[Congressional Record (Bound Edition), Volume 145 (1999), Part 10]
[Senate]
[Pages 13617-13618]
[From the U.S. Government Publishing Office, www.gpo.gov]



                         MANAGED CARE PRACTICES

  Mr. LEVIN. Mr. President, we in the United States have become known 
around the world for providing what can only be called the gold 
standards of health care. People come to the United States from all 
over the world to receive our high-quality health care. Yet I find that 
too many of my constituents are not receiving this world-renowned 
health care. Due to current practices in the managed care area, too 
many HMOs are denying critically needed care to too many of their 
beneficiaries.
  For instance, in Detroit, I met with Donald Anderson, a quadriplegic 
who is in a wheelchair. When he changed jobs, he also changed health 
care providers. Donald told me that his new provider would not cover a 
rolling commode wheelchair for him after the wheel broke on the one he 
owned, even though his doctor classified the wheelchair as a medical 
necessity. The HMO told him that the chair, which he uses to take 
showers, is considered a luxury item. His physician intervened and 
tried to get Donald a rolling commode but was repeatedly denied.
  In Detroit, I also met with Amaka Onumono, who had been recovering 
from injuries sustained when a man dumped hot grease on her and set 
part of her home on fire. She spoke about gaps in service because she 
needed to get a referral from her primary care physician after every 12 
visits to her occupational therapist. ``Every time it comes time to 
make an appointment, there is a hassle,'' her mother Denise Avery said.
  In Lansing, I spoke with Dr. William Weil, a Michigan State 
University pediatrician, who said that some families whose children 
have chronic illnesses frequently have trouble getting HMOs to approve 
pediatric subspecialists, especially if none is located in the 
immediate community. ``In many HMOs, there is a tendency to use 
neurologists and orthopedists who specialize only in the care of 
adults,'' Dr. Weil told me.
  In Midland, MI, I spoke with Dr. James Bicknell, head of the 
emergency room at Mid Michigan Medical Center. He told me that problems 
sometimes occur when managed care personnel, by telephone, tried to 
screen people out of the emergency room. Dr. Bicknell said that 
``managed care companies should be held accountable if patients are 
harmed because companies deny care.''
  Stories such as these necessitate reforming the managed care area, 
which is why passage of a strong Patients' Bill of Rights is so 
crucial. Let's take the previous examples and apply the Patients' Bill 
of Rights--a strong one--to see what would have happened to these 
people had that legislation been enacted.
  Donald Anderson would have received a rolling commode, since his 
doctor determined it was medically necessary. A strong Patients' Bill 
of Rights allows the physician, not the insurance company, to decide 
what prescriptions and equipment are medically necessary.
  Amaka Onumono, the burn victim, would not have had to get a new 
referral every time she needed to see a specialist under a strong 
Patients' Bill of Rights. Our bill would allow the patient with a 
chronic health problem to have a standing referral to see such a 
specialist.

[[Page 13618]]

  The patients of Dr. William Weil, the MSU pediatrician, would not 
have been denied access to pediatric specialists. The strong Patients' 
Bill of Rights specifically maintains that an individual should have 
access to a specialist, including, in the case of a child, the 
appropriate pediatric expertise.
  In the case of Dr. James Bicknell, our Patients' Bill of Rights 
mandates that all patients receive emergency treatment if a prudent 
layperson considers the patient's condition to be ``an emergency 
medical condition.'' So our health care programs, our strong Patients' 
Bill of Rights, would hold health plans accountable for the decisions 
they make.
  I have heard similar stories all over my home State of Michigan. 
While most HMOs do a good job of providing quality health care while 
managing costs, too many put money before good medicine. A good, 
strong, national Patients' Bill of Rights would establish a Federal 
framework that would provide very high quality assurance for patients 
all over the country.
  There is overwhelming support in the public for managed care reform. 
That would include, necessarily, the following patient protections:
  First, ensure that treatment decisions are made by a patient's 
doctor, not a bureaucrat at an insurance company.
  Second, hold managed care plans accountable when their decisions to 
withhold or limit care injure patients.
  Third, ensure that patients undergoing treatment can continue to see 
the same health care provider if their provider leaves the plan or 
their employer changes plans.
  Fourth, allow patients to see an outside specialist at no additional 
cost whenever the specialist in their plan can't meet their needs.
  Fifth, require that insurance companies pay for emergency services if 
a reasonable person would consider the situation to be an emergency.
  Sixth, promote access to clinical trials that may save time.
  The idea of a strong Patients' Bill of Rights is not a radical 
notion. Doctors, for instance, are strongly in favor of this. Doctors 
who receive years of training and specialization are too often now 
being told by managed care companies they cannot provide the care that 
they deem to be appropriate. When doctors are no longer making the 
decisions they were trained to make, something is wrong.
  What is wrong is that too many HMOs are not providing the services 
which the American public has a right to expect. The way to right this 
is to adopt a strong Patients' Bill of Rights. I hope the Senate will 
take this real-life issue up promptly, resolve it, and adopt a strong 
Patients' Bill of Rights.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Hagel). The Senator from Kansas.

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