[Congressional Record Volume 150, Number 18 (Thursday, February 12, 2004)]
[Senate]
[Pages S1293-S1294]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. BOXER:
  S. 2083. A bill to amend the Public Health Service Act and the 
Employee Retirement Income Security Act of 1974 to protect consumers in 
managed care plans and other health coverage; to the Committee on 
Health, Education, Labor, and Pensions.

[[Page S1294]]

  Mrs. BOXER. Mr. President, according to a Kaiser Family Foundation 
and Harvard School of Public Health survey of non-elderly Americans 
with private health insurance, one-half reported that they had a 
problem with their health insurance plans in the previous year. They 
cited delays and denials of coverage or care as their two most common 
problems. They also said they worried that if they became sick, their 
health plans would be more concerned about saving money than providing 
the best treatment. For those in managed care plans, such as HMOs, over 
two-thirds had this concern.
  And they have good reason to be concerned. Let me tell you about two 
of the many people, who were hurt when HMO decided it needed to save 
money. Ruby Calad had a hysterectomy and her doctor recommended that 
she stay in the hospital longer than a day. Cigna, Ruby's insurance 
company said one day was enough. So Ruby went home, but she was soon in 
the emergency room because she had developed serious complications. Had 
Ruby been able to stay in the hospital longer, as recommended by her 
doctor, this would not have happened.
  Juan Davila suffers from diabetes and arthritis. His doctor 
prescribed VIOXX for his arthritis because it had a lower rate of 
bleeding and ulcers than drugs on the formulary developed by Aetna. But 
instead of approving the VIOXX, Juan was required to enter a step 
program and try two other medications before VIOXX could be approved. 
He was given naprosyn--a cheaper drug--and three weeks later was rushed 
to the hospital. He had developed bleeding ulcers, which caused a heart 
attack and internal bleeding. Juan survived but now cannot take any 
pain medication that is absorbed by the stomach.
  These examples show why medical decisions should be made by doctors, 
not HMO bureaucrats, and in 2001, the Senate, in a bipartisan vote of 
59-36, passed S. 1052, the Bipartisan Patient Protection Act to make 
sure that happened. Yet, intransigence from the House leadership and 
the White House prevented that bill from becoming law. Nearly 3 years 
later, we still have not acted. So, today, I am introducing the exact 
same bipartisan bill that passed in the Senate in 2001.
  This bill provides comprehensive protections to all Americans in all 
health plans. It says to all Americans who have health insurance, you 
have rights and protections. It says to HMOs, you have responsibilities 
and will be held accountable for your wrongful and harmful actions.
  This bill ensures that patients have the right to have medical 
decisions made by their doctors and not HMO bureaucrats. Patients will 
have the right to see a specialist and go to the closest emergency room 
for treatment. They will be able to keep the same doctor throughout 
their medical treatment and appeal adverse claim decisions to an 
independent reviewer. And if they are injured by a decision made by the 
HMO, they will have the right to hold their HMO accountable in a court.
  A meaningful patients bill of rights is long overdue. I urge my 
colleagues to support this legislation.
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