[Congressional Record Volume 147, Number 103 (Monday, July 23, 2001)]
[House]
[Pages H4417-H4423]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           MANAGED CARE REFORM FROM A DEMOCRATIC PERSPECTIVE

  The SPEAKER pro tempore (Mr. Kirk). Under the Speaker's announced 
policy of January 3, 2001, the gentleman from New Jersey (Mr. Pallone) 
is recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, I intend this evening with some of my 
colleagues on the Democratic side to focus on the same issue that the 
previous Republican Members focused on, and, that is, the Patients' 
Bill of Rights, the HMO reform bill.
  I must say that it disturbs me a great deal to see some of the 
opponents of the real Patients' Bill of Rights, the bill that has been 
sponsored by the gentleman from Michigan (Mr. Dingell), who is a 
Democrat; the gentleman from Iowa (Mr. Ganske), who is a Republican and 
a physician; and the gentleman from Georgia (Mr. Norwood), who is a 
Republican and a dentist, and that was voted on overwhelmingly by every 
Democratic Member of the House of Representatives in the last session 
and about 68 Republican Members, the real Patients' Bill of Rights, is 
now being superseded on the other side of the aisle by the Republican 
leadership which is now promising to bring an alternative bill which 
they also refer to as the Patients' Bill of Rights to the floor.
  I would remind my colleagues that the real Patients' Bill of Rights, 
the one that we voted on, one that all of us, most Democrats and a 
significant number of Republicans have been pushing for for probably 5 
or 6 years, is the bill that should be allowed to come to the floor 
rather than the Republican alternative, the Fletcher bill, which is in 
my opinion nothing but a fig leaf and which does not accomplish the 
goal of truly reforming HMOs.
  There are two essential goals of HMO reform that are in the real 
Patients' Bill of Rights. One goal is to make sure that medical 
decisions are made by the physician, the health care professional and 
the patients, not by the HMOs, not by the insurance companies; and the 
second goal is to make sure that if you have been denied care by the 
HMO that you have a legitimate and reasonable way of seeking a redress 
of grievances and overturning that decision so you can get the care 
that you need.
  I would maintain, and we will show this evening once again, that the 
Fletcher bill does not accomplish that goal; and the real Patients' 
Bill of Rights, the Dingell-Ganske-Norwood bill, does.
  I wanted to, if I could this evening before I yield to some of my 
colleagues, really point to the two major criticisms that I heard on 
the Republican side of the aisle tonight against the real Patients' 
Bill of Rights. One is that there are going to be too many lawsuits. 
The second is that it is going to drive up health insurance costs.

  The best way to refute that is to refer back to the Texas law that 
has been on the books for a number of years now which is exactly the 
same really as the real Patients' Bill of Rights and which shows 
dramatically that neither one of those disasters, all these lawsuits, 
all this litigation, or the other disaster that my Republican 
colleagues talked about, that health care costs are going to be going 
up, that insurance companies are going to drop their patients, neither 
one of those disasters befell the State of Texas because a real 
Patients' Bill of Rights was put into effect.
  It is interesting because, in reality, what President Bush is doing 
in the last few weeks and leading up to hopefully a vote this week on 
the Patients' Bill of Rights is that President Bush is waving the same 
flags that he used in the State of Texas when he was Governor to say 
there is going to be too much litigation and that insurance companies 
are going to drop patients and not let Americans have health insurance, 
that they are going to drop health insurance. These were the arguments 
that the President used when he was the Governor, they are the 
arguments that he is using now, and it is simply not true.
  Mr. Speaker, if I could just give some statistics. This goes back to 
1997 when then Governor Bush said of the Texas law and I quote, ``I'm 
concerned that this legislation has the potential to drive up health 
care costs and increase the number of lawsuits against doctors and 
other health care providers.'' What did the President, then Governor 
do? He vetoed a bill similar to the Patients' Bill of Rights in 1994.
  In 1997, when it came up again, he did everything he could to 
sabotage the bill to the point that he actually refused to sign it but 
I guess for political reasons figured that he could not veto it again 
and so he simply let it become law without his signature. But we are 
getting the same rhetoric again.
  Last week as the Patients' Bill of Rights, the real one, made its way 
towards debate in the House, the President said almost the same thing; 
and I quote. He said, ``This is how best to improve the quality of care 
without unnecessarily running up the cost of medicine, without 
encouraging more lawsuits which would eventually cause people not to be 
able to have health insurance.''
  Again, that people are going to have their health insurance dropped, 
that litigation is going to increase.
  Let us look at the facts. Since the 1997 Texas law that Bush opposed 
so strongly has taken hold, the disastrous effects he had predicted 
have yet to occur in the Lone Star State. In the 4 years since, even 
the law's opponents acknowledge that none of then Governor Bush's 
predictions have come true. Instead of becoming a bonanza for all these 
trial lawyers, the right to sue an HMO or an insurance company in Texas 
has been exercised just 17 times. In all the years since 1997 that it 
has become law, only 17 lawsuits. That is an average of three or four 
per year.
  According to the Texas Department of Insurance, the number of Texans 
enrolled in health insurance or HMO plans has actually increased 
steadily since the 1997 law was passed. Enrollment has grown from 
2,945,000 Texans at the end of 1996 before the law was passed to 3.2 
million at the end of 1997 to 3.9 million at the end of 2000. There is 
just no truth to this. In fact, when you talk about the cost, the cost 
of HMO premiums in Texas have risen but less than the national average. 
So the bottom line is the disaster has not occurred.
  I know I almost hesitated to talk about what is happening in Texas 
because my two colleagues whom I know are going to join me tonight are 
both from Texas and I do not like to speak about another State, but it 
is all positive. The experience has been totally positive.
  How can the President or any of our Republican colleagues on the 
other side of the aisle suggest the same kind of thing, the same kind 
of disaster that is going to befall the Nation when Texas has been such 
a success story?
  Just to give an example, one of the reasons, of course, and I always 
maintain that what the HMO reform would do and what the Patients' Bill 
of Rights would do was essentially correct the errors of the system. 
Because once the HMOs know that they cannot get away with these things, 
then they start taking corrective action and making sure that patients 
get the type of care that they want. Because they know that if they 
deny care there is going to be an external review by independent people 
outside the HMO, or they know that ultimately people can go to court. 
So they correct the situation. It becomes preventative. That is 
essentially what the Patients' Bill of Rights will do.
  Again, the Texas situation points that out very dramatically. In 
Texas, you could go straight to the courts if you want to, but people 
overwhelmingly go to the independent review. This is an external 
review, a group of people that review a denial of care that are not 
appointed by the HMO and not influenced by the HMO.
  From November, 1997, through May, 2001, independent review doctors 
have considered 1,349 complaints in Texas. In 672 of these assessments, 
or 50 percent, they overturned the HMO or the insurance company's 
original ruling, I guess in about half the cases. What we are seeing is 
now that patients know that they can go outside the HMO and

[[Page H4418]]

have an independent review of a denial of care. They are exercising 
that. They are not going to court because nobody wants to go to court 
and have litigation and spend money and go on and on for years. Nobody 
wants to do that, not the patients any more than the HMOs or the 
insurance companies.
  What they set forth in Texas is a very easy way to review denial of 
care. It has been largely successful. The bottom line is there is 
absolutely no reason why we should not try to implement it on the 
national level.
  Some people have said to me, well, if the States are doing this, why 
do we need the national law?
  First of all, not every State is doing it. Texas has probably the 
best law. None of the others are as good. Most States still do not have 
anything near the protection that Texas offers.
  In addition to that, because of a statute called the Employee 
Retirement Income Security Act, or ERISA, those people who are insured 
through employers who are self-insured, and I do not want to get into 
all the bureaucracy of that, but that is about 60 percent of the people 
who are insured in this country, they are not subject to the State 
laws. You need the national law like the Patients' Bill of Rights to 
make sure that they have the same kind of protections that they would 
get in States like Texas if they were covered by the Texas law.
  The other thing that really upsets me, and I have to be honest about 
the Fletcher bill, the Republican alternative that we heard about 
earlier this evening, is that it would preempt the State law. Experts 
in Texas will tell you that if the Fletcher bill, the one that my 
Republican colleagues were talking about tonight, were to become law, 
it would supersede the Texas law and we could have a situation where 
the very people that are being protected by that law now and have that 
independent review or the ability to go to court might not have that 
kind of protection because the Federal law, the Fletcher bill, would 
preempt it.
  What is happening down here? Mr. Speaker, my colleagues might say, 
are we ever going to get to this Patients' Bill of Rights? Are we ever 
going to get to HMO reform? Is it even going to come up in this House? 
The leadership on the Republican side have said that they are going to 
post the bill this week. What bill? We do not know. Are they going to 
give us a clean vote on the real Patients' Bill of Rights, the Dingell-
Norwood-Ganske bill? Or are they just going to let us consider the 
Fletcher bill, which is a weak alternative? Are they going to give us 
the chance to consider any bill? I would suggest that there is a 
serious question of that.
  What is happening right now, from what I understand, and I am just 
reading some news clips as well as what I hear, the scuttlebutt around 
the floor here in the House of Representatives is that the votes are 
not there for the Fletcher bill. In other words, almost every Democrat 
is going to vote for the real Patients' Bill of Rights and a good 
percentage of the Republicans are going to do it, also, as they did 
last session. The votes are not there to pass the weak alternative, the 
Fletcher bill that my Republican colleagues were talking about earlier 
this evening.
  So what is going to happen is that we hear the President is coming 
back tomorrow from Europe and that he is going to spend the rest of 
Tuesday, Wednesday, maybe Thursday trying to twist arms to convince 
Republicans who supported the real Patients' Bill of Rights last year 
to not support it this year and vote for the weaker Fletcher bill. Then 
if that does not happen and there are not enough votes, then we are not 
going to have an opportunity to vote on the Patients' Bill of Rights 
this year.
  That is not fair. I know that Democrats are in the minority here in 
the House of Representatives. Republicans control the agenda, and they 
can bring up whatever they want. But the bottom line is that we know 
that there is a majority for the real Patients' Bill of Rights, for the 
Norwood-Dingell-Ganske bill that is made up of almost every Democrat 
and enough Republicans to create a majority. We have a right, given 
that that majority exists, to have that bill come up for a clean vote 
this week. I will say right now to the Speaker and to my colleagues 
that if that right is denied us because the Republican leadership 
realizes that there are enough votes to pass the real Patients' Bill of 
Rights and not enough to kill it with the Fletcher alternative, there 
is going to be a lot of recriminations around here because we do not 
have the right to vote on that bill.
  So I would say to the Republican leadership, bring up the Patients' 
Bill of Rights. You want us to vote on the Fletcher bill? The votes 
will not be there. Bring it up. Then let us vote on the real Patients' 
Bill of Rights, the Dingell-Ganske-Norwood bill.

                              {time}  2045

  But either way, let us have a clean vote this week, because that was 
the commitment that the Republican leadership and the Speaker made, and 
they should fulfill that commitment this week and let us vote on the 
patients' bill of rights on HMO reform.
  Mr. Speaker, I would like to yield now to one of my two colleagues 
from Texas, both of whom have been here on a regular basis with me 
speaking out on this issue, and I particularly like to see the two of 
them tonight, because I know of their experience with the Texas law and 
their involvement in the health care issue and the HMO issue for so 
many years as Members of our Health Care Task Force. I yield to the 
gentlewoman from Texas.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the distinguished 
gentleman from New Jersey. I am delighted to be able to join him, along 
with my distinguished colleague, the gentleman from Texas (Mr. 
Rodriguez), who has served in the State legislature and serves, as I 
do, on the Energy Brain Trust of the Congressional Black Caucus. He, of 
course, leads the leadership of the health issues with the Hispanic 
caucus. We know that these are global American issues, and so we come 
to speak to them as they are global issues.
  I was fascinated by the debate of my colleagues that occurred just a 
few short minutes ago regarding the pending debate as relates to now 
new legislation, H.R. 2315, now known as the Fletcher bill. I was quite 
fascinated because one of the strongest elements of the Ganske-Dingell-
Norwood bill and the McCain bill is the bipartisanship and the age of 
the bills. These bills have been vetted throughout the country, they 
have been vetted by Members of both sides of the aisle, and they have 
been seen to be logical and direct responses to the needs of American 
people.
  I am very disappointed that the administration, with the leadership 
of President Bush, that comes directly out of the State of Texas, who 
has seen a bill similar to the Ganske-Dingell-Norwood bill work, would 
now throw this curve, so that we could not do this for the entire 
citizenry of America.
  There is a study that exists, and I cannot quote the particular 
survey that was done, but it was recently done out of Fort Worth, that 
shows in the time frame of the passage of the State bill that is very 
similar to what we are debating and hopefully will debate, the real 
patients' bill of rights, shows that there have been less than 30 cases 
dealing with challenges to HMOs, lawsuits, if you will, and all of them 
have been non-frivolous and they have been based upon the negligence of 
the HMO in denying medical care.
  Let me just refer to you my thought processes here on the Fletcher 
bill. First of all, it now becomes a potpourri, a kitchen sink, of 
private savings accounts for health care and a myriad of other tax 
issues and accounting issues, and this is not what the American people 
are asking for.
  The basic underlying principles of the Ganske-Dingell-Norwood bill, 
and we could put it in any other framework, the bill passed in the 
Senate, the McCain bill, is about accountability. The simple basic 
premise is not frivolous lawsuits, it is not harassment, it is not 
intimidation, it is simply to hold HMOs accountable for negligence. It 
is not even holding them accountable for their existence. There are 
many viewpoints about HMOs, but we have seen that many of the holders 
of HMOs, the individuals who have health plans, like their individual 
health plan.
  This is not an uprising by the American people to randomly throw out 
health plans without cause. The bottom line of why we thought it was 
necessary some 3 or 4 years ago, as the gentleman from New Jersey is 
well

[[Page H4419]]

 aware of, to come to the aid of the American people, were the 
egregious denials that were occurring to various holders of health care 
or managed care programs and plans throughout the Nation.
  Right now I can remember the lady that was flown from Hawaii because 
she was denied service, and, as she got off the plane in Chicago, she 
died. I remember the very moving and stirring presence of, I think, a 
multiple amputee, of a little boy about 8 to 12 years old, that the 
gentleman from Iowa (Mr. Ganske) brought to the floor of the House to 
educate us about a young boy who was denied emergency care, and, 
because of that, suffered multiple amputation of his limbs. We are 
talking about egregious circumstances that have to be addressed.
  Interestingly enough, we are still holding the American Medical 
Association, the premier group that knows about medical care in today's 
hospitals and today's rural and urban communities, who have indicated 
their strong and committed support of the legislation of the real 
patients' bill of rights.
  Let me cite to you a direct quote from the American Medical 
Association. It says, ``June 28, 2001, the American Medical Association 
called on Congress to reject the HMO lobby's desperate smokescreen that 
the McCain bill,'' which is, on the House side, the Dingell-Ganske-
Norwood bill, ``would increase the number of uninsured. In the nine 
states that have comprehensive patients' rights laws in place, there 
have been very few lawsuits, and the laws have not caused premiums or 
the number of uninsured to skyrocket.''

  This goes to the very point dealing with the fact that employers, 
well-meaning employers, good-intentioned employers, will be the ones 
that will suffer. First of all, I know we are looking to address that 
question, but primarily that kind of result is not the result, did not 
happen in Texas, and certainly we cannot expect it to happen, as 
evidenced by the statement of the American Medical Association, which 
has assessed the nine states that have this bill. We have not seen 
evidence of skyrocketing costs, uninsured individuals skyrocketing, and 
employers running away from their employees in providing health 
insurance.
  Let me cite you an additional point. Last year, without a patients' 
bill of rights to blame, insurers nationwide, no patients' bill of 
rights existed, increased premiums by an average of 8.3 percent. That 
is ten times what it would cost for the liability provisions in the 
McCain bill, and, again, that is the House bill as well that we have, 
and the number of uninsured went down.
  That is by Dr. Reardon, the President of the American Medical 
Association. I think what we need to do is to present to the American 
people the facts, and, if we present to them the facts, they will 
adhere to the reasoning of why we have come to their aid.
  For example, we know that HMOs, or managed care entities, have found 
as the basis for their existence the controlling of hospital 
admissions, diagnostics tests or specialty referrals, either through 
programs to review the use of services, or by giving participating 
physicians a financial stake in the cost of the services they order.
  Here lies the angst of the American people. What the American people 
have been used to and have asked for us to remedy for them is the 
ability to pay for health insurance plans and to be able to access 
those plans. What we have had over the last couple of years without a 
patients' bill of rights is hard-working Americans being denied access 
to emergency care, access to specialty care, and, in women in 
particular, access to Ob-Gyn care and being able to select them as our 
primary care.
  As you can see, I was so struck by the earlier debate, forgive me for 
utilizing all these facts, but I believe that we have worked so long, I 
am recalling hearings that we had, where people came from across the 
country to share with us some of the terrible examples, stories, 
anecdotes, personal experiences, where they were denied care, not by 
their physician who encouraged the care, but by an HMO, and, as we have 
noted before, HMOs that are using various computers and nonmedical 
personnel, plugging in to the computer and sending back the message to 
Houston, Texas, or to Orange, New Jersey, if you will, or Newark, New 
Jersey, or San Antonio, or Chicago, Illinois, that the service will be 
denied.
  This is what is not provided in the Fletcher bill. It does not 
guarantee, according to the American Medical Association, access to 
pediatric specialists. Now, my State and many States have huge medical 
centers. We are very proud of the Texas Children's Hospital. We see 
patients from around the country. My district is next door to that 
facility. But it is world-renowned.
  In that hospital there is a great need for specialists. When children 
come from around the world, they come there because they have been 
referred. But in many instances when they are sent back to their home 
destinations, those doctors wanted to refer them to specialists to 
continue their care. The Fletcher bill does not guarantee access to 
pediatric specialists.
  Tell me one parent that wants to accept the kind of health care that 
does not allow them to secure the best specialty services for their 
child? Juvenile diabetes, which we know is a terrible devastating 
disease, how many want to be referred back to their home community and 
cannot access a pediatric specialist?
  The Fletcher bill fails to guarantee referrals to specialists for 
patients with congenital conditions, and obviously I am very gratified 
for the research and technology that has allowed us to live longer with 
congenital disorders. We cannot do so, however, if we leave the large 
medical institutions that we have maybe in the large cities, go back to 
our respective communities, and cannot be referred to specialists.
  It does not allow women to see gynecologists without asking 
permission from the HMO. When should that become a specialist, such 
that you have to require affirmation or confirmation on what is 
necessary care for women on an ordinary daily basis? As we well know, 
preventative care is the key.
  Let me conclude by adding this: it does not guarantee that a 
specialist be geographically accessible or the specialist be 
appropriate for the medical condition of the patient. I mean, if you 
are suffering from pancreatic cancer, which, of course, is enormously 
deadly, and they want to send you to an internist who focuses on 
general medical conditions, that does not relate to the seriousness and 
the devastating impact of your disease.

  In addition, the Fletcher bill contains numerous loopholes in the 
point of service option which severely limit the ability of patients to 
buy coverage that allows visits to out-of-the-network providers. What 
that simply says is I have got a long-standing relationship with my 
physician, and many of us who grew up with our pediatrician and grew up 
with doctors who visited our homes or grew up with the family 
practitioner, we know when we join HMOs plans, to our chagrin, the 
network prevented us from going back to those physicians who knew our 
family history, who had cared for us; and, I tell you, senior citizens 
in my district have been painfully impacted by not being able to have 
their long-standing physicians, as well as they have been painfully 
impacted by the Medicare HMOs who canceled out because it has not been 
profitable for them.
  So this whole idea now of a substitute, and let me attribute to my 
colleagues good intentions; let me attribute to those who have offered 
H.R. 2315 good intentions. But I can assure you that as they have 
offered these good intentions, what really is happening are smoke and 
mirrors.
  I said I was concluding, but if the gentleman would just bear with me 
for just a moment, and I will conclude to just simply say some 
additional points that are just glaring and frightening.
  If you take H.R. 2315 and you want to look at what is happening to 
the Senate bill and the House bill, listen to all of the ``no's'' on 
the side of the Fletcher bill. Requires coverage for minimum hospital 
stay for breast cancer treatment, no; prohibits discrimination based on 
genetic information, no; requires choice of primary care providers, no; 
prohibits provider incentive plans; no; requires prompt payment of 
claims, no; protection for patient advocacy, no. In the course of the 
McCain bill and the House bill, you have ``yes'' to all those 
necessities that are part of our efforts.
  I would simply say to the House and to the leadership, give us the 
opportunity to have a full debate on the

[[Page H4420]]

McCain bill, on the Ganske-Dingell-Norwood bill, and for those of us 
who have experienced a personal crisis with our loved ones, as I have 
done in the last 3 to 4 years, with a loved one and a parent, where I 
had to press the point of the kind of specialty care that would have 
extended his life. Unfortunately, I lost him.

                              {time}  2100

  Unfortunately, I lost him. Many of us have seen the loss of our dear 
relatives. I would say that there is nothing more personal and more 
privileged than good health care. I would hope that our colleagues 
would see the error of their ways and begin to open the doors in the 
next 48 hours for us to be able to debate the real Patients' Bill of 
Rights, what America has asked for, and that we can carry on the truth 
serum, if you will, the good medicine, and get this legislation passed.
  Mr. Speaker, I yield to the gentleman from New Jersey.
  Mr. PALLONE. Mr. Speaker, I want to thank the gentlewoman from Texas 
for bringing out all of the really good points that she did in 
effectively refuting most of the points that the Republicans who 
support the Fletcher bill, the weaker bill, if you will, the points 
that they made this evening.
  But there were two areas that I would like to focus on before I yield 
to the gentleman from Texas (Mr. Rodriguez) that I think the 
gentlewoman really brought out and that I did not bring out, and one is 
that I focused a lot, and I think that the Republicans on the other 
side focus a lot, on the liability issue, the question of whether one 
can sue or not sue. I think to some extent, in refuting them, I kind of 
fall into the trap of discussing the liability issue.
  The fact of the matter is, and the gentlewoman pointed it out very 
effectively, that part of the problem or a major problem with the 
Republican alternative, with the Fletcher bill, is that it does not 
provide the patient protections that the real Patients' Bill of Rights 
that we advocate provides. The gentlewoman pointed out a number of 
them, but just to mention a few others: The Fletcher bill fails to 
protect the patient-doctor relationship. It leaves out two things with 
regard to the patient-doctor relationship that we have in the real 
Patients' Bill of Rights.
  First of all, we have the gag rule that says that the doctors can 
freely communicate with their patients and the HMO cannot tell the 
doctor that if it is their procedure or some type of care that is not 
covered that they cannot tell the patient that it is available. It is 
called the gag rule. Well, the Fletcher bill does not protect against 
the gag rule. The HMOs could still tell the physicians that they cannot 
talk about a type of care that is not covered, which is a horrendous 
thing. I mean, people would not believe that a doctor could be gagged 
in that way.
  Secondly, the Fletcher bill does not protect against using these 
improper incentive arrangements where the doctor gets paid more if he 
provides less care or does not provide as much care, depending on the 
procedure, he gets paid a little more. That is not protected in the 
Fletcher bill.
  The other thing, and the gentlewoman went into this, so I will not go 
into it too much, but basically the Fletcher bill has a lot of flaws in 
the area of access to specialty, clinical care and clinical trials.
  The other thing I will mention briefly before I yield to the 
gentleman from Texas is the poison pills. One of the ways that the 
Republican leadership succeeded in the last session in killing the real 
Patients' Bill of Rights, as the gentlewoman knows, and we all know 
that it passed here in the House, the Ganske-Dingell-Norwood bill 
passed and almost every Democrat and 68 Republicans, I believe, voted 
for it. But when it got to conference, what they did is, they kept 
arguing, if you will, over these poison pills. In other words, it 
passed in the House, but it had these poison pills with regard to the 
medical savings accounts and the malpractice suits.
  The Fletcher bill has two poison pills like this. It expands the 
medical savings accounts and also the association health plans. I do 
not want to spend time tonight getting into all of those, but the 
bottom line is they have absolutely nothing to do with the Patients' 
Bill of Rights or patient protection. They have to do with the way they 
save money and deal with your health insurance and what kind of health 
insurance pools we have. They do not belong in this bill. If we pass 
that bill, we will have the same thing again in conference where they 
try to argue those issues and they manage to kill the real Patients' 
Bill of Rights.

  Again, we need a clean bill. That is what we are asking for, the real 
Patients' Bill of Rights, the clean bill that only deals with HMO 
patient protection and does not mess things up with all of these poison 
pills. I am glad the gentlewoman brought that up, because it is another 
criticism of this Fletcher Republican alternative.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, if the gentleman will yield, I 
appreciate him reinforcing that point. Because as I was reading through 
some of my materials, the poison pills are so damaging because they are 
contrary to the American people.
  Two points: Over 80 percent of the American people believe that HMOs 
should be held accountable for negligence. They are not asking about 
Federal savings accounts and other issues. They also believe they 
should be able to get to emergency rooms in the 80 percent range. It 
does not seem like they are focusing on all of this other baggage that 
the Fletcher bill has.
  Before the gentleman yields, and I thank the gentleman from Texas for 
allowing me to make this point, as I was coming to the floor and 
hearing the debate that preceded us, there was some comment about 
minorities and how this would have a negative impact on minorities. We 
know that African Americans, Hispanics, Asians, whatever group we want 
to classify as minorities come at all economic levels. Certainly, many 
of us in the minority community, African American community, 
particularly Hispanic community, Asian community, carry HMO coverage 
and many do not. They need to access either public assistance or they 
need other sorts of assistance, or we are trying to work with their 
employers so that they can have the kind of coverage that they should 
have. But I think that it is certainly misrepresenting to suggest that 
this bill will hurt minorities.
  Mr. Speaker, I want to reinforce that this bill will give all 
Americans a Patients' Bill of Rights to reestablish the patient-
physician relationship and help individuals who are unable to fight the 
system by being able to hold HMOs accountable. So if one happens to be 
the bus driver, the waitress, the schoolteacher, the accountant, the 
doctor, the lawyer, one can still have the ability to hold the HMO 
accountable for negligence when they have denied you the care that you 
have paid for. I cannot see any way that this will hurt minorities.
  In fact, for those minorities who we well know have a disparate 
access to health care, whose health has been impacted because they 
cannot get good health care, to make HMOs more accountable and ensuring 
that when a physician calls from an inner city needing added care for 
that particular victim or patient, I should not say victim but patient, 
that that physician can access that health care, regardless of whether 
they are in the inner city of Harlem or Houston or anyplace else that 
might relegate them to inadequate health care.
  So I refute that, and I question any comment suggesting that this 
bill would hurt minorities and, in particular, let me say, African 
Americans, and I cannot find any evidence in this bill where that would 
occur.
  I thank the gentleman.
  Mr. PALLONE. Mr. Speaker, I thank the gentlewoman for bringing that 
up, because I think essentially what our bill does is empower people. 
It does not matter who one is, one's race, one's color. The bottom line 
is people who are sick are not easily empowered. They are victims, even 
though we do not want to use that term. What it does is it empowers 
people at a time when they really need help, regardless of their race, 
religion or whatever, and that is what we are all about.
  I thank the gentlewoman.
  Mr. Speaker, I yield to the gentleman from Texas (Mr. Rodriguez).
  Mr. RODRIGUEZ. Mr. Speaker, I thank the gentleman for allowing me to 
be here. I also had a chance to listen to the dialogue that was coming, 
and I

[[Page H4421]]

have the hour after yours regarding border health, but I needed to come 
up here because, in all honesty, there was a sense of frustration and 
some anger. Because, as the gentleman well knows, for the last two or 3 
years we have been talking about making sure we pass a Patients' Bill 
of Rights. We know that people are, throughout the country, having 
those difficulties. Not only do they have to fight their illness when 
they get sick, but they have to fight their HMO and their managed care 
system, and that is unfortunate.
  One of the good things about it is, if nothing else, now they are 
talking about it. Now they have brought up the issue. Now they realize 
that it is something that is serious and so they need to at least begin 
to give it lip service. But we are hoping that they do more than just 
lip service, because I know that they can do that and then decide not 
to do what they are supposed to be doing.
  Mr. Speaker, I cannot help but recall an incident back when I was in 
the State legislature when we talked about access to rural health care. 
One of the first things we talked about was how can we get access to 
rural Texas. At that time, when I was in the Texas legislature. I 
remember that a person with any logic, any sense of wanting to really 
respond to the problem, would start thinking, well, let us see how we 
can get a doctor down there. Let us see how we can get a mobile unit 
down there. Let us see how we can get some nurses down there.
  Well, the response from what actually occurred after all that, 
because I was real naive to the political process, was they decided to 
draft legislation that was tort reform. So here we stand and what I 
hear is the lawyers are going to get it. I am not a lawyer. I do not 
care about attorneys. The only thing I do care about is to make sure 
that those people have access to health care. Yes, in some of those 
critical situations, if HMOs are not responsive, they should have 
access to the judicial courts. No one who is sick would want to go to 
the courts. No one who has been hurting and is tired enough of having 
to fight their HMO wants to go see an attorney. I know I would not want 
to do that. But one has to be able to leave that as a last option, no 
matter what.
  I will share an example. I have a friend who was working in the 
garage, cut his finger, his finger fell off completely, and he got 
scared, grabbed it, and he went to the hospital. He went into the 
emergency room. This happened prior to the legislation. First, they had 
some trouble getting the doctor that he should have been seeing, and 
then the specialist, they had trouble getting the specialist. Well, the 
insurance company, the bottom line was, told him, number one, we are 
not going to pay for that specialist because we did not okay it. So 
here he is, losing a finger, and he has to try to get an okay as to 
whether this specialist should put it on or not. Well, he lost his 
finger. He does not have the finger now. They are still unwilling to 
pay, approximately, a little less than $3,000. What does he do? What 
does he do?

  So one of the things that this particular legislation does is it 
allows an opportunity for the person to choose the doctor of their 
choice, and that is so important. Not only is that critical, but it 
also allows that physician to determine whether one needs a specialist 
or not. Those are the ones that are supposed to be making the 
decisions, not the accountant, not the insurance based on how much 
profits they are going to be making or not making if they make certain 
decisions. It should be made on the needs of that person.
  Secondly, the bill covers all Americans, and that is so important, 
whether one works for small businesses or not. There are company 
doctors that are out there that we need to be concerned about. A lot of 
times the company doctors will choose to make decisions based on the 
needs of the company and not the particular patient. So that becomes 
real important.
  Thirdly, it ensures that all external reviews of medical decisions 
are conducted by independent, qualified physicians, and that is so 
important. We want to make sure, if you are there, if your mother is 
there or if a loved one is there, you want qualified people making 
those decisions. You do not want them to be made because they are going 
to save a few hundred dollars or a few thousand dollars in choosing not 
to do certain procedures.
  The other thing is that doctors right now, and the gentleman 
mentioned this, are gagged by the gag rule. They are actually being 
told that they cannot provide certain options where they can tell the 
patient, look, you have this disease, these are the options. You can do 
this, this, or this other option and then decide. The cost varies. They 
are not even allowed to do that.
  We ought to be ashamed of ourselves. We have passed this piece of 
legislation several times already, and the Republican-dominated 
Congress continues to kill it in conference. Now, they get up here, and 
now they are talking about it.
  Well, let us see if it does not turn into a situation where the rules 
will allow a lot of other amendments to come in and then, very similar 
to what happened in campaign finance, where they allowed so much junk 
out there so that they were going to pile it up so that not even the 
author would want to be able to vote for that piece of legislation.
  So I am hoping that, as we move forward now, that at least we got 
them to a point that they are at least talking about it, and that we 
can go forward in making sure that we do the right thing when it comes 
to the Patients' Bill of Rights, when it comes to our patients 
throughout this country.
  I want to thank the gentleman for his hard work that he has done, 
because he has been at the frontline. We need to keep hitting on this 
issue. It is something that is right, and it is something that we need 
to do.
  I just want to remind the gentleman that President Bush, then 
Governor Bush, initially vetoed the first Patients' Bill of Rights in 
Texas.

                              {time}  2115

  The second time, and that was in 1998 when it came back, then at that 
point he allowed it to go through, although he had the same arguments 
then of that bill that he has now. That is, his arguments against the 
bill were that it would increase costs and increase the number of 
lawsuits against doctors. That has not occurred. That has not happened. 
He also mentioned that other health providers would also be hurt by it. 
That has not occurred.
  It has been a good piece of legislation. It still has some holes that 
need to be worked out, but I think that we could do this, and it would 
go a long way throughout this country to providing those people who 
have insurance right now and who get sick at least that leverage to be 
able to fight the disease and not have to fight the managed care 
system, so that the managed care system becomes more accountable to our 
constituency throughout this country.
  Mr. PALLONE. I want to thank my colleague from Texas. I know that my 
other colleague wants to add something too, so I yield got to the 
gentlewoman from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I would just inquire of the 
gentleman about an example, or I guess it is not an example when one 
loses a finger. I think the gentleman has just highlighted a very 
potent part of what this debate is about: human beings. The gentleman's 
friend lost a finger because someone made a medical decision.
  I cannot for the life of me understand why we cannot have 
commonality, common ground on supporting the gentleman's friend or that 
patient's ability to be able to have the best health care that any plan 
could provide or any services in the United States could provide.
  My question is, we seem to have fallen victim to special interests, 
because we have the American Medical Association physicians from all 
walks of life who simply want to be able to treat that patient whose 
finger was amputated through a work injury, or to treat a child 
suffering from a congenital heart defect or juvenile diabetes, or treat 
someone who is suffering from pancreatic cancer, which is devastating.
  What we do not want is to have that person be told, ``There is no 
room at the inn. The door is closed. You cannot get services.''
  I would say to the gentleman, this gentleman's friend seems to be 
suffering from an entity, a corporate structure, or an institutional 
structure

[[Page H4422]]

that was not really concerned about his health care. What we are trying 
to do with the Patients' Bill of Rights is to put the patient and 
doctor back together again.
  Mr. PALLONE. Mr. Speaker, if I could just say to the gentlewoman, she 
is getting to the point that I wanted to raise by our colleague from 
Texas.
  He talked about lip service, and what has been happening here with 
our Republican colleagues on the other side tonight is that they 
realize now that the Patients' Bill of Rights has the support 
overwhelmingly of the American people.
  As the gentlewoman said, the special interests have been out there, 
the HMOs, the insurance companies, fighting this thing tooth and nail. 
Even with all of that, look at all of the recognized groups that care 
about patients, and the AMA being probably the most prominent, but 
there are so many other supportive groups, the nurses and all the 
specialty care doctors, too.
  Our colleague, the gentleman from Connecticut, mentioned one 
specialty care, but I could rattle off every specialty care diplomate 
organization in the country that is supportive of the Dingell-Ganske-
Norwood bill.
  What they are doing now is paying lip service to the issue because 
they know it is an issue that is strong and that people want because it 
affects real people, like the guy who lost his finger.
  What I wanted to say if I could, and then I will yield back, is that 
we have to be very careful what we do here. These people that oppose 
the Patients' Bill of Rights, the special interests, they are pretty 
sophisticated. What they are trying to do tonight with this Fletcher 
bill is suggest that somehow this is not that different from the 
Dingell-Norwood-Ganske bill.
  It is not true. It is simply not true, because we have to remember 
that that person who is in extremis, the person who lost their finger, 
they are very vulnerable individuals. If we are going to make sure that 
the decision about what type of care they get is made by the doctor, 
and that if that is denied that they have a real way to redress the 
grievances, we could make some very simple changes in the law and 
eliminate both of those things.
  That is what they have done with the Fletcher bill, because one of 
the things we have in the real Patients' Bill of Rights is to say that 
the standard of review about what kind of care is necessary, what the 
physician should be allowed to provide, is decided by the physicians, 
by the standard of care within the medical community, and particularly 
within those specialties, the pediatric standard, the cardiological 
standard for the specialty care, or the general standard for family 
practice care.
  They have basically said in their bill, in the Fletcher bill, that 
that review process is going to be different. It is going to be stacked 
against the patient.
  I will just give an example. The bill, basically what it says is the 
standard review used by the external review process requires the 
reviewer to make its decisions on only the patient's record and 
scientific evidence, and does not allow them to get to the standard of 
care that exists within the larger community or that exists for that 
specialty.
  I probably sound like a bureaucrat in relating all this, but the 
bottom line is, we make sure that the decision about what medical care 
is necessary is the standard that the AMA would use, that the 
cardiologists' Board of Diplomates would use. They are not using that 
standard. The guarantee that that decision is going to be based on what 
the physician thinks is necessary is denied by the Fletcher bill.
  The other thing is that we have a rapid ability to overturn a denial 
of care, in our bill. What the Fletcher bill does is to put all kinds 
of barriers in the way, so that guy who lost his finger, he cannot 
easily say, I have been denied care and I can go to somebody, and they 
right away turn around that decision, so he can get his finger 
reattached in a timely fashion. They put all kinds of barriers in his 
way.
  I will just give an example. In the Ganske-Dingell-Norwood bill, we 
require the decisions are made with regard to the medical exigencies of 
the patient's case. This means the plan has to act quickly when needed.
  There is no such requirement in the Fletcher bill. There is nothing 
that says, my finger is detached. If they are denying me care, I have 
to have somebody who is going to within minutes change that decision 
over the phone. That is not the case. They could say under the Fletcher 
bill that one would have to wait a few days, a couple of weeks. How 
does that work with a guy who loses his finger?
  I will give one more example, but there are ten that I could give 
here.
  The patient, under the Ganske-Dingell-Norwood bill, it requires that 
patients have a right to appeal to an external reviewer before the plan 
terminates care. That is not true in the Fletcher bill. So to use the 
example with the guy who lost his finger, they can continue to provide 
him all kinds of care, but maybe not what is necessary to reattach the 
finger. He cannot go to the board and have the decision turned around 
while they are continuing to treat him in some maybe not effective way.
  So there are all kinds of ways to get around the basic protections 
that we are providing in the Ganske-Norwood bill. The problem with the 
Fletcher bill, it is using all kinds of little ways to get around that. 
We do not have time to go into it all tonight, but I want there to be a 
basic understanding that there is a real difference here between these 
two bills.
  As the gentlewoman said, my colleague from Texas, they are giving lip 
service to the Patients' Bill of Rights, but they are not really for 
the real Patients' Bill of Rights.
  I yield back to the gentleman from Texas (Mr. Rodriguez.)
  Mr. RODRIGUEZ. Mr. Speaker, I would hope that when people provide lip 
service, I would hope that we judge people on what they also do. So 
when they give it lip service, I am hoping they will go beyond that and 
start acting in an appropriate manner.
  But when we talked about rural health care, they came up with tort 
reform. If they use it for political reasons to get after and reward 
their friends and do in their enemies, then that really upsets me and 
angers me. I saw the tones of that when they got up here.
  The majority of people do not like attorneys. I am not one, and I do 
not know if the gentleman is one. I apologize if the gentleman is. But 
the bottom line is that we have the judiciary for a reason. Those 
judges, I respect the judges out there, with the exception of the 
Supreme Court in the last decision that they made. Beyond that, most 
judges do the right thing. We would expect that people would go only to 
the judiciary in the last resort.
  With our piece of legislation, it allows a review board, and it 
allows that review board to be able to look at that data before any 
court decision. So it would be very obvious to anyone if something 
wrongful had occurred. And if it does occur, and if it occurs with 
one's loved one or anyone, then that person deserves to receive justice 
if they were denied access to a certain care that caused them injury.
  So I think that is important, and that ultimate right still belongs 
to every American. It should not be taken away by the insurance 
companies of this country. Just because they have paid insurance all 
their lives, and all of a sudden they are sick and find themselves not 
having access to the quality care they had been paying for and had been 
promised, and they find themselves once again fighting the disease and 
the illness and also fighting the HMOs, then they would wonder, where 
are our politicians? Where are they?
  We have been trying to make this happen, and I hope that they are 
sincere about trying to make something happen and make people 
accountable, and make those insurance companies accountable for doing 
the right thing when those people find themselves in need.
  Mr. PALLONE. I appreciate the gentleman's comments. I yield to the 
gentlewoman from Texas (Ms. Jackson-Lee), Mr. Speaker.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, the gentleman made a slight 
comment as he was describing the Fletcher bill procedure, and he said 
he was sounding like a bureaucrat. No, the gentleman was explaining the 
bureaucracy that the Fletcher bill was now going to recreate to inhibit 
the direct review or direct opportunity to hold HMOs accountable.

  Fingers do not last long that are detached, and emergency surgery or

[[Page H4423]]

needs for immediate care cannot tolerate scientific review and 
paperwork review and computer review and standards review. They can 
tolerate a trained specialist or physician looking at the facts with 
the patient before them, consulting with their colleagues and making an 
immediate decision to save this person's life.
  What I see is a pitiful response to the outcry of Americans about 
care and the relationship between physicians and patients. It is 
creating this whole new established bureaucracy that does nothing but 
delay the decision. If I have to get my child into an emergency room 
circumstance with a pediatric specialist at hand and if that is denied 
me, then I may shorten the opportunity for my child to recuperate.
  We have seen some tragic incidences occurring with children just this 
summer. When the summertime comes, we know that children engage in fun, 
but we also know it opens them up to various incidents that occur. They 
need immediate health care.
  I would say to the gentleman, no, he is not the bureaucrat, but the 
Fletcher bill would certainly create a whole new independent set of 
bureaucracies that do not get care to the patient. I just think that we 
should come together in this House and the Senate and vote for the real 
Patients' Bill of Rights.
  Mr. PALLONE. I want to thank the gentlewoman, and both of my 
colleagues from Texas.
  I think we only have another minute or so. I wanted to say that my 
real concern, of course, is that we never get a chance to vote on the 
Patients' Bill of Rights this week or even this year. We know that the 
leadership, the Republican leadership, has promised that the bill will 
come up for a vote this week.
  We are going to hold them to the fire on that, that it must come up 
and that we must have a clear vote, a clean vote on the real Patients' 
Bill of Rights. We will be here every night, if necessary, this week to 
make that point until that opportunity occurs.

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