, she talks about the importance of those 
barriers and cultural competencies. If you are a woman, you might want 
to see a woman, depending on the type of illness. There is no doubt 
that in terms of feeling more comfortable, sometimes even a Hispanic 
might not make you feel comfortable. And so it is important that you 
see the doctor of your choice. Once again, she mentioned the issue of 
lawsuits. I think it is important that the judiciary is always the

[[Page H3244]]

last resort. If you are doing the right thing, you should not be afraid 
of that. But when you do have people that are not physicians making the 
decisions whether you should see a specialist or not, then you need to 
be liable. I think it is important that the decision is based on money.
  What we found in Texas that has the same rights as we want to 
establish here, we have not seen the lawsuits. We have not seen the 
abuse. Where we have seen the abuse is where they feel they can do and 
undo as they please because of the fact that you cannot do anything 
about it. It reminds me of that story, of that person who finds 
themselves having to fight both the disease and the system.
  I want to thank the gentlewoman for joining me here tonight. We have 
a few more that have come over, a young lady that has also talked about 
coming and talking, so we will continue to do that. I do not know if 
she wanted to make any other comments.
  Ms. SANCHEZ. That is fine. I know you have a couple of more over here 
to talk about their feelings and what people in their districts are 
feeling with respect to the Patients' Bill of Rights. We really need to 
do something about righting this situation. People should have choices. 
They should be comfortable that they have choices, and they should feel 
that they have been dealt a fair hand in dealing with the insurance 
coverage that they have. I thank the gentleman for doing this Special 
Order.
  Mr. RODRIGUEZ. I thank the gentlewoman from California (Ms. Sanchez) 
for joining us.
  We are pleased to be joined by several other Members. I want to ask 
them to go to the mikes as they get comfortable, and then later on we 
will be dialoguing as they come in. I want to ask both of them to join 
us as we bring closure to the comments of tonight. I thank them for 
coming out here tonight as we talk about the Patients' Bill of Rights 
and the impact and the importance of having access to the doctors of 
our choice, making sure that if the physician says that we need a 
specialist, that we do have a specialist. I thank the gentleman for 
being here.
  Mr. STRICKLAND. I thank the gentleman for sharing these few moments 
with me. I will be very short. I was watching the gentleman on C-Span. 
I thought of one of my constituents that I wanted to come over and 
share with him. Tonight in Hillsboro, Ohio, in Highland County, Ohio, 
there is a constituent of mine who is 31 years old. Her name is Patsy 
Haines, she is a wife and a mother, and she has chronic leukemia. This 
Saturday we are going to have an auction. We are going to auction off 
items that neighbors and friends have contributed to get money to try 
to help Patsy Haines and her family afford the medical care she needs.
  I would like to explain something else briefly. Patsy Haines worked 
for a particular company that had a self-insured policy, insurance 
plan. She worked there for 5 years, until she became too ill to work. 
Her husband has worked at that company for 7 years. Patsy Haines has a 
brother who provides a perfect match for a bone marrow transplant. Her 
doctor says if Patsy Haines receives this transplant, the chances are 
she will be cured and live a long life and rear her child and be a wife 
to her husband.
  This is the problem: the insurance company refuses to pay for the 
transplant, saying that it is experimental. I went to the James Cancer 
Hospital in Columbus, Ohio, where some of the world's leading cancer 
experts work. I talked to the transplant team there. I talked to a 
young, very inspirational physician, degrees from Stanford and Harvard 
and a leading expert in bone marrow transplant.

                              {time}  2030

  He confirmed that this is exactly what Patsy Haines needs. He said it 
is the standard treatment.
  I went to the Ohio Department of Insurance and I shared Patsy Haines' 
story with them and they were sympathetic but they said we really have 
no jurisdiction over this situation.
  So we find ourselves in the United States of America, in the year 
2001, where a young woman, a wife, a mother, is facing a situation 
where she may lose her life. It is shameful. All of us in this Chamber 
should be ashamed that we have not passed a Patients' Bill of Rights 
long ago. It is beyond belief almost that we would actually stand in 
these Chambers and debate whether or not an American citizen should 
have the right to go into a court of law to have their rights defended 
when they are denied necessary and needed medical care.
  I thank the gentleman for this special order. The American people 
need to know what is going on. If they do know, I believe we will be 
forced to do the right thing even if we choose not to. So I thank the 
gentleman for this special order and for this time that has been given 
to me, and I hope that we can move together in the days and the weeks 
to come to accomplish this good thing for the American people.
  Mr. RODRIGUEZ. Mr. Speaker, I want to thank the gentleman very much 
for sharing that story. As we see, each Congressman that has come has 
shared a story from their constituents; and I want to thank them for 
that.
  As we start bringing closure, I want to make sure I recognize my 
fellow Congresswoman, the gentlewoman from California (Mrs. 
Napolitano), who is joining us tonight.
  Mrs. NAPOLITANO. Mr. Speaker, I came in at the tail end of this; and 
I certainly want to add my two cents. I have been in the labor market, 
so to speak, over 50 years. It may seem kind of crazy, but I have been. 
In those years, I have seen the different types of coverage that 
employees have had because during my work period I can remember when an 
employee would have an illness or a need to have surgery. There was 
never any question about the services to be rendered to that individual 
by the coverage the company afforded them. There never was a question 
about whether or not it was legitimate or not. It was assumed that if 
the employee was determined to have a need, that need would be filled 
by the provider.
  Well, things have changed. And through the years, we see that the 
companies have put in place deterrents for people to get the type of 
care that they are entitled to, because the insurance company provides 
it for them and they determine that they are the ones who are going to 
determine whether or not it is going to be treatable.
  Well, that affects us all. I have had numerous phone calls from 
constituents just recently, a gentleman, a business owner no less, who 
has been in business many years, diabetic, had a foot infection. He was 
waiting for the provider to tell him whether or not he could get 
services in a hospital to take care of an infection. That is a very 
serious thing for a diabetic to have a toe infection. So I asked him to 
go to the top and make his wishes known. He was a businessman that 
should have been able to reach somebody besides an accountant telling 
him, well, wait until the decision is made.
  We have many people whose lives hang by a thread and the more that 
they are made to wait the chances for their survival diminish. I think 
it is important for the people to understand that we want to have the 
ability to pass such legislation so they should also be aware that as 
we go through this session that we would like to have their input so 
that we can then be more cognizant of what we need to do.
  We already have all kinds of information. However, it is not 
happening; and I think it is time that we move forward and get through 
Congress this year an effective bill of rights that allows any 
individual, legitimately needing a service, to be able to obtain it.
  Mr. RODRIGUEZ. Mr. Speaker, I thank the gentlewoman from California 
(Mrs. Napolitano) for her comments. The Ganske-Dingell piece of 
legislation allows this opportunity. By the way, this particular bill 
has been passed by the House and we will have an opportunity to pass it 
again and hopefully pass it through both Houses and be able to make it 
through.
  Once again, I want to thank all the Members that have come out today 
to provide their testimony of the importance of the Patients' Bill of 
Rights and the importance of passing this to be able to see the doctor 
of one's choice.

                          ____________________