[Congressional Record Volume 147, Number 107 (Friday, July 27, 2001)]
[House]
[Pages H4770-H4772]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
{time} 1530
PATIENT PROTECTIONS IN THE REPUBLICAN PATIENT BILL OF RIGHTS
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 3, 2001, the gentleman from Kentucky (Mr. Fletcher) is
recognized for the remaining time of the gentleman from Florida (Mr.
Weldon).
Mr. FLETCHER. Mr. Speaker, I just wanted to rise and discuss some
issues regarding patient protections.
As we know, this is a piece of legislation that is anticipated to
come before this body next week. It is a piece of legislation that has
been debated for quite some time for a number of years here. Yet,
unfortunately, we seem to be at somewhat of a logjam.
Let me say that we have been able to reach quite a compromise
position in the bill that we have put forth, myself along with the
gentleman from Minnesota (Mr. Peterson), a Democrat, as well as the
gentlewoman from Connecticut (Mrs. Johnson), who have worked very, very
hard to really come together with a piece of legislation that is a very
balanced approach.
Mr. Speaker, we have come a long way. However, there are some Members
who did not want to increase the liabilities of HMOs at all. There are
some people who wanted to open up unlimited lawsuits that would have
driven up the cost of health care and increased the number of uninsured
in this country.
Yet, Mr. Speaker, we have reached a good balance in this piece of
legislation, the Fletcher-Peterson-Johnson legislation, that does three
things particularly.
One, it increases the quality of health care in America. How does it
do this? It does that by establishing the right of every patient in
America that has insurance to be able to appeal to a panel of expert
physicians. These are practicing physicians that are trained in the
specialty to be reviewed. So if a patient has an HMO that questions
their ability to get a particular treatment, they can go to this panel.
What we do is set the criteria of that panel to make sure that it is
the highest standards of medical care in this country, state-of-the-art
care. We establish that based on a consensus of expert opinion and what
we call referred journals. Those are those medical journals like the
New England Journal of Medicine, the Journal of the American Medical
Association, that are reviewed by peers to make sure that the
information in those journals is accurate and substantiated by
scientific research.
We make sure that every patient in America has that option of coming
and asking that expert panel whether or not they should receive this
treatment. If they are not given that treatment, then we hold the HMOs
liable. We hold them liable. Actually, if the HMO refuses to give what
the experts say, we hold them just as liable as any physician is held
liable in this country.
Yet the other side says that is not enough because they want to allow
trial lawyers to sue no matter what the case is, even if the plan is
offering the care; or if the plan actually is saying that the experts
say this is not the appropriate treatment, then they want an
opportunity, a right, to be able to sue that managed care facility.
What is that going to do? This is unlimited lawsuits. We have debated
this for years. As a family physician, I know the extra costs of what
we call defensive medicine, what the costs are. It is not thousands, it
is not millions, it is billions of dollars of tests that are run,
procedures that are performed, that are only done because of fear of
frivolous lawsuits.
That does not improve the quality of health care. It actually has
just the opposite effect on the quality of health care. There have been
some studies done to show that frivolous lawsuits do not improve the
quality of health care. As a matter of fact, they impair it.
Under the Democrats' bill, and again, they have been unyielding and
lack the ability, it seems, to be able to yield or to compromise at all
on this issue. Even though we have opened up liability tremendously,
making sure that we punish bad players, they are unwilling to
compromise. What has that done? That has made us unable to get a bill
passed here.
Now I would hope they would be able to compromise some, because I
believe all of us truly want to get a bill signed by the President that
can help patients in this country.
Why will we not support the bill that has unlimited frivolous
lawsuits and has no provisions, substantial provisions, for access?
Because we know it will increase the uninsured in this country. Some
estimates say from 7 million up to 9 million people will lose their
health insurance.
What effect does that have on a patient? Patients that do not have
insurance have poorer health. Disease progresses further along before
they are actually diagnosed of the disease. If they are hospitalized
and they do not have insurance, they die at three times the rate of a
patient that has insurance. So it is very troubling to me when I see
the flagrant disregard for the uninsured that the Democrats have
expressed in their unwillingness to compromise with us and reach a real
solution for patients in this Nation.
When I talk to constituents, Mr. Speaker, the number one concern I
hear about, and I have been through many factories and small businesses
and talked to workers, I ask them, ``What are several of the things
that are important to you?'' They talk about the education of their
children. But when we get down do it, just as important to them is the
health care of their children.
Under the Democrat bill on this Patients' Bill of Rights, they will
be threatened with losing their health care through many small
businesses, and maybe even large businesses, because of the added
burden of liability.
I have letters that have come, a number of letters from small
businesses that say, we are not going to be able to offer health care
to our employees under the provisions of the Democrat bill because of
the liability that exists there. That is not helping patients. That
will result in people losing the health care they get through their
job, and that is one of the most important aspects about many
individuals' employment.
I can think of a young lady on the line of Toyota Manufacturing
Company. She installs the bumpers on Avalons and Camrys. I asked her
about the benefits she gets through Toyota. She
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mentioned one of the major benefits she gets is the health care through
her employers. Yet, that may be threatened under their plan. It would
require that they look and ask, is it going to be possible to withstand
the liability? Are they going to end up giving the money to this young
woman, and having her have to go out and buy her own insurance?
Many companies will find out some way to make sure that does not
happen, but inevitably, it will raise the premiums that that young lady
is going to have to pay. That means there is less money for her to take
care of those children she is so concerned about. That means there is
less security that she is able to provide for her family. That means
there is less peace of mind that she has as she is working to take care
of those children.
Mr. Speaker, I want to cover a few more things about our health care
bill. As we look at the guiding principles for our health care bill and
this Patients' Bill of Rights, and again, this is a compromise that has
been developed over a number of years, it is to improve the quality of
health care. I spoke about that. It is making health care more
accessible, more affordable, especially to the uninsured.
I mentioned that their bill does very little to do that. Actually, it
will result in millions probably losing their health care. But we
provide something called medical savings accounts. That means we can
set aside money, much like an IRA, through our jobs, and we can use
that money for health care. We can use it for routine health care that
we all get to prevent diseases and to detect diseases early. We might
use it for eyeglasses or other things that are important for health
care and well-being.
This will allow more individuals to get insurance because in some of
the pilot programs we have done with medical savings accounts, almost
one-third of the people that get insurance through those did not
previously have health insurance, so that certainly makes it more
available to the uninsured, and helps us reduce the problem of 43
million Americans uninsured.
As we look at holding health plans accountable, we talked about if a
health plan does not follow that external review, then they are held
accountable, just as accountable as any physician. That is very
important, and so we want to make sure that there is accountability.
When we look at the number of uninsured, just to kind of give you an
idea of what the magnitude of the uninsured are in this country, look
at these cities: Portland; Bakersfield; Phoenix; Denver; Dallas;
Atlanta; Orlando; Lexington, and then that is my home city; Charlotte;
Hartford; Syracuse; Cleveland; Chicago; Des Moines; Minneapolis; Salt
Lake City.
If we added the population of all of those cities, that would equal
the number of people in this country that have no health insurance. The
last thing we want to do is to drive up the cost of health insurance.
Now, as we look at the provision, another provision I want to talk
about, that is association health plans. We talked about MSAs, or
medical savings accounts. But association health plans, what that does
is allow small businesses to come together to self-insure and to offer
a product nationally.
So, for example, my farmers are paying $800 or $900 a month for
premiums to buy their health insurance on the individual markets. What
this would allow is the American Farm Bureau Association to offer a
national plan that is self-insured, much like the large companies do.
It is a fairness issue. Why can we not have small companies coming
together and offering insurance products just like large companies do?
If we do that, it is estimated that it will reduce the premiums by 10
percent to 30 percent. That will possibly allow us to insure as many as
9 million Americans.
If we look at that, it is equivalent to the people living in the
following cities that are highlighted in black: Salt Lake City,
Phoenix, Des Moines, and Atlanta. That is a number of people, an
equivalent number of people of several cities in this Nation that would
be able to get insurance through these association health plans.
Let me just close by saying there is a lot of. I think, demagoguery
going on and criticism of the plan saying that we do not allow direct
access, for example, to OB-GYN and pediatricians. In fact, that is just
not true. We have the equivalency of 400,000 physicians in different
organizations that endorse this bill because it does exactly what they
know it needs to do to ensure that they can deliver the treatment they
need to their patients.
It allows direct access to OB-GYN physicians. It makes sure that if a
young lady is being cared for during her pregnancy, if the plan and the
physician no longer have a contract together, that she can continue to
get that care through that same physician: a physician whom she trusts,
especially trusts for the delivery of a newborn child; and not only
that, but post-partum care.
We also allow for clinical trials; that if there is a treatment that
provides hope and it is approved by the FDA or by the National
Institutes of Health or by the veterans' programs, that we can actually
guarantee that the plan would cover that treatment.
It may be the only hope that that child has left, or that individual
has left, ensuring that they get the treatment that would offer them a
hope of health and well-being.
We also have been criticized, saying that we do not provide emergency
care for neonatal care. This criticism is most laughable, and there is
certainly a tremendous degree of demagoguery from the Democrats because
of this reason.
We actually improve the provision they have, and say that not only a
layperson's definition, but if even in the opinion the health
professions, and even if the mother was not aware of the condition of
the child, but if, under the opinion of a health care professional, the
mother needed to bring that child in, that we guaranteed that that
child would get treatment.
I can recall a child that needed treatment. The mother was in our
practice and gave me a call. This happened to me on several occasions.
I asked her to bring that child in. I can even recall one situation
where the child was in very critical condition when that child arrived.
Yet, young mothers sometimes do not know all of the precautionary
signs, so it is very important to have this access provision.
We offer better access and better cover for neonates and those young
infants, the newborns, than the other side does.
They are also talking about preemption of State laws. Yet our
provisions make it easier for States that have equivalent patient
protections to be able to use their laws, instead of having to use the
Federal mandate. So we actually do less to supersede State law than the
other side does, because about 33 States have passed patient
protections at this time, and we think it is important that we allow
that.
The bottom line, the Democrat plan is a bad plan for the most
vulnerable in this Nation. Who are those? They are the low-income
minorities, those right on the border. I know they speak a lot about
this constituency, but when it comes down to the bottom line, they are
putting politics before the most vulnerable in this society, because
their plan will disproportionately affect low-income and minorities in
this Nation and cause a disproportionate number of those to lose their
insurance. It threatens the health care they get through their job.
Ours provides several plans to ensure that we can cover more
individuals with health insurance, up to 9 million more. It has been
estimated under their plan that several million will lose their health
care, as we have shown.
So Mr. Speaker, I appreciate sharing this time on the Patients' Bill
of Rights. I would hope that the Democrats, as we come back next week
into session, that they would be willing to reach a compromise that is
good for the American people; to stop this logjam and be able to pass a
Patients' Bill of Rights that we can lay on the President's desk,
because he has spoken very passionately about this issue, and wants
very much a Patients' Bill of Rights for the American people.
I would hope they are willing to reach a compromise. We have
compromised tremendously so we might get a patients' bill of rights
passed.
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