[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

[[Page H4771]]

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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