[Congressional Record (Bound Edition), Volume 145 (1999), Part 10]
[House]
[Pages 14046-14053]
[From the U.S. Government Publishing Office, www.gpo.gov]



                        PATIENTS' BILL OF RIGHTS

  The SPEAKER pro tempore (Mrs. Emerson). Under the Speaker's announced 
policy of January 6, 1999, the gentleman from New Jersey (Mr. Pallone) 
is recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Madam Speaker, let me say that this evening my plan is 
to discuss the Democrats' Patients' Bill of Rights.
  I think many of my colleagues know that within the Democratic party 
we have, for several years now, highlighted and prioritized HMO reform 
as one of the major issues that we would like to see addressed in the 
House of Representatives, and our answer to the need for managed care/
HMO reform is a bill called the Patients' Bill of Rights. And we call 
it the Patients' Bill of Rights essentially because it is a 
comprehensive way to provide protections to patients against some of 
the abuses that we have seen within managed care and within HMOs.
  The reason I am here tonight, Madam Speaker, is because I want to 
highlight the fact that once again in this session of Congress, and 
just like the last session of Congress, Democratic Members, including 
myself, have been forced to resort to a petition process, what we call 
a discharge petition, that many of us signed. Today we started the 
process, this morning, and I believe now there are 167 Members, 
Democratic Members, who have signed a discharge petition at this desk 
over here near the well, because we have not been able to get the 
Republican leadership, which is in charge of the House of 
Representatives, to have a hearing or have a committee markup or bring 
to the floor the Patients' Bill of Rights.
  That is an extraordinary procedure, to move to the discharge 
petition. It is something that the minority usually is not required to 
do because the majority party allows debate, or should allow debate, on 
issues that are of importance to the average American. But in this 
case, once again, I would suggest that the reason is because the 
Republican leadership is so dependent on the insurance industry and so 
determined to carry out the will of the insurance industry that they 
have been unwilling to let the Patients' Bill of Rights be considered 
in committee or come to the floor.
  In fact, what we saw last year in the House and what we are seeing 
again this year in the House is essentially a three-pronged strategy by 
the Republican leadership to deny a full debate and vote on the 
Patients' Bill of Rights.
  First of all, they simply delay for 6 months, since January, by not 
allowing the bill to be heard in committee or marked up in the 
committee. And then, when that seems to fail because the pressure gets 
too strong that they have to do something, they come forward with what 
I call a piecemeal approach.
  Just the other day, about a week ago, in the Committee on Education 
and the Workforce, one member of the Republican leadership brought 
eight individual bills that were purported to deal with the need for 
HMO or managed care reform. But those were individually bills or 
collectively bills that did not add up to much in terms of adequate 
protections for patients in HMOs. And I would say that, once again, 
this piecemeal approach is a way to avoid having the comprehensive 
bill, the Patients' Bill of Rights, heard.
  In fact, when the ranking member, the senior Democrat on the 
Subcommittee on Postsecondary Education, Training and Life-Long 
Learning, that sought to bring up the Patients' Bill of Rights, he was 
essentially gaveled down and told that he was out of order in trying to 
raise the Patients' Bill of Rights in committee.
  And what happened today, my understanding is, that even some of the 
Republicans on the committee, who are not in the leadership and 
basically did not support the Republican leadership, threatened if they 
were not allowed to

[[Page 14047]]

bring more comprehensive patient reform or HMO reform to the full 
Committee on Education and the Workforce, that they would basically 
support the Democrats and ask that the Patients' Bill of Rights or a 
more comprehensive approach be brought up. They essentially defied the 
Republican leadership.
  It is nice to know that there are some Republicans here that are 
willing to defy the leadership over this very important issue of HMO 
reform. But, unfortunately, the leadership is still in charge and they 
simply postponed the markup on those HMO reform bills.
  Now, the next step is, because we are signing this discharge 
petition, because so many of us will eventually sign this discharge 
petition, the next step in the effort to stifle managed care reform was 
what we saw last year in the Republican Congress, which is they then 
bring up a bill which is so loaded down with nongermane issues, like 
medical malpractice, medical savings accounts, health marts, that it 
obscures the basic patient protection legislation and causes such 
mucking up of HMO reform that the bill ultimately dies of its own 
accord.
  So I do not know what the Republicans are going to do this year, but 
from what I can see they are simply stalling, refusing to bring up the 
Patients' Bill of Rights, and we are all, Democrats and friendly 
Republicans, going to have to keep pushing and pushing with our 
discharge petition.
  I would like to yield now to a member of the Committee on Education 
and the Workforce, the gentleman from Minnesota (Mr. Vento).
  Mr. VENTO. Madam Speaker, I thank the gentleman from New Jersey (Mr. 
Pallone) for yielding, and I wanted to agree with him and reemphasize 
some of the points that he has made.
  Just a very simple one, and a point that I think is very important 
with regard to HMO reform, and that is that only the Congress, only the 
National Government can make the types of changes that need to be made 
with regard to HMO reform in this instance because of the nature of our 
laws in terms of interstate businesses and HMO involvement and 
insurance.
  Our State lawmakers cannot modify the conditions that are placed and 
the requirements imposed in terms of those HMO agreements. They must 
fundamentally be made by the United States Congress. The States alone 
cannot do this. So it is not a repeat or a reiteration of what States 
have done.
  Now, I think that along the way, many HMOs have, in fact, extended 
some of the benefits and some of the reforms on a single and a 
voluntary basis, and I commend them for that. But I think all too often 
this becomes a patchwork quilt of policy which does not have any 
symmetry, and it is necessary for Congress to act. And Congress has, 
frankly, not been able to get its act together and to, in fact, present 
a rational health care policy.
  I think as the changes have occurred very rapidly in the health care 
programs and in the insurance benefits that are extended to our working 
families, clearly it means that in many instances consumers really do 
not have a place at the table when the HMO or health care decisions are 
made that affect their families and their lives.
  And of course, as we know, increasingly health care professionals, 
including medical doctors, do not have a place at that table. So I 
think the primary effort here is to try to build a policy in which 
there is a voice for consumers, that there is a voice for health care 
professionals, along with those that are trying to obviously make 
health care efficient in terms of saving dollars and providing a 
benefit to service.
  That is the ultimate goal. But we must act here because of the nature 
of interstate laws. And Congress is reluctant to do that. Today I 
signed the discharge petition. I was number 65. I think the gentleman 
from New Jersey was probably before me in that number. I think we have 
maybe 100 signatures, and if we can accomplish the goal of getting 218 
signatures, then notwithstanding the fact that the majority, the 
leadership in this House, has not saw fit to schedule this bill for the 
floor, not even permitted votes on it to date in the committees of our 
House, then we, in fact, could bring that important priority that the 
American people have and that American families need to the House floor 
and act on that policy.
  I know our counterparts in the Senate, the Senate Democrats, are 
experiencing the same problems; that it is being frustrated in terms of 
deliberate consideration. I think this system that we have is somewhat 
cumbersome and somewhat difficult, but it is the only recourse that we 
have based on the policy that is being enunciated in terms of trying to 
prevent these matters from being voted upon on the floor.
  So I hope we can get the type of bipartisan support that is necessary 
to bring this important matter to the floor, and I commend the 
gentleman for his efforts in terms of voicing these concerns tonight on 
the floor and to the public.

                              {time}  1815

  Mr. PALLONE. Mr. Speaker, I want to thank the gentleman. If I could 
just follow up on a couple of things that he said.
  We had today in the Committee on Commerce a subcommittee hearing on 
the question of independent and external review, which again I was 
somewhat critical of the fact that the Committee on Commerce, which has 
the major jurisdiction over health care in the Congress, has not had a 
hearing on the Patients' Bill of Rights but now again is sort of taking 
this piecemeal approach and looking at little pieces of this. But I 
would say that the issue of holding managed care companies responsible 
for denial of care with a real, reliable, and enforceable appeal and 
remedy is an important issue.
  One of the things that came up was we had testimony from someone who 
was involved in the Texas law, and Texas has a very good law on the 
books that incorporates a lot of the patient protections that we have 
in the Patients' Bill of Rights, but one of the points that she made 
was exactly what the gentleman from Minnesota (Mr. Vento) made, which 
is that this is great for Texas but the majority of Texans do not take 
advantage or cannot because of the ERISA Federal preemption that we 
have as a matter of Federal law.
  One of the things that was stressed was that when Texas imposed an 
independent external review process, if they had been denied a 
particular treatment, one of the Federal courts has recently actually 
ruled that Texas did not have the power to do that at all because of 
the ERISA Federal preemption. So it just, once again, brings home the 
fact of why we need action on the Federal level.
  The other thing that I thought was interesting was that I thought it 
was sort of painfully obvious at this hearing that there were several 
Republican Members who really supported a comprehensive approach and 
essentially agreed with all the Democrats that this is what we should 
be doing, yet it was very obvious that the Republican leadership had no 
intention of doing that.
  So again, there are some Members that will join us on the other side 
and, hopefully, will sign our petition so we get to the 218. But so 
far, the Republican leadership has slammed the door and said, there is 
no way we are going to consider this Patients' Bill of Rights, and that 
is very unfortunate and what we have to keep fighting for.
  I want to just briefly, if I could, mention some of the key things 
that we are fighting for in the Patients' Bill of Rights. And then 
maybe I will yield to one of my colleagues that are here joining me 
this evening.
  The two most important things that I would say, one is this whole 
issue of providing for real enforceability. What happens now with many 
HMOs is that if they deny them care or particular treatment, the only 
review or appeal they have is an internal one within the HMO. And of 
course, they, being very prejudiced in most cases, will simply deny the 
appeal.
  What we are saying is that there has to be an independent external 
appeal outside the HMO; and, in addition to that, there has to be 
ultimately the

[[Page 14048]]

right to sue the HMO, which does not exist today under the Federal 
preemption. That is one of the most important aspects of the Patients' 
Bill of Rights.
  The other one that is linked to that is the definition of ``medical 
necessity.'' Right now the insurance company decides what is medically 
necessary; and if they define that and all that happens once they are 
denied care or treatment is that that is reviewed, their own definition 
of what is medically necessary, then, even if they have a good 
independent appeal or the right to sue, it will not necessarily help 
them because they are using their definition.
  What we say in the Patients' Bill of Rights is that the decision 
about what is medically necessary, what kinds of care they should 
receive should be made by the physician and the patient based on 
standard norms within the medical community for that particular 
specialty or whatever it happens to be and not by the insurance 
company. Those are the two key aspects that are not included in any of 
these eight piecemeal bills that are being circulated by the 
Republicans in the House or the legislation that the Republicans are 
bringing up in the Senate. Neither of those key points are included.
  Mr. Speaker, I yield to the gentlewoman from California (Mrs. Capps), 
who has a background as a nurse and who has been on the floor many 
times talking about this issue in very real terms because of her own 
experience.
  Mrs. CAPPS. Mr. Speaker, I thank my colleague from New Jersey (Mr. 
Pallone) for organizing this time for us to speak together.
  It has been a day on behalf of patients, I believe, here in the 
Congress, and that feels good to me as a nurse that we are finally now 
speaking clearly. What we need to do now is move this discussion from a 
march onto the floor by many Members who seek to have it be placed on 
the agenda. We need to move it from the hearing room. We need to move 
it right to the deliberation stage.
  It is fine for us to talk here, and I am glad we can have a chance to 
do that and maybe summarize some of the things that have been going on 
and some points that my colleague has been making. And it is wonderful 
to see a colleague from Illinois here, as well, ready to speak. Because 
this is not a situation particular to one part of the country. I am 
from California, and it involves me personally and directly with all of 
my constituents. It addresses all of us.
  This is a national crisis now. This is an issue that needs to be 
addressed across this country and, for that reason, needs to be dealt 
with in this House. Yes, we have great examples of States, and I 
commend a State like Texas that has put into place within their State 
framework strong patient protection rights and has seen clearly that 
when they do this it does not make the cost of health care skyrocket. 
It really does not do that.
  So it is wonderful to have the examples of communities and entities 
and States even where strong steps are taking place. But for us to 
speak on behalf of all of the citizens of this country, we need to do 
it here in this body, and I am pleased that we can do that.
  Now a year has gone by. I was first running for office a year and a 
half ago as a nurse, as a school nurse, in my community for 20 years. 
The strongest stories that were told to me were told to me by patients 
who were so frustrated with their managed care, we have had managed 
care in California for a long time, and the flaws in it. That was good. 
That happened in the beginning when the cost of health care, which had 
skyrocketed, was brought down. But then the excesses began to show 
themselves and so many citizens, also patients, came up to me and 
talked to me about their stories, real horror stories, of what had 
happened to them, many of them quietly. They never really told anyone 
before. But we reached out to them.
  I believe that the Patients' Bill of Rights gives voice to many of 
these concerns, the frustration about not being able to choose their 
own doctor, having any say in what choices they have for health care; 
the gag rules that prevent a health care provider from telling them all 
the options, whether or not their insurance covers it; access to 
specialties, to second opinions, to emergency room treatments.
  These seem common sense to me, something that we should not really 
have to legislate about. But, unfortunately, we do because of these 
excesses that have come to bear.
  The bottom line, as my colleague has pointed out, the bottom line has 
to do with who is making the important life-saving health and medical 
decisions, who do we trust our lives with, the lives of our loved ones 
with? Do we want it to be a bureaucrat who is an accountant, may be a 
whiz at being an accountant, or do we want to take advantage of 
someone's highly skilled training and dedication, someone we can look 
in the eye and can also look at our bodies and understand what health 
conditions we are talking about? So many of these decisions now are 
made without even access to the patient's records let alone meeting 
with the patient.
  The second bottom line is who is going to be accountable when grave 
mistakes are made? And again, I hark the situation we heard about in 
our hearing today, when accountability is put into a protection clause 
in the health care law, it does not necessarily skyrocket the prices. 
And when a life is at stake, I believe we need to really focus on that.
  The hearing that my colleague and I attended today on the importance 
of a strong appeals process, that was a good hearing. But again, it is 
time to move it here to the floor where we can take some action on 
this.
  Our country's health care system has changed from fee-for-service to 
managed care by and large. We have seen a revolution in health care, 
and we need to address the attendant issues which have gotten out of 
control. We do not want patients to have their medical needs denied 
because some third-party person is following a form here that has 
nothing to do with their own individual needs, and that is what we are 
talking about.
  The patient that I am thinking of right now is a mother really with a 
very young child who came to me desperate with the situation that had 
happened to her, gave birth to twins, already had a child. So the 
household was full. One of the twins was born with many critical health 
problems. They discharged the little baby to this newly delivered 
mother and denied the request for skilled nursing care in the home.
  It was an awful situation, just an awful situation. By the time they 
were able to seek redress and seek remedy for this, so much damage had 
been done to that young baby. And here was this household stressed to 
the limit with what was placed upon them, entirely inappropriate. The 
doctor recommended skilled nursing care in the home, and it was denied 
by the managed care company.
  Now, this is exactly where we want this external appeal situation to 
be in place, but also the ability to seek redress when grievances are 
incurred.
  This was during the campaign, and I made a pledge to this young 
family that I would work as diligently as I can. And I am. And I know 
that there is a commitment on the part of so many of us to do this, 
because we do have people's faces in our hearts as we are doing this. 
This is not some theory that we are trying to expound. We are talking 
about real-life situations, and we need to do it now. The longer we 
wait, the more hardships our country is faced with and the harder it is 
to really address some situations that have gotten so far out of 
control.
  So I believe my message is to the leadership of this House that we 
need to pay attention to our constituents and come together. We can 
talk about Republican bills. We can talk about Democrat bills. This is 
really not a partisan issue. We should be able to demonstrate to the 
American people who send us here that we can enact common sense, 
patient first legislation that really speaks to the needs of our 
constituents and really addresses health care in our country. And it is 
about time that we do it.
  Mr. Speaker, reclaiming my time, I want to thank the gentlewoman for 
her

[[Page 14049]]

comments. I really appreciate when she uses those examples of her own 
constituent, because I keep stressing that this is really common sense. 
We are coming at this because our constituents have cried out and even 
from personal experiences.
  I think I was actually gesturing to the gentlewoman today about the 
fact that at the hearing one of the, I do not know if he represented 
the HMOs, but he certainly seemed to be an apologist for the HMOs, who 
said that there was no reason to allow HMOs to be sued because they do 
not make medical decisions. And I was outraged by that. Because, in 
fact, that is the problem. They are making the medical decisions.
  And I did not use the example today, but when my colleague was 
talking about the twins that were born, I was thinking about my own 
son, who is now four. When he was born, he was born C-section. And they 
had that rule then, it has been changed now in New Jersey because of 
the State law, that said that for a C-section they could only stay in 
the hospital 2 days. I guess the normal length of time that is 
recommended by physicians is 4 days. And after the second day, the 
doctor came to us and said, ``Well, you know, your wife has to go home 
because we have this policy that you can only stay 2 days. I do not 
agree with the policy,'' the doctor said outright to us, ``but I have 
no choice.''
  Then I guess the law in D.C. requires that a pediatrician see the 
baby before it leaves the hospital. And he came and saw our son and 
said that he was jaundiced. And so they made an exception, said he 
could stay an extra day, the third day.
  But to me that just brought home, of course they are making the 
medical decision. They are telling the doctor what to do. So how can 
they say they are not making the medical decision? They clearly are. 
And that is what we do not want. We do not want the insurance company 
to make the medical decisions that contrary to what physicians and 
nurses think should be the general practice. And that is what we have.
  Mr. Speaker, I yield to the gentlewoman from Illinois (Ms. 
Schakowsky), who has also been out front on this issue on many 
occasions on the House floor.
  Ms. SCHAKOWSKY. Mr. Speaker, I thank the gentleman from New Jersey 
(Mr. Pallone) for his leadership on this issue and for organizing this 
discussion tonight.
  I was happy to join that long line of people this morning who were 
signing a discharge petition to allow us to fully debate HMO reform on 
the floor of this House. I guess we are up to about 167 Members now who 
are saying simply, let us discuss HMO reform, let us bring up this 
important legislation so that we can represent what we are hearing from 
constituents.
  But I did something else today. I put an appeal to my constituents on 
my website today so that they can join and be a force in helping to 
pass this legislation.

                              {time}  1830

  When you get to my web site, which by the way is www.house.gov/
schakowsky, and if anyone wants to go there, I would welcome it. 
Whether or not you are in my district, I would appreciate hearing from 
you about this. It says, in flashing letters, ``Help me end HMO 
abuses.'' What I am asking them for, it is a constituent alert, send me 
your HMO horror stories. I think it will be helpful to us if we get 
them to tell us. All of us have heard and I have got lots of letters 
myself, but I am hoping to collect a lot more.
  Let me read my colleagues this invitation. It says, ``The time is now 
for Congress to pass the Patients' Bill of Rights, H.R. 358. It is time 
for HMOs to be held accountable for their actions and for medical 
decisions to be made by doctors and nurses, not by HMO accountants.
  There are proposals in Congress that claim to offer reform but 
instead would let HMOs go about their business of cutting care, 
limiting services, and raising costs while enjoying record profits. I 
need your help to pass real reform and defeat phony legislation. I know 
that many of you have fought battles with your HMOs and more often than 
not you lost. If you believe that it is time to stop HMO abuses, the 
time to act is now. E-mail me your HMO horror story, let me know if you 
have been denied care, forced to change your doctor in the middle of 
treatment, lost coverage, refused access to a specialist, or had to 
work for days to get what you deserved. Together, we can convince 
Congress to pass the Patients' Bill of Rights.''
  The other thing that is on the web site is a petition that has been 
on many web sites around the country now calling on Congress to pass 
the Patients' Bill of Rights so that we can get our constituents 
involved in the process here, bring their voice here to Congress. That, 
I think, ultimately is going to be the thing that will pass this 
legislation. I want to urge people, and I think we are making a 
commitment today to do everything we can, but I am urging people who 
may be listening and I am certainly trying to urge my constituents to 
pick up the phone, call your Member of Congress, let the President 
know, let the Speaker of the House, Dennis Hastert, know that you want 
real HMO reform.
  By that, we should be talking about H.R. 358. I think the gentleman 
has done a good job in describing the important pieces that are in that 
legislation that are not in others. I am a new Member of Congress. I 
have found that there are a whole lot of ways to either skirt an issue 
or to water it down. One of them is, first of all just do not bring it 
up. So that is why today so many of the Members of this body signed 
this discharge petition so that we could have the debate. I think it is 
too bad that we have to go through these kinds of mechanisms in order 
to just discuss things.
  One is, do not bring it up, delay it as long as you can. But the 
other is to offer a solution that sounds like a solution but is not 
really a solution. That is the other thing that is going on here. There 
are bills that people want to be able to stand up and say, ``Oh, this 
is the Patients' Bill of Rights. This will really solve the problem.''
  We have looked carefully at all those proposals and seriously at all 
those proposals; and we know that the elements that need to be in 
there, really putting health care decisions in the hands of health care 
professionals, making sure that HMO plans are held accountable. I had a 
similar experience in Illinois where I was in the general assembly. The 
lobbyist for the HMO who came to testify before our health committee 
said, ``Oh, no, we don't make health care decisions. We only make 
coverage decisions. We're an insurance company.''
  I said, ``Well, excuse me, sir, but in the real world, there is no 
difference between a health care decision and a coverage decision, 
because you are saying then to people, oh, you can have your heart 
transplant, but you have to go out and pay for it yourself. That bone 
marrow transplant might do you some good in your cancer treatment, but 
we aren't going to cover it, but you can go buy it yourself.''
  Ordinary people cannot go out and buy expensive tests, expensive 
treatments, go off to a specialist that they feel that they need or 
that even their primary care doctor may feel that they need. So health 
care decisions are made every day by HMOs because they will only cover 
certain things. And so they should be held accountable.
  That is what H.R. 358 does. It also gives patients the right to 
appeal those decisions and not just to appeal it to the HMO who just 
denied them the care, they will have the right to external appeal, 
someone outside, an objective observer to look in and say, ``Were you 
wrongfully denied the care that you asked for?''
  So there is phony HMO reform and there is real HMO reform. That is 
what we are involved in with our discharge petition. I hope that is 
what we can engage the American people in, in a debate on this, real 
health care reform, HMO reform, and I hope that people will send their 
horror stories to me, will get the petition signed through the Internet 
and get this bill on the floor and get it passed.
  Mr. PALLONE. I want to thank the gentlewoman. One of the things that 
I

[[Page 14050]]

have noticed about newer Members like yourself is that you are always 
trying to get the public more involved through the Internet process. 
That is really great. I assure you that you are going to get all kinds 
of people contacting you, because the number one issue that I get 
contacted about in my district offices are problems with HMOs and 
managed care.
  Again, I just stress what I said before, which is that we are not 
coming at this out of some cloud or pie in the sky notion. This is just 
what people are telling us on a regular basis. People are shocked when 
you tell them as the gentlewoman from California brought up and talked 
about the gag rule. I have told some of my constituents, the way the 
law is, the insurance company can tell the doctor that they cannot 
discuss with you a mode of treatment that is not covered by the 
insurance, even though they think you should have it. They cannot 
believe it. They think that that is a violation of the first amendment 
or un-American. Of course it is, all those things, but they are just 
shocked to find out that that is okay under the law.
  Really we are just talking about common sense proposals that are 
coming to us. You will get a lot of them, I am sure, on the web site.
  Mr. Speaker, I yield to the gentleman from New York (Mr. Serrano) who 
again has joined me quite often in the past on this and other issues 
and I am pleased to see him here tonight.
  Mr. SERRANO. I want to thank the gentleman once again. It has been 
said quite a few times on the floor, but you always manage to get us 
involved in discussing the issues that we should discuss. I am reminded 
of a conversation that I had with the spouse of a foreign dignitary 
from one of the Latin American countries that I will not mention, not 
to get into a discussion, a country that is not as advanced as we are, 
and I did with that spouse what I do with a lot of people. I said, what 
impresses you the most about our country and what do you find hard to 
understand?
  She said, well, obviously your overabundance of food. You have so 
much food in this country, you hire people to keep food from falling 
out of the bins in the supermarket. That is how much food you have.
  I said, ``What touched you or made an impression on you in a negative 
way?'' She said, ``Well, I got sick and it took me more time to discuss 
where I was going, who was going to treat me and what was available to 
me than the time it took me to realize that I was hurting and sick. I 
can't understand why your country would take such red tape and put it 
in front of people.''
  Obviously that person, as you said, like many of our constituents, 
just do not understand until we try to explain it to them that there 
are things that are happening in this industry, this so-called health 
providers industry, that is just hard to believe, that a doctor, as you 
just mentioned, that a doctor would not be allowed to do what a doctor 
does best, which is to advise a patient on what he or she feels that 
patient should have because they are ordered basically or not allowed 
by an HMO or the coverage group to present that as an alternative.
  This is the United States of America in 1999. We cannot seem to get 
people to understand that you just cannot do that. The whole idea, I 
mean, sometimes I have watched my wife during the times when we have to 
sign up here, we, Members of Congress, have to sign up for our health 
plans, and I have seen my wife sit there at the dinner table with the 
thought of three children at home ranging in ages from 17 to 10 and 
trying to figure out which one, is it three from this column and seven 
from that, if we are covered for this, we are not covered for this. We 
have to ask permission for this so that we can get that. I join her in 
that, I say, my God, if this is what we go through and we supposedly 
get told all the time that we have this fabulous plan, what is 
everybody else who has no clue as to what they are dealing with are 
going through?
  Again it is picking from this column and from that column. I was very 
proud today, and I can say this with all honesty, when we marched into 
this Chamber and began to sign that petition to get this bill on the 
House floor. I have been here now 9 years and on many occasions I have 
to scratch my head and wonder why the other party in the last few years 
will not bring a bill to the floor. As I have said, I have stood here 
and scratched my head, but I have never scratched my head as much as on 
this bill.
  I mean, this is something the American people want. This is something 
that you provide to everyone. This is not partisan in any way, shape or 
form. This is not something that one party can take and run with and 
say we did it, this is something we as a House, as a Congress, can say 
we did it because we did it for our families, we did it for the public, 
we did it for our friends, we did it for all of us.
  And yet this resistance, this desire to either say no to bringing a 
bill to the floor or trying to present other measures which sound like 
they are addressing the issue when they are not addressing the issue. I 
think what has happened here tonight and for the next days and weeks is 
exactly what was mentioned here before by the prior speaker and, that 
is, to get the American public involved, to get the American public to 
let us know that their Members of Congress how they feel about this.
  If there is a parent this evening who is going through the same kind 
of situations where you are trying to figure out what is the best way 
to get coverage and you have gone through these experiences where you 
cannot get the right information or the proper information or the right 
support from your doctor because his hands or her hands are tied, if 
you have to spend hours trying to figure out, do I ask for this 
medicine, do I allow this prescription, am I covered by it, am I not 
covered, if any of this has happened to you, it is time you wrote, it 
is time you e-mailed, it is time you visited a web page, it is time you 
made a phone call, because I do not know of an issue that affects more 
Americans than this one at this moment.
  I mean, we have stood on this floor and discussed an issue that we 
are making some gains on, which was the issue of the uninsured 
children. The gentleman was the first one to bring this to the House 
floor, the whole issue of uninsured people throughout this country. We 
have made some gains on that. But this continues still to be the one 
area in this country where we just do not want to budge.
  I do not know who it is we are concerned that we are upsetting. Are 
HMOs more important than your family doctor? Is your family doctor 
someone that you are so proud of and then you turn around and you say, 
``Well, don't prescribe this and don't prescribe that?'' What are we 
talking about here? Just a few minutes ago, and I want to close with 
this, we were debating and we will be debating tomorrow this whole 
issue of desecration of the flag. I remember my first time here on the 
House floor when I looked at that flag behind the podium and I said, I 
wonder if that flag could speak to us, what would it tell us.
  It may not tell us to protect it from physical abuse. It may surprise 
us by telling us, ``Why don't you do that which makes me feel good and 
symbolizes everything I stand for.'' So on the same day that some 
people here are saying we have got to protect that flag, they reject a 
notion of protecting one of the things that the flag stands for, which 
is providing basic care to our children, to our women, to our elderly, 
to our working families in this country. And so what a better way to 
honor and respect the flag this week than for the Republicans to agree 
that they will bring this bill to the floor and discuss that issue here 
and give people the opportunity to get the coverage we deserve.
  We are the greatest country on earth, we are the wealthiest country 
on earth, we are the greatest democracy on earth, but there are still a 
few pieces missing that we have to put together to fulfill our full 
potential. One of them right at the top is this inability we have to 
deal with this issue without worrying about who we upset, because we 
are not going to upset children, we

[[Page 14051]]

are not going to upset the elderly, we are not going to upset the 
American people, and if we upset a few insurance companies, if we upset 
a few HMOs, we are not out to kill anybody.

                              {time}  1845

  We will work, and all we want is dialogue and the ability to give 
people their right. At the same time we protect the industry. Our job 
here is not to destroy one to save the other; it is to protect that 
which is right.
  So I want to thank the gentleman once again. I know that he will be 
on the floor at other times with this issue again, and I will be glad 
to join him then as I have joined him today and in the past.
  Mr. PALLONE. I want to thank the gentleman, and if I could just 
comment on what he said about why the Republicans will not bring it up. 
I sound so cynical in saying it, but I believe strongly that it is the 
power of the insurance industry and the power of the insurance lobby, 
and I, as my colleagues know, witnessed that myself. I mean they spend 
millions and millions of dollars on TV ads talking about why the 
Patients' Bill of Rights and HMO reform should not take place. In fact, 
in my last election about $4 million was spent in independent 
expenditure by, primarily by, the HMOs to try to defeat me because they 
see me as a spokesman on the issue. So they are willing to spend all 
this money.
  Mr. SERRANO. Mr. Speaker, if the gentleman would yield because I want 
to get that right? He said that $4 million was spent by HMOs and 
insurance companies to try to get a Member of Congress out of here who 
supports children and elderly getting their fair share.
  Mr. PALLONE. Absolutely, and it was not just done to me; it was done 
to others as well. And the irony of it is what you just said which is 
that, you know, if you look at what we are actually asking be done, it 
is not going to put them out of business.
  In fact, today in the Committee on Commerce we had someone come in 
who was responsible and put together the Texas law which is very 
similar to our Patients' Bill of Rights, and as my colleagues know, one 
of the things she said was that all the debate in the State legislature 
in Texas about this, all the managed care and HMOs were saying we are 
going to be out of business, there will no longer be any managed care 
in Texas. In fact just the opposite is true. They have not suffered at 
all. There are more managed care options in Texas today in fact than in 
a lot of other States even though they have a very similar law on the 
books.
  So we are not hurting them, but obviously they perceive that we are, 
and they are wrong, but we just have to keep making the point, so I 
want to thank you again for coming down.
  And I would like to yield now to the gentleman from Maine who has not 
only been outspoken on this issue, but also on the issue of the cost of 
prescription drugs in a bill that he has sponsored to try to correct 
that problem, and he has been concentrating on these health care issues 
that impact all Americans.
  I yield to the gentleman.
  Mr. ALLEN. I want to thank the gentleman from New Jersey for 
organizing this special order on the Patients' Bill of Rights, and as 
you indicated, I have been spending a lot of time trying to lower the 
cost of prescription drugs for elderly. I think it is a very important 
issue and one we ought to be dealing with. In fact, that is one of the 
frustrations these days of being in this Congress. It seems hard to get 
good legislation up to the floor here for a vote.
  As my colleagues know, last year the Patients' Bill of Rights 
legislation failed by just five votes, and in the past year the need 
for that legislation has not diminished. We ought to be able to get it 
up for a vote, but the Republican leadership is preventing that from 
happening.
  So I am proud that we as Democrats today took the first step to 
filing a discharge petition, and lots of people around the country do 
not know what a discharge petition is, but it is a procedure by which 
we can bring legislation to the floor if we get 218 signatures on that 
petition without having it to go through the Republican leadership and 
the Committee on Rules.
  As my colleagues know, we have already had to start a discharge 
petition in this House to try to get campaign finance reform 
legislation to the floor. Again, there was legislation that passed in 
the last Congress by 252 votes. With 252 Members supporting the 
legislation we still cannot bring that up. So we are going to try the 
same procedural tactic that we have used there.
  As my colleagues know, my home State of Maine has been slow to move 
to managed care particularly under Medicare. We only have a few hundred 
people signed up for managed care under Medicare. But people are still 
anxious about HMOs and about managed care. In many respects what 
managed care companies are doing is good. The emphasis on prevention, 
when it is there is a real step forward in helping people take care of 
themselves in ways that perhaps they have not before.
  But it is very important that managed care be more than managed cost. 
In the early days of managed care it has been clear that the companies 
have been successful in driving down costs. All we are saying with the 
Patients' Bill of Rights is we want to make sure that driving down 
costs does not come at the expense of quality care. That is really what 
this is all about. We want to make sure that certain provisions are 
really there for everyone.
  Some States have enacted patient protections. My home State of Maine 
has, but there are still people because of Federal preemption who are 
not covered by those State laws. In Maine there are 250,000 people 
roughly who are not covered by the State patient protection provisions. 
My constituents recognize we need a national solution to a national 
problem, and that national solution is the Patients' Bill of Rights 
Act.
  I know you have mentioned this before, but I want to go over what it 
would do. First of all, it would guarantee access to necessary care. 
The bill provides direct access to a specialist for patients with 
serious ongoing conditions. The bill requires access to and payment for 
emergency service. People who go to the emergency room when they are 
hurting need to know that as long as a reasonably prudent lay person 
would do that, they are going to be paid, they are going to get 
coverage for that service. The bill also allows doctors to prescribe 
prescription drugs that are not on an HMO's predetermined list so that 
the doctor is making the decision, the doctor and the patient are 
making the decision, about the most appropriate care.
  The Patients' Bill of Rights Act also provides a fair and timely 
appeal process when health plans deny care. The bill holds managed care 
plans accountable when their decisions to withhold or limit care 
injures patients, and it also guarantees protections for the provider 
patient relationship.
  The bill bans gag clauses as well as bonuses and other financial 
incentives to doctors to deny care. The bill protects providers who 
advocate on behalf of their patients with the insurance company. And 
furthermore, the bill prevents drive-through mastectomies and other 
arbitrary medically inappropriate decisions by plans.
  The American people are clear on this issue. They want real 
protection, they do not want a watered down bill, and we have a chance 
in this Congress to enact real reform, and that real reform would make 
health care plans accountable for their mistakes just as everyone else 
in this country except foreign diplomats are responsible for their 
mistakes.
  I think this is a case where, as my colleagues know, we know the 
problem, we are just this far away from finding the right solution to 
the problem. We ought to pass the Patients' Bill of Rights Act. I 
regret that we have to go through this discharge petition process in 
order to try to bring this matter to the floor. It ought to come to the 
floor now.
  We have had some Republicans in the past Congress who have been 
willing to sign on and support this legislation, and I hope we will 
have Republicans supporting this again, but for now we are simply going 
to do everything we

[[Page 14052]]

can as Democrats just to say: Give us a vote, give the American people 
a chance to express their opinion, and let their representatives cast 
the vote on the Patients' Bill of Rights Act. We ask for support for 
that particular legislation.
  And I just want to say to the gentleman from New Jersey (Mr. 
Pallone), my friend and colleague, ``We really appreciate all the work 
you do on health care in general, and in particular, on the Patients' 
Bill of Rights Act.
  Mr. PALLONE. I want to thank the gentleman, and I am glad you brought 
up the point about the drug formularies as well because there is that 
aspect of the bill as well, and the other thing I wanted that you 
brought up and I want to stress again is that, as my colleagues know, 
in some ways maybe we are fortunate in that we had to move this 
discharge process very late in the session last time. Even though 6 
months have passed, if we are able to get not only all the Democrats to 
sign on to this discharge petition, but also able to get a few of our 
Republican colleagues, we still do have some time left to try to get 
this to the floor, and hopefully we will be successful, and we are 
certainly going to keep trying until we are successful and we do bring 
the bill to the floor.
  So I want to thank the gentleman again, and I also want to yield now 
to the gentleman from Texas (Mr. Green), my colleague on the Committee 
on Commerce, and he has been really outstanding in particular in 
pointing out how in his home State of Texas where they have actually 
enacted significant patient protections and what a positive impact that 
has had on the State even though it does not apply, of course, to so 
many people that have been preempted by the federal law. I yield to the 
gentleman.
  Mr. GREEN of Texas. Mr. Speaker, the biggest concern I have in 
comparing what we are trying to do here in Washington and what has been 
done in State of Texas and other States is that the States can pass 
laws that regulate insurance policies in their States.
  Now I have employers that are multi State, employers who are self 
insured, and they come under federal law. So the State of Texas, the 
State of New Jersey, the State of Maine, State of California can do all 
they want and pass a Patients' Bill of Rights, but it only affects in 
fact less than 40 percent, in some cases maybe even less than 20 
percent of the insurance policies that are issued in their State. In 
the State of Texas we have over 8 million people who have insurance 
policies that are covered by ERISA. When you think we have about 11 
million, a little over 11 million people covered, that is a little less 
than 80 percent of the people are not covered by the State protections 
that were passed not only in 1997, but even earlier over the last 4 or 
5 years, and that is why we need to have a federal legislation. And 
today is a special day, I guess, because we, a few of us, because of a 
frustration of not being able to have a managed care bill to debate 
here on the floor of the House and to compare our ideas or my ideas and 
yours or my colleagues' on the Republican side; we do not have that 
opportunity, and so we had to, all of us, a number of us, sign a 
discharge petition today to actually take a bill away from the 
committee you and I serve on. We serve on the Committee on Commerce. I 
am proud to be on that Committee on Commerce, but we are literally not 
doing the people's business by not addressing managed care reform and 
Patient Bill of Rights.
  One of the concerns I had back during the Memorial Day recess, I 
spoke to some business owners in my district, and they said, well, we 
are concerned that this Patient Bill of Rights that you have will let 
our employees sue their employer, and I said that is the further these 
thing from the truth, and tonight I would like as much time as you have 
left to address some of those half truths and outright untruths that we 
have been hearing.
  One, there is nothing in this bill that will allow for an employee to 
sue an employer. All this does is that that employer buys an insurance 
policy, it is covered under Federal law, that that employer, that 
employee will have some rights under that insurance policy. Never would 
there ever be a suit against the employer because again employers can 
afford a Cadillac insurance plan, or they can afford the Chevy 
insurance plan, but as my colleagues know, some will pay for 
everything, some pay for only certain things, maybe higher deductibles 
and things like that.
  But that is not what is in this bill, so they are using scare tactics 
to say we are going to have employees suing employers. That is just not 
true.
  The other thing that they used is, is it going to raise the cost of 
health care? In fact, one publication I saw said it could increase 
insurance rates 40 percent, which is outrageous. Today I heard 
testimony; I think you did, too; that the State of Texas that did the 
managed care reforms that we are trying to do, there were hardly any 
increases at all. In fact, the increases in managed care rates were 
comparable to States that had no reforms that were passed. In fact, 
even my argument, I think, that some of those increases were already 
built in because the managed care companies were increasing rates 3 or 
6 percent depending on the market, and they were doing that in other 
States that have not done it.
  So what we are trying to do and the other concern I have is that they 
say that it will increase rates. Well, it may increase rates, but maybe 
it will increase them because they are having to pay some of those 
claims because in the State of Texas one of the items that is important 
in a Patient Bill of Rights is an appeals process, a fair and accurate 
and fast appeals process. In the State of Texas, the number of appeals 
that have been appealed by the patient to an impartial body, 50 percent 
of those appeals have been found for the patient.
  So granted, it may increase rates because for 50 percent they are 
going to have to start paying for actual health care instead of denying 
it unfairly, and that is what we found in the State of Texas. And so 
maybe that will increase their rates. I hope not because I think their 
actuaries already have premiums based on what those experiences ought 
to be.
  So in the Texas experience, for less than the cost of a happy meal at 
McDonald's patients in managed care could really have some fairness and 
protection and accountability.

                              {time}  1900

  In my home State, we have passed a lot of these patient protections, 
including the external appeals and the accountability and the 
liability. Physicians are always frustrated, health care providers 
saying wait a minute, if I do something wrong, my patient can sue me, 
but if I call an insurance company and they say no, you cannot do that, 
you have to do this and the patient is injured by that, that is not 
fair, because they cannot sue that insurance company because they are 
the one practicing medicine. So that is why accountability is so 
important.
  I would hope we would have the same experience as the State of Texas 
has, who has had that accountability and liability in law now for 2 
years. Again, I have heard testimony today literally that there was 
only one or two cases filed, simply because if we have a fair appeals 
process, people will get what they need, and that is adequate health 
care. People do not want to sue insurance companies, they just want to 
have them pay for what they should be paying for in their health care.
  Again, one of the old truths that we have heard is that there will be 
a mass exodus in employers dropping insurance coverage. Again, in the 
State of Texas, we have had literally an increase in the number of 
people who are covered under managed care plans, even under the new 
rules we have. In fact, again today, under sworn testimony, we heard 
that Aetna Insurance said that the State of Texas, and I assume this 
was recently, said the State of Texas's insurance market is the filet 
mignon of insurance markets, and that is a quote from a hearing today 
that we both attended. I have to admit, if the State of Texas under our 
managed care reform is the filet mignon, all I am concerned about is 
the hamburger.

[[Page 14053]]

Typically, most of our folks can afford decent hamburger. So there will 
be no mass exodus of employers dropping health care coverage just 
because we are giving insurance companies some rules to live by.
  Emergency care so that a person does not have to drive by the closest 
emergency room to get to the one that may be on their list, because 
frankly, we want to make sure they have the quickest and fastest 
emergency room care as possible.
  Anti-gag. A physician or health care provider should be able to talk 
to their patients. They ought to be able to say, this is what your 
insurance company will pay for, this is what they will not pay for. 
Again, we have employers who can pay for the Cadillac plan and the 
Cadillac plan may pay for everything, but the Chevrolet plan may not 
pay for everything, but that doctor ought to be able to talk to their 
patients.
  Open access to specialists for women and children, particularly 
chronically ill patients, so that every time they do not have to go 
back to their family practice person or their gatekeeper before they go 
to their oncologist, for example, if they are diagnosed with cancer. 
That should not have to be the case. Women ought to be able to use 
their OB-GYN as their primary care. Children ought to be able to go to 
a pediatrician without having to go back to a primary care doctor.
  Of course, I talked about the external and binding appeals process 
and how important it is, and how important it is to have the 
accountability linked to that, that the accountability is hardly ever 
used if one has a real effective appeals process.
  Those are the important things that managed care reform bill offers. 
I do not know, I heard we had 161 signatures, 167 now, so I would hope 
that we get to the 218. Of course, we are going to have to have it 
bipartisanly, and last session it was. We had some Republican Members 
who were supportive of the Dingell bill, and hopefully we will see them 
come together over the next few weeks so we can really see some 
national managed care reform, similar to what the States have been 
doing and doing so successfully.
  I hear all the time that we do not want to in Washington tell States 
what to do. Well, I do not want to do that. But we can use the States 
as a laboratory, as an example, and say, okay, it is working in Texas, 
has been for 2 years. There is not a lot of lawsuits, there is not an 
increase in premiums. Actually, people are winning half of those cases.
  I like to use the example that if I was a baseball player and had a 
300 batting average, which is a 30 percent batting average, I would be 
making $8 million a year. But for my managed care provider, if they are 
only right half the time when they decide my health care, I want a 
better percentage than the flip of a coin.
  In Texas, that is our experience. We have seen that we have the flip 
of the coin. We want a better percentage. Managed care providers I hope 
will see that percentage where they are not overturned, because they 
are actually providing better care and they are providing for more 
adequate care to their customers, our doctors, patients, and our 
constituents.
  So that is why I think it is important. This year we need to have a 
real Patients' Bill of Rights. Last session we had one that was worse 
than a fig leaf, because it actually overturned laws that were passed 
by our State legislatures. So it would have hurt the State of Texas, 
the bill that passed this House last session by 5 votes. Thank goodness 
the Senate killed it. This year, hopefully we will have a real managed 
care and Patients' Bill of Rights.
  I thank the gentleman for his leadership as our health care task 
force person on the Democratic side. We are doing the Lord's work in 
trying to do this.
  Mr. PALLONE. Mr. Speaker, I thank the gentleman. I know our time has 
run out, but I think the gentleman said it well about using the Texas 
example to show how what we are proposing here works and has worked in 
Texas over the last two years.

                          ____________________