[Congressional Record Volume 147, Number 87 (Thursday, June 21, 2001)]
[Senate]
[Pages S6533-S6535]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          BIPARTISAN PATIENT PROTECTION ACT--MOTION TO PROCEED

  The PRESIDING OFFICER. Under the previous order, the Senate will now 
resume consideration of the motion to proceed to S. 1052, which the 
clerk will report.
  The legislative clerk read as follows:

       A motion to proceed to the bill (S. 1052) to amend the 
     Public Health Service Act and the Employee Retirement Income 
     Security Act of 1974 to protect consumers in managed care 
     plans and other health coverage.

  The PRESIDING OFFICER. Under the previous order, the time until 9:30 
a.m. shall be equally divided between the managers of the bill or their 
designees.
  Who yields time? The Senator from Massachusetts.
  Mr. KENNEDY. Madam President, as I understand, the time between 9:20 
and 9:30 is evenly divided.
  The PRESIDING OFFICER. The Senator is correct. That is the order.
  Mr. KENNEDY. I yield myself 5 minutes.
  Madam President, this is a very important day in the lives of 
families across this country. Today we are addressing one of the 
principal concerns of families from Maine to Florida, from the State of 
Washington to California, and the heart of the Nation. That is, are we 
going to make sure that medical decisions, decisions being made by 
doctors, nurses, and families, are going to be the final decisions in 
terms of treatment and care for those particular patients? That is what 
the issue is all about.
  As all of us have seen, we have countless examples where those 
decisions are

[[Page S6534]]

being overridden by HMOs and bureaucrats and bean counters. They are 
making medical judgments, effectively practicing medicine, which they 
are clearly not qualified to do. As we have seen in the Senate with 
countless illustrations, that just about every Member has shared, they 
have caused enormous damage to, and sometimes even cost the lives of, 
these patients.
  The protections we stand for are reasonable. They are sensible. They 
are common sense. When we get to the debate on this issue, we will have 
a chance to review them.
  We have waited 5 long years since this legislation was introduced to 
come to this day. We have not had the opportunity to the present time. 
We have had 14 days of hearings. We have the support of more than 800 
organizations. There are few, if any, medical organizations which 
represent children, women, parents, the disabled, or any of the other 
patients organizations, that do not support the proposal which has been 
introduced by Senators McCain, Edwards, myself, and others. We take 
heart that we are advocating for the doctors and nurses in America. 
They have committed themselves to help those in need, and have acquired 
the skill and training to make a difference in the lives of these 
patients.
  The fact is, this should not be a partisan issue. It is not. It is 
bipartisan in the Senate, and it is bipartisan in the House. We welcome 
our friends on the other side to join with us. As was mentioned 
previously, the essential aspect of this legislation has been supported 
by 63 Republicans in the House of Representatives. There are important 
leaders in the Republican Party, including Dr. Norwood, who have led 
this crusade in the House and continue to do so.
  This bill is bipartisan, and has the virtual unanimity of the medical 
professions and patient organizations behind it. It comes with a series 
of recommendations which are common sense in their nature, and 
effectively holds the HMOs liable if they take action that is going to 
cause injury. This is an important formula for good quality health care 
in America.
  As we have said so often, when we have effective accountability and 
effective liability, these provisions are rarely used. We have seen 
this in recent examples from California and Texas. What they do reflect 
is additional quality protections when they are included in the law.
  That is what we are interested in. Those of us who are supporting 
this measure know what it is all about: It is for the care and 
protection of patients. We have had a chance to examine it. This issue 
has been studied, restudied, and studied again.
  I look forward to a strong vote at the appointed hour.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. FRIST. Madam President, how much time do we have on this side?
  The PRESIDING OFFICER. Five minutes.
  Mr. FRIST. Madam President, I rise to support the commitment, the 
vote we will take in a few minutes, to proceed.
  As the Senator from Massachusetts said, America is ready for strong 
patient protections. America is ready to hold HMOs accountable when 
they are making medical decisions. The debate that will ensue today and 
will take some time, I believe, is an important one to the American 
people because all 170 million people who receive their health care 
through employer-sponsored plans will be affected. All of them are 
going to pay more money for their premiums because of the legislation 
on the floor.
  These are new rights, new protections. We will see a bill that will 
be ultimately signed by the President, I am confident of it, if it is a 
bill that is balanced, that respects this balance which all Americans 
deserve--the balance between accountability and patients' rights.
  We do need to get the HMOs out of the business of practicing 
medicine. There is no question the pendulum has swung over the last 10 
to 15 years to the point that HMOs have gone too far and gotten away 
from medical decisionmaking, medical decisionmaking being made locally 
with the doctor-patient relationship. Now it is time to swing that 
pendulum back.
  We need to hold HMOs accountable for decisions they make that are 
medical decisions. We need to return that decisionmaking back to the 
doctor-patient relationship. At the same time, we can't unnecessarily 
pass mandates that don't add protections, that drive the cost of 
premiums up, that drive the cost of health care up to all 170 million 
Americans out there unnecessarily because that does drive people to the 
ranks of the uninsured.
  We know if you don't have insurance, you don't have access to as good 
quality of care. It is that balance that I am very hopeful we can 
achieve in the Senate.
  As the Senator from Massachusetts said, it is not a partisan issue; 
it should not be. The President of the United States, a Republican, is 
leading on this issue with the principles he put forth in February. The 
lead sponsor of the Kennedy bill is a Republican, Senator McCain. The 
lead sponsor of the Breaux-Frist-Jeffords bill is a Republican. It is a 
nonpartisan issue, as we reach out to get patients the protections they 
deserve.
  The time element we will be discussing because, although people say 
we debated this over and over, we have not debated these liability 
provisions. We did not mark up, so-called mark up, these liability 
provisions in the Health, Education, Labor, and Pensions Committee. The 
last hearings we held on patient protection legislation were 2 years 
ago, and that was on the Jeffords bill that did not have liability or 
suing HMOs in it at all. What we will have over the next several weeks, 
for the first time on the floor of the Senate, is a debate on a bill 
that was introduced last Thursday, beginning the discussion on 
liability.
  Very quickly, let me illustrate what this entails because it is 
complex, as we go forward.
  Madam President, how much time do I have?
  The PRESIDING OFFICER. A minute 22 seconds.
  Mr. FRIST. This chart is an outline of the McCain-Edwards-Kennedy 
coverage determination and liability process. I have started to walk 
through it as it was in the bill introduced last Thursday. As you can 
see, it is quite complex. We are going to have to go through the 
internal appeals process, the external appeals process, and march 
through and see how much liability should be at the Federal level, how 
much should be at the State level, and should you go back and forth 
from Federal to State.
  Those are the issues we are going to have to debate as we look at how 
the whole HMO is accountable. I encourage my colleagues to vote in 
favor of proceeding so we can engage in the debate and improve the 
underlying bill.
  With that, I look forward to the first amendment at about noon today 
as we go forward.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Nevada.
  Mr. REID. Madam President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The question is on agreeing to the motion. The clerk will call the 
roll.
  The bill clerk called the roll.
  Mr. NICKLES. I announce that the Senator from Kentucky (Mr. 
McConnell) and the Senator from Oklahoma (Mr. Inhofe) are necessarily 
absent.
  I further announce that, if present and voting, the Senator from 
Kentucky (Mr. McConnell) would vote ``aye.''
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 98, nays 0, as follows:

                      [Rollcall Vote No. 193 Leg.]

                                YEAS--98

     Akaka
     Allard
     Allen
     Baucus
     Bayh
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Breaux
     Brownback
     Bunning
     Burns
     Byrd
     Campbell
     Cantwell
     Carnahan
     Carper
     Chafee
     Cleland
     Clinton
     Cochran
     Collins
     Conrad
     Corzine
     Craig
     Crapo
     Daschle
     Dayton
     DeWine
     Dodd
     Domenici
     Dorgan
     Durbin
     Edwards
     Ensign
     Enzi
     Feingold
     Feinstein
     Fitzgerald
     Frist
     Graham
     Gramm
     Grassley
     Gregg
     Hagel
     Harkin
     Hatch
     Helms
     Hollings
     Hutchinson
     Hutchison
     Inouye
     Jeffords
     Johnson
     Kennedy
     Kerry
     Kohl
     Kyl
     Landrieu
     Leahy
     Levin
     Lieberman
     Lincoln
     Lott
     Lugar
     McCain
     Mikulski

[[Page S6535]]


     Miller
     Murkowski
     Murray
     Nelson (FL)
     Nelson (NE)
     Nickles
     Reed
     Reid
     Roberts
     Rockefeller
     Santorum
     Sarbanes
     Schumer
     Sessions
     Shelby
     Smith (NH)
     Smith (OR)
     Snowe
     Specter
     Stabenow
     Stevens
     Thomas
     Thompson
     Thurmond
     Torricelli
     Voinovich
     Warner
     Wellstone
     Wyden

                             NOT VOTING--2

     Inhofe
     McConnell
       
  The motion was agreed to.
  Mr. REID. I move to reconsider the vote by which the motion was 
agreed to.
  Mr. GREGG. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. McCONNELL. Madam President, on rollcall vote No. 193, I was 
unavoidably detained and was unable to cast a vote. If I had been 
present, I would have voted in the affirmative on the motions to 
proceed.

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