[Congressional Record Volume 147, Number 90 (Tuesday, June 26, 2001)]
[House]
[Pages H3600-H3602]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2001, the gentleman from New Jersey (Mr. Pallone) is 
recognized for the remainder of the minority leader's hour, 
approximately 47 minutes.
  Mr. PALLONE. Mr. Speaker, I do not know whether I will use all of 
that time, but I do want to discuss tonight another health care issue. 
I appreciate my colleague, the gentleman from Vermont (Mr. Sanders), 
talking about the prescription drug issue and the reimportation issue; 
and that is certainly one of the major health care issues that needs to 
be addressed in this Congress.
  I talk all the time about three health care issues that I know that 
President Bush said during the course of his campaign he would address 
and that have not been addressed. Unfortunately, what we have here in 
the House, with the Republicans in control, the Republican leadership 
so far has been unwilling to address the three major areas that I hear 
about most in health care. One is prescription drugs, which my 
colleague from Vermont just mentioned; the other is the Patient's Bill 
of Rights, or HMO reform; and the third is the need to try to cover 
those 40 to 45 million Americans who have no health insurance.

                              {time}  2015

  Mr. Speaker, fortunately, the other body is now discussing HMO 
reform, the Patients' Bill of Rights. I would say that the reason that 
has happened is because of the switch in the majority from Republican 
to Democrat in the other body. The first order of business that the new 
Democratic majority took up was HMO reform, the Patients' Bill of 
Rights.
  Tonight I would like to discuss briefly why I think it is important 
to pass the Patients' Bill of Rights, and not just any Patients' Bill 
of Rights, but the Patients' Bill of Rights, or HMO reform, that was 
introduced in the other body by Senator McCain, Senator Kennedy, and 
Senator Edwards, and that has been introduced in the House by the 
gentleman from Iowa (Mr. Ganske) and the gentleman from Michigan (Mr. 
Dingell).
  These are bipartisan bills, but I need to point out that the thrust 
of the bills is from the Democratic side, because the Republican 
leadership, even though there are some Republicans that are playing a 
key role on these bills, the Republican leadership has refused to bring 
them up in either House, or to support the Ganske-Dingell bill, the 
real Patients' Bill of Rights here in the House, or the McCain-Kennedy-
Edwards, the real Patients' Bill of Rights in the other body.
  I will not refer to them necessarily as the Democratic bills because 
we do have some Republican support, but they are Democratic bills in 
that the Democratic leadership supports them in both Houses and the 
Republican leadership does not support them in either House.
  Why are we talk talking about the Patients' Bill of Rights and HMO 
reform. Two reasons. This comes from my constituents and from Americans 
from all walks of life. Increasingly, if a person is in a managed care 
situation, if you are in an HMO, the decision about what type of care 
you get, and that means whether you get a particular medical procedure, 
whether you can go to a particular hospital, whether you can stay in 
the particular hospital for a particular length of time, these types of 
decisions about your care unfortunately are made almost exclusively now 
by insurance companies, by the HMOs.
  What the Democrats have been saying and what the real Patients' Bill 
of Rights says is that that needs to change. That needs to go back to 
medical decisions, what is medically necessary for you as a patient, 
that decision is made by your physician, your health care professional 
and you as a patient, not by the insurance company. That is the one 
major change, and the one need for reform with regard to HMOs that the 
Patients' Bill of Rights seeks to accomplish.
  The other major issue and the other major change is the fact that 
today in HMOs, if a decision is made about what type of care you get, 
and you do not agree with that, in other words you have been denied the 
care that your doctor and you feel is medically necessary, you do not 
have any place to go. You can file a grievance with the HMO; and they 
will review it and say sorry, we made a decision, and we are not going 
to change it.
  What the Democrats would like to see, what the Dingell-Ganske bill 
would do is turn that around and say if you want to seek a redress of 
grievances because you feel you have been improperly denied care, you 
can go to an external review board, an independent review board outside 
of the HMO, and they will review that decision by the HMO. They have 
the power to overrule it if they think that care was improperly denied 
and you need the care that your physician says is necessary.
  Failing that, in certain circumstances you would be able to go to 
court and bring suit so you could have the decision of the HMO turned 
around, or you could even be granted damages if you were seriously 
injured and it was too late to correct your situation; or God forbid, 
you died, your estate could sue for damages.
  Now, those two things, those two basic theories, the decision about 
what kind of care you get is made by a health care professional, not by 
the insurance company, and that you have some place to go to right that 
wrong and to turn that decision around are really at the heart of the 
Patients' Bill of Rights.
  Mr. Speaker, I want to talk about some of the specific things that 
the Patients' Bill of Rights will do which I think are important. I 
will mention a few that apply to patients, and then I want to mention a 
few that apply to doctors, because I think as you know, the doctors now 
under HMOs feel that they cannot even practice medicine. There are a 
lot of restrictions on what they can do, so the decision is important 
for the doctors as well as for the patients.
  One area is access to emergency room care. The Patients' Bill of 
Rights allows patients to go to any emergency room during a medical 
emergency without having to call a health plan first for permission. 
Emergency room physicians can stabilize patients and begin to plan for 
post-stabilization care without fear that health plans will later deny 
coverage.
  This is a big concern that patients have. I get chest pains, I think 
I am having a heart attack. I cannot go to the hospital that is down 
the street. I have to go to one 150 miles away. I may suffer damage 
because I have to go to an emergency room so far away. That makes no 
sense. We reverse that and say if you feel, if the average person feels 
by having severe chest pains they need to go to the closest hospital, 
they have the right to go there and the insurance company has to pay 
for that emergency room care.
  Access to needed specialists. Part of the problem now is many 
patients, many Americans in HMOs do not have access to a specialist. 
They may have access to a family physician, but if they want to go to a 
specialist in that particular area where they need help, they cannot 
obtain that through the HMO.
  The Patients' Bill of Rights ensures that patients who suffer from a 
chronic condition or require care by a specialist will have access to a 
qualified specialist. If the HMO network does not include specialists 
qualified to treat a condition, such as a pediatric cardiologist, for 
example, to treat a child's heart defect, it would have to allow the 
patient to see a qualified doctor outside the network at no extra cost.
  The Patients' Bill of Rights also allows patients with serious 
ongoing conditions to choose a specialist to coordinate care or to see 
their doctor without having to ask their HMO for permission before 
every visit. This is common sense.
  The Patients' Bill of Rights also allows direct access to an OB-GYN. 
It allows the woman to have direct access to OB-GYN care without having 
to get a referral from her HMO. Women would also have the option to 
designate their OB-GYN as their primary care physician. This is very 
important to women.
  Finally, and there are so many other patient protections, and I just 
want to

[[Page H3601]]

mention a few because I want everyone to understand how important these 
patient protections are, the Patients' Bill of Rights says that needed 
prescription drugs would be available to patients. Currently, many HMOs 
refuse to pay for prescription drugs that are not on their preapproved 
list of medications. As a result, patients may not get the most 
effective medication needed to treat their condition.
  The Patients' Bill of Rights ensures that patients with drug coverage 
will be able to obtain needed medications even if they are not on the 
HMO's approved list. If your plan does not include drugs, we are not 
saying that you are going to get it. But if your plan includes drugs, 
they cannot limit you to the preapproved list of medications.
  Let me talk about some of the ways in which the Patients' Bill of 
Rights, the Dingell-Ganske bill and the McCain-Kennedy-Edwards bill, 
frees up doctors to practice medicine, because many times they feel 
that their hands are tied. My point is what I originally said, is that 
accountants and insurance company executives and staff should not be 
making medical decisions. It is the doctor who should be able to make 
medical decisions.
  What the Patients' Bill of Rights says is that it prohibits insurers 
from gagging doctors. Patients have a right to learn from their doctor 
all of their treatment options, not just the cheapest. The Patients' 
Bill of Rights prevents HMOs from interfering with doctors' 
communications with patients. Doctors cannot be penalized for referring 
patients to specialists or discussing costly medical procedures.
  People do not understand that a lot of Americans are in HMOs where 
they say that the doctor cannot talk to you about a preferred method of 
treatment. If the insurance plan does not cover a particular procedure, 
then they can tell the doctor that he cannot talk to you about it even 
if he thinks that you need it. That is the gag rule. We have eliminated 
it.
  The Patients' Bill of Rights allows doctors to make the medical 
decisions. It says that doctors rather than insurance company 
bureaucrats will basically decide what kind of medical care you get. 
HMOs are prevented from inappropriately interfering with doctors' 
judgments and cannot mandate drive-through procedures or set arbitrary 
limits on hospital lengths of stay.
  In addition, doctors and nurses who advocate on behalf of their 
patients will be protected from retaliation by HMOs. There are many 
patient protections in the Patients' Bill of Rights. I am not going to 
go into all of them tonight, Mr. Speaker. Suffice it to say the main 
thing is the idea that doctors will make decisions, not the insurance 
company; and there is some way to appeal that decision outside of the 
HMO.
  Mr. Speaker, I wanted to go into some other areas that relate to the 
Patients' Bill of Rights because we know that the other body is 
considering it. They have done so for about 10 days, and we are hoping 
that it will come here to the House of Representatives eventually. Some 
of the arguments that are being used now against the real Patients' 
Bill of Rights, the Democratic bill, are that a lot of States have 
already enacted legislation that would protect patients, and so it is 
not really necessary for the Federal Government to act. I hear this 
from time to time.

  My State of New Jersey has actually passed a fairly strong patient 
protection act. Some people say we have it in New Jersey, or maybe we 
have some form of it in other States. Why do we need to do something on 
the Federal level? I think that is a very important point that needs to 
be responded to. I just want to talk a little bit about that tonight if 
I can, Mr. Speaker.
  First of all, the real reason we need Federal legislation is that 
these protections that do exist today are sort of like a patchwork 
quilt, and there are a lot of holes in it and a lot of differences from 
State to State. There are a lot of differences in the protections that 
are afforded to people. There are enormous differences in the way that 
a person can redress their grievances, what kind of external review 
they would have, what kind of ability to sue that they would have. 
Also, let me just get into basically three areas, if I could, where we 
see the State laws different and I can explain why we need a Federal 
bill.
  Of the 10 areas of consumer protections that are primarily the focus 
of the Patients' Bill of Rights, only one State has adopted most of 
those protections. In a lot of States maybe half of the protections are 
provided and half of them are not. But even in States that have adopted 
specific patient protections, those laws are not applicable to many of 
the States' residents. So you might have in a State with no patient 
protections, or in a State that has some; but you might not be in a 
group that is covered by those patient protections. The State laws 
differ in terms of who is covered.
  For example, some States have the prudent-layperson standard for 
emergency room care. If I feel as an average person because I have 
chest pains I should go to the local emergency room, I can go there and 
it will be paid for. That varies. Some States have it, and some States 
do not. About 43 percent of all employees who get their health care 
coverage through their employer are not covered by protections even in 
the States that have something like a Patients' Bill of Rights.
  Mr. Speaker, I do not want to dwell on this forever, but the point I 
am making is that it is a very hollow argument for somebody to say that 
we do not need the Federal law because some States have enacted this 
because some States have, and others have not. Some people are covered 
in those States, and others are not; and they may have some 
protections, but they may not necessarily have all of the protections.
  In New Jersey, which has a pretty strong Patients' Bill of Rights, 
there was an article just a couple of months ago in one of my local 
papers, the Home News Tribune, an editorial, that advocated for a 
Federal Patients' Bill of Rights because it said that it is very 
difficult in New Jersey to sue if you have been denied care.

                              {time}  2030

  That is just another example, even in a State as strong as New 
Jersey, where we need some Federal action.
  I wanted to talk about two other things tonight, Mr. Speaker, two 
other areas related to the Patients' Bill of Rights, before I yield 
back the balance of my time.
  One is that I know that in the other body, efforts are being made to 
weaken the Democratic proposal, the McCain-Kennedy-Edwards bill, 
through amendment. Fortunately, those efforts have failed. I think it 
is significant because it shows that even though this is primarily a 
Democratic bill, that we clearly have enough Republicans now that are 
coming over with us on these key amendments that we are forging a 
bipartisan coalition to support the real Patients' Bill of Rights 
regardless of the fact that the Republican leadership opposes the bill.
  The two amendments that came up within the last week, I think, are 
significant. One of the amendments which was rejected by a vote of 56 
to 43 proposed to exempt employers from health care lawsuits in every 
situation. Now, this has been a major point of contention, because some 
people say, well, the problem with the Patients' Bill of Rights is that 
employers may be sued. What we have said is there is a very limited 
situation where employers can be sued and that is only if they have 
taken direct responsibility and have been directly involved in the 
decision of what type of care you should get. But the Republican 
leadership wanted to just say that they could not be sued under any 
circumstances. I think that is wrong. I was glad to see that that 
amendment was struck down. I think actually that took place today in 
the other body.
  The other amendment which I believe was defeated last week related 
basically to tax breaks. This was a Republican proposal to add a 
provision speeding up tax breaks to cover costs of health insurance for 
the self-employed. I mention that one, although it may not be as 
obvious why that is a bad thing, because what we have seen in the past, 
and this is what happened in the House of Representatives last year 
when we took up the real Patients' Bill of Rights, is that there was an 
effort to try to add all kind of things to the bill, what I call poison 
pills, to load it up with all kinds of unrelated ideas, if you will, or 
proposals so that it would never pass.
  What really happened last year is that the Republican leadership was 
fairly successful, in that even though we passed a good Patients' Bill 
of Rights in the House of Representatives,

[[Page H3602]]

they put in all these poison pills or extraneous provisions related to 
tax breaks, related to malpractice, related to medical savings 
accounts, and so that when the bill went to conference between the two 
Houses, it was virtually impossible to get a bill out of conference and 
to the President because of all these poison pills, added provisions, 
loading down the Patients' Bill of Rights so that it could not pass and 
was not a clean bill. We do not want that to happen again.
  I have been very happy with what is happening in the other body 
because it is clear that we have a majority, albeit a slight one, 
between most of the Democrats and a few Republicans to try to have a 
bill that clearly will shift the burden so that decisions are made by 
doctors and there is a real way of redressing your grievances and, on 
the other hand, not loading this bill down with all kind of extraneous 
material so we can never get it out of conference and to the 
President's desk.
  But the other development that occurred today that was disturbing, 
and I think I need to speak out on it because I need to expose again 
what the Republican leadership this time in the House is trying to do, 
is that the Republican leadership in the House, which so far has 
refused to bring up the real Patients' Bill of Rights, will not have it 
go through committee, will not bring it to the Committee on Rules, will 
not bring it to the floor, as the Republican leadership has unveiled 
their own HMO reform bill which, of course, you know, they are going to 
call the Patients' Bill of Rights, but it is not the real Patients' 
Bill of Rights. It is not the bill that has already passed the House, 
that is now being considered in the other body, that has the support of 
almost every Democrat and about a third of the Republicans.
  I want to talk a little bit, if I can this evening, Mr. Speaker, 
about why this latest House Republican leadership proposal for HMO 
reform does not cut the mustard and is just a subterfuge to try to kill 
the real Patients' Bill of Rights, because what I think is going to 
happen is that the Republican leadership when we come back from the 
July 4th recess is going to try to bring up their version of HMO reform 
and ignore the real Patients' Bill of Rights and try to make it so that 
the real Patients' Bill of Rights never gets considered on the House 
floor.
  Let me tell you a little bit about what this Republican plan that was 
introduced today, or they had a press conference today, is all about. I 
would characterize it as an HMO, an insurance company bill of rights 
rather than a Patients' Bill of Rights. Once again the Republican 
leadership is protecting managed care plans from simply being held 
accountable for their actions. Unlike the real Patients' Bill of 
rights, the Republican plan leaves the review of patient grievances in 
the hands of the insurance companies and still allows insurance 
companies the ability to dictate the services patients receive.

  Now, I have said before why this is unacceptable. It is unacceptable 
because the core of the real Patients' Bill of Rights is the idea that 
the insurance companies do not make medical decisions; the doctors and 
the patients do. We want to see a real Patients' Bill of Rights, that 
is what our constituents tell us, not a phony one.
  The legislation that the Republican leadership introduced today does 
not provide many of the assurances that I talked about tonight that the 
real Patients' Bill of Rights provides. It allows HMOs to choose the 
external appeals panel and then allows the panel to determine whether 
the patient can go to court without allowing the patient the right to 
appeal. In addition, the Republican bill provides only a narrow venue 
for State lawsuits which then forces all suits over improperly denied 
care to go to Federal court.
  Now, some people may say, Well, what's the difference whether I sue 
in State court or Federal court? Let me tell you, it makes a big 
difference. What the Democratic bill says is that you can sue in State 
court. If the Republican bill forces you into Federal court, there are 
not that many Federal courts and their dockets are overcrowded and 
people have a much harder time suing in Federal court, and it costs you 
a lot more money to sue in Federal court. So there is a difference. I 
do not want to play it up in a major way, but I want to explain why 
there is a difference.
  I think that what the Republican leadership did today in the House is 
that basically what they are trying to do is sort of outbest what the 
other body is doing. They know that the other body is likely to pass a 
real Patients' Bill of Rights, and they want to bring up a fake one 
here in the House that the majority of the Members, almost all the 
Democrats and even about a third of the Republicans are opposed to.
  We will see what happens, but I think that we need to expose what is 
happening here and how this latest bill which was much heralded today 
by the Republican leadership really does not accomplish the major goal 
of the real Patients' Bill of Rights, which is to switch the decision 
about what kind of care you get to your doctor and you rather than the 
insurance company and that allows you to basically appeal a denial of 
care to an independent body outside of the HMO and ultimately to court 
if you do not have a fair shake.
  Mr. Speaker, I just wanted to say, I know that every night this week 
the Democrats are using our time during Special Orders to draw 
attention to the Patients' Bill of Rights and why we need to pass the 
real bill here in the House and also in the other body. Last night we 
had Members of the Texas delegation get up, and I thought that was very 
significant because, as you know, President Bush said during the course 
of the campaign that he would sign a bill that was like the Texas law. 
Frankly, the Dingell-Ganske bill, the McCain-Kennedy-Edwards bill, the 
real Patients' Bill of Rights, is exactly like the Texas law. Yet now 
President Bush says he will veto that bill and he does not find that 
bill acceptable and is asking for something else. I think that is not 
the commitment he made during the campaign. It was not the commitment 
he made when he was Governor. And it certainly is a commitment that he 
should keep and hopefully if we send him the real bill, he will sign it 
even though he is now threatening to veto it.
  The second thing I wanted to say is that tomorrow night, the 
Democrats will have some of our Members who are health care 
professionals, who are nurses and who are other types of health care 
professionals, taking to the floor.
  The reason we are doing that is because I think that oftentimes it is 
the people that are in the health care profession, the doctors, the 
nurses, the technicians, these are the people that understand, I think, 
oftentimes even more than the patients, why it is important to have a 
real Patients' Bill of Rights, because they want to take care of their 
patients. They want to make sure they get the proper care and the care 
they deserve. They do not want monetary or other considerations, the 
bottom line, to dictate the quality of care for the average American. 
We will be here as Democrats every night this week and also when we 
return after the July 4th recess to bring up the point that the real 
Patients' Bill of Rights must pass. It is the highest priority of the 
Democrats in both Houses, and we are determined to see it through.

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