[Congressional Record (Bound Edition), Volume 145 (1999), Part 15]
[House]
[Pages 20943-20944]
[From the U.S. Government Publishing Office, www.gpo.gov]



                     PATIENT PROTECTION LEGISLATION

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentleman from Iowa (Mr. Ganske) is recognized for 
60 minutes as the designee of the majority leader.
  Mr. GANSKE. Mr. Speaker, I welcome back all my colleagues from across 
the country, both sides of the aisle.
  Congress has a lot of work to do in the last couple months of this 
year. Part of that work that many of us would like to see completed, at 
least in the House, and get to conference would be to pass a bill here 
in the House on patient protection legislation.
  Now it is now September, Mr. Speaker, and the Speaker of the House, 
the gentleman from Illinois (Mr. Hastert) had told us that in June that 
we would see a patient protection bill on the floor before the August 
recess. In fact, he personally told me that it is his, quote, intent to 
have managed care reform legislation on the floor in July before our 
August recess.
  Unfortunately, Mr. Speaker, it did not happen, so we went off to our 
August recesses, talked to our constituents, and the managed care 
industry continued their $100 million advertising campaign against this 
legislation.
  Now there are only 435 Members of this House, Mr. Speaker. If you 
divide that into a hundred million, that is an awful lot of money that 
a special interest group is using to try to defeat a common-sense piece 
of legislation. But the August recess gave them their chance to go on 
TV, go on the radio, initiate phone calls into offices, and do my 
colleagues know what? I welcome that.

                              {time}  2100

  Because it identified a number of people in my office, for instance, 
who are interested in healthcare, and when we had a chance to explain 
to them the bill, the bipartisan bill, H.R. 2723, the Bipartisan 
Consensus Patient Protection Bill of 1999, overwhelmingly the people 
who were stimulated to phone in to my office by the opponents to this 
legislation said, You know what? That does not sound like it is such a 
bad piece of legislation. In fact, we have a neighbor or a family 
member who has had problems with their HMO, and we think you ought to 
do something about it.
  Well, as I said, the managed care industry initiated this big 
advertising blitz over the August recess. What did they accomplish? I 
think the polling will show that two-thirds of the American people 
continue to want to see managed care patient protection legislation 
passed. Overwhelmingly, people think doctors ought to be able to tell 
their patients all of their treatment options.
  Overwhelmingly, the American public think that they ought to be able 
to go to an emergency room if they are truly having an emergency. If 
they are, for instance, having crushing chest pain and they have seen 
that the American Heart Association says that could be a heart attack, 
you better get right to that emergency room, they think we ought to 
pass legislation that would say if you have that common layperson's 
definition of an emergency, your HMO should have to pay the bill, even 
if afterwards it turns out you did not have something quite as serious 
as a heart attack, because if you delay getting to the emergency room, 
you may end up dead before you get to the emergency room.
  Well, over the last month, since the gentleman from Georgia (Mr. 
Norwood), the gentleman from Michigan (Mr. Dingell), myself and others 
introduced the bipartisan Consensus Patient Protection Act of 1999, we 
have had a number of organizations from across the country sign on 
endorsements for this piece of legislation. In fact, Mr. Speaker, I 
would like to introduce a list of 156 endorsing organizations for H.R. 
2723, the Bipartisan Consensus Managed Care Improvement Act of 1999.
  Let me just read through some of these letters of endorsement. I 
think they make good points. Now, I am not reading these in any 
particular order. I am not going to have time in this 1-hour special 
order to read every letter of endorsement, but I think that many of 
them deserve being shared with my colleagues.
  The first one I have is the American Nursing Association endorses the 
bipartisan managed care bill. The American Nursing Association 
represents 2.6 million registered nurses throughout its 53 constituent 
organizations. This is what it had to say about the bipartisan managed 
care reform bill:
  ``The American Nurses Association is pleased to endorse this bill and 
encouraged by the cooperation and compromises made to achieve real 
reform, real progress on managed care reform,'' said ANA President 
Beverly Malone.
  ``It is heartening to see Congress working together to solve 
problems. This is how Congress should be working. Given the nursing 
profession's preeminent role in patient advocacy, the American Nursing 
Association is particularly heartened by the steps proposed to protect 
registered nurses and other healthcare professionals from retaliation 
from HMOs when they, the nurses, advocate for their patients' health 
and safety. As the Nation's foremost patient advocates, nurses need to 
be able to speak up about inappropriate or inadequate care that would 
harm their patients. Nurses at the bedside know exactly what happens 
when care is denied, comes too late or is so inadequate that it leads 
to inexcusable suffering, which is why we need to maintain strong 
whistleblower protection language in this bill. Nurses want to see 
strong comprehensive patient protection legislation enacted this 
year.''
  Mr. Speaker, shortly before the August recess this House 
overwhelmingly voted to protect federal employees who blow the whistle 
on contractors or others who are breaking the law. There is a well-
known case that has been reported in the press about a Department of 
Defense employee who blew the whistle and was punished by her superiors 
for it, and this House, Republicans and Democrats, overwhelmingly voted 
to support the whistleblower protections that my own Senator from Iowa, 
Senator Grassley, has been a strong proponent of.
  I would ask my colleagues, look, if we think a strong whistleblower 
protection is good enough for federal employees, do we not also think 
it is important that nurses who are on the front lines, who see the 
effects of HMOs decisions, that they are able to speak their minds 
freely without fear that they could lose their jobs? Well, that is the 
American Nursing Association endorsement.
  Here I have the endorsement by the American Medical Association: 
``The 300,000 physician student members of the American Medical 
Association strongly urge the House of Representatives to pass 
meaningful patient protection legislation.'' The AMA endorses H.R. 
2723, the Bipartisan Consensus Managed Care Improvement Act of 1999, 
introduced by the gentleman from Georgia (Mr. Norwood) and the 
gentleman from Michigan (Mr. Dingell).
  Then the AMA goes through why they think this is a good bill. It has 
a strong external appeal section. All patients should be guaranteed 
access to an external appeals process whenever a denial of benefits 
involves medical judgment or concerns medical necessity. But we have a 
situation, Mr. Speaker, where, because of past federal law, people who 
receive their insurance through their employers do not have

[[Page 20944]]

that protection. If you purchase your insurance as an individual, you 
are under State insurance commissioner protection. But if you receive 
your insurance through your employer, Congress 25 years ago passed a 
bill that basically say said that health plan can give a definition of 
whatever they want to medical necessity.
  Now, let me explain what that means. Before coming to Congress I was 
a reconstructive surgeon. I took care of children with cleft lips and 
palates, a hole in the lip and a hole in the roof of the mouth. The 
prevailing standard of care for treatment of that is surgical 
correction so that the child can learn to speak, so that food does not 
come out of his nose.
  There are health plans, HMOs, that define medical necessity as the 
cheapest, least expensive care, quote-unquote. So what would that mean 
to a child with a cleft palate? It would mean that that health plan 
could say, Hey, we are not going to give you surgery to fix that defect 
that you are born with; we are just going to give you a piece of 
plastic to shove up into that hole. Will that little boy or girl be 
able to speak correctly? No. But it does not matter, because under 
federal law the health plan can determine medical necessity.
  We need to change that. That change is in the bill that the AMA is 
endorsing.
  The AMA talks about accountability of health plans. If they are 
making medical decisions, they ought to be responsible for those: point 
of service, emergency services, prohibiting gag clauses that will keep 
physicians from being able to tell a patient all of their treatment 
options.
  Let us say that I have just examined a patient, a woman, with a lump 
in her breast, and she belongs to an HMO, and that HMO has a gag clause 
that says before you tell a patient her treatment options, you have to 
first get an okay from us.
  So I listen to this patient's story, I examine her, and then I have 
to say, Excuse me, go out to the phone, get an HMO on the line and say, 
This patient has three treatment options, one of which may be more 
expensive than the other. Is it all right to tell her about them? That 
is absurd. It is ridiculous. But do you know what? Those types of 
practices have happened. Those types of contracts exist, or at least 
have existed until we started to shine the light of the disaffected 
upon those practices. We need to make sure that I can tell that patient 
her treatment options, whether her plan covers it or not. She deserves 
to know all of her treatment options.
  Those are important reasons why, for instance, the American Medical 
Association has given its endorsement to the bipartisan Consensus 
Managed Care Improvement Act.
  How about the American Osteopathic Association? The American 
Osteopathic Association represents the Nation's 43,000 osteopathic 
physicians. Eugene Oliveri, Dr. Oliveri says, ``As president, I am 
pleased to let you know that the AOA endorses the Bipartisan Consensus 
Managed Care Improvement Act of 1999. Why? Because physicians are 
allowed to determine medical necessity. Health plans are accountable 
for their actions, a fair and independent appeals process is available 
and the protections apply to all Americans. Employers and patients,'' 
this letter says, ``are tired of not receiving the care they are 
promised, they pay for and they deserve, and H.R. 2723 will help bring 
quality back into health care.''
  Here I have another letter of endorsement. This is from the American 
Dental Association:
  ``On behalf of the 144,000 members of the American Dental 
Association, we wish to endorse H.R. 2723, the Bipartisan Consensus 
Managed Care Improvement Act of 1999. This is the first truly 
bipartisan comprehensive patient protection bill in the 106th 
Congress.'' This was a letter to Congressman Norwood.
  ``By joining forces with Representative Dingell, you have breathed 
new life into the movement to establish a few basic rules to protect 
all privately insured Americans from unfair and unreasonable delays and 
denials of care.''
  The letter goes on: ``We recognize that powerful groups that oppose 
managed care reform will continue spending millions of dollars in their 
relentless efforts to scare the public and badger lawmakers who attempt 
to improve the health care system. However, we will do all we can to 
make sure that our members know of your courageous efforts on behalf of 
them and our patients. Patient protection is a genuine grassroots issue 
that cuts across geographic, economic and political boundaries, and we 
believe that only bipartisan action will achieve the goal that you 
want.''
  Here I have a news release from the American Academy of Family 
Physicians: ``Today the 88,000 member American Academy of Family 
Physicians announces its support for H.R. 2723.''
  I have here a letter of endorsement from the American College of 
Physicians, the American Society of Internal Medicine: ``The American 
College of Physicians, ASIM, is the largest medical specialty society 
in the country, representing 115,000 physicians who specialize in 
internal medicine and medical students. The American College of 
Physicians believes that any effective patient protection legislation 
must apply to all Americans, not just those in employer plans, require 
that physicians rather than health plans make determinations regarding 
medical necessity, provide enrollees with a timely access to a review 
process that is independent, offer all enrollees in managed care plans 
a point of service that enables them to obtain care from physicians 
outside the network and hold all health plans accountable.''
  Mr. Speaker, I have a letter of endorsement from the American Academy 
of Pediatrics: ``On behalf of the 55,000 general pediatrician-pediatric 
medical specialists and pediatric surgical specialists, I am writing to 
express our strong support of H.R. 2723. We are especially pleased that 
your legislation recognizes the unique needs of children and addresses 
them appropriately. Children are not little adults. Their care should 
be provided by physicians who are appropriately educated in unique 
physical and developmental issues surrounding the care of infants. You 
clearly recognize this, and have included access to appropriate 
pediatric specialists, and we are endorsing your bill.''

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