[Congressional Record (Bound Edition), Volume 145 (1999), Part 15]
[House]
[Pages 21132-21136]
[From the U.S. Government Publishing Office, www.gpo.gov]



               HMO REFORM UPPERMOST ON MINDS OF AMERICANS

  The SPEAKER pro tempore. 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. Mr. Speaker, the issue of HMO reform has become one of 
the most important issues on the minds of Americans today, and I can 
certainly tell you that from the forums and the people that I met and 
talked to during the August break that we recently held with the House 
of Representatives. I had a number of forums in my district that were 
specifically about HMO reform where we talked about the Patients' Bill 
of Rights and what some of us are trying to do in the House of 
Representatives to reform HMOs and to end some of the abuses. And I 
found overwhelmingly that at my general forums or my forums that were 
specific to HMO reform that people felt that the need to address the 
abuses of HMOs and managed care was the number one issue on the minds 
of my constituents. And we know that polling around the country amongst 
Democrats, Republicans, and Independents shows that that is certainly 
the case as well.
  There have been also I should mention a number of front page articles 
in the leading newspapers, the New York Times, the Washington Post on 
the fevered pitch, if you will, that the debate over managed care 
reform has assumed on Capitol Hill, and it is also assumed I would say 
a clear and identifiable framework.
  The debate is now one between supporters of managed care reform on 
the one hand, mostly Democrats, and some Republicans and the Republican 
leadership on the other hand. The Republican leadership which with the 
insurance industry are fighting tooth and nail to undermine the various 
managed care reform proposals that have been introduced either by 
Democrats, by Republicans or on a bipartisan basis.
  The issue of HMO reform has reached the dimensions it has because 
patients are being abused within managed care organizations. It is just 
common sense. Many people come up to me because they have had problems 
with HMOs where they felt that common sense would dictate that they 
should be able to go to an emergency room or they should be able to 
have particular treatment or stay in the hospital a few extra days, and 
they are told that they cannot.
  Patients today lack basic elementary protections from abuse, and 
these abuses are occurring because insurance companies and not doctors 
are dictating which patients can get what services under what 
circumstances. Within managed care organizations, HMOs, the judgment of 
doctors is increasingly taking a back seat to the judgment of the 
insurance companies. Medical necessity is being shunned aside by the 
desire of bureaucrats to make an extra buck, and people are literally 
dying because they are not getting the medical attention they need; and 
ironically enough, they are in theory paying for it in their premiums.

                              {time}  2100

  I cannot emphasize enough, Mr. Speaker, how many times during the 
break, during the August recess, that people came into my district 
office complaining about abuses related to HMOs and managed care.
  Now, because of the importance of this issue, there are a number of 
legislative proposals that have been introduced to give patients the 
protections they deserve. I have been on the floor many times talking 
about the Democrat Caucus' Health Care Task Force, which I cochair; and 
together with the gentleman from Michigan [Mr. Dingell] and most 
Democratic Members here in the House, we have introduced legislation 
which would provide patients with a comprehensive set of protections 
from managed care abuses. This is the Patients' Bill of Rights, as it 
is called. It is not an attempt to destroy managed care, it is an 
attempt to basically improve it and to make it better.
  I cannot emphasize that enough. During the forums I had during the 
break, I had actually people from an insurance company who sold 
insurance policies for managed care, and I suggested to them over and 
over again and explained to them that those of us who want reform are 
not against managed care. Managed care is here to stay. We know that it 
saves money; we know there are positive values to it. But on the other 
hand, the abuses have to be corrected.
  Now, I wanted to say that what happened just before the August break 
in that first week of August when we were last in session was very 
significant. At that time and a few weeks prior to that the Republican 
leadership was saying they were willing to bring some kind of managed 
care reform to the floor and let us vote on it, up or down. However, 
they ultimately decided not to allow that, not to do that.
  Because of that, there were Republican Members, and I will mention 
the two leaders, the gentleman from Georgia [Mr. Norwood] and the 
gentleman from Iowa [Mr. Ganske], both Republicans, both health care 
professionals, who decided they were going to join together. Because 
they could not get a vote on the floor on managed care reform from the 
Republican leadership, they would join together and bring some of the 
Republican colleagues over to help most of the Democrats who had 
sponsored and put forward the Patients' Bill of Rights.
  So just before the break, it was announced there would be a new 
bipartisan bill sponsored by these Members, the gentleman from Michigan 
[Mr. Dingell] and the gentleman from Georgia [Mr. Norwood], the 
gentleman from Michigan [Mr. Dingell] being our Democrat and ranking 
member on the Committee on Commerce, and the gentleman from Georgia 
[Mr. Norwood] and the gentleman from Iowa [Mr. Ganske], also Republican 
members of the Committee on Commerce; and we would put together a new 
bipartisan Patients' Bill of Rights, which is very similar really to 
the Democratic bill that came out of our Democratic Health Care Task 
Force and that we as Democrats have been talking about for the last 
year or more, and we now have 20 Republicans who have agreed to 
cosponsor this new bipartisan Patients' Bill of Rights.
  That was a major achievement. There are now a majority of Members

[[Page 21133]]

of this House on both sides of the aisle that are willing to say that 
they want the Patients' Bill of Rights brought to the floor and are 
willing to cosponsor the bill.
  Unfortunately, nothing has really changed in terms of the Republican 
leadership. The Patients' Bill of Rights, this new bipartisan one, does 
not enjoy the support of the Republican leadership. In fact, if we are 
to believe, if you will, what we read in the newspaper, it is not just 
the Patients' Bill of Rights that the Republican leadership opposes. 
They appear to be opposed to the larger notion of managed care reform. 
They are simply not willing to cross the insurance industry in order to 
give patients better protections and doctors greater power over medical 
choices.
  I would like to point out that the GOP leadership's opposition to the 
new bipartisan Patients' Bill of Rights is not exclusive to the House. 
In the Senate, Senator Nickles recently lambasted the American Medical 
Association for supporting the Patients' Bill of Rights. During the 
break the American Medical Association, I should mention, came out in 
support, unconditional support, of this new bipartisan Patients' Bill 
of Rights. Yet Senator Nickles said he was shocked that they would do 
it, and he suggested that the AMA's support of the Patients' Bill of 
Rights would jeopardize their relationship with the Republican Party.
  I have to point out that it is not just the AMA, it is not just the 
AMA representing doctors, it is almost every health care professional 
organization that has now come out in support of the Patients' Bill of 
Rights. We have over 100 patients, medical health care and consumer 
groups that have announced their support for the bill, and I think the 
problem with the GOP leadership, the Republican leadership, is that 
rather than hear the voices of the vast majority of their constituents 
and the overwhelming voices of the medical and the health care 
professionals and the consumer groups that say they support the 
Patients' Bill of Rights, instead the Republican leadership just looks 
to the special interests, the HMOs and insurance companies, and only 
hears their voices to decide what they as Republican leadership should 
do.
  Basically what we have, now that we have come back into session, and 
we will be in session for most of the fall, is essentially a scene or a 
showdown, if you will, between the supporters of the Patients' Bill of 
Rights, bipartisan, and the Republican leadership. With very few 
legislative days left in the 106th Congress, those who support patient 
protection believe it is increasingly important that everyone come 
together and send a strong message to the GOP leadership about getting 
the Patients' Bill of Rights to the floor for a vote.
  I would bet any money that if the Republican leadership brought the 
new bipartisan Patients' Bill of Rights to the floor of this House, it 
would pass overwhelmingly, so that is why they are not doing it, 
because they are afraid that would in fact happen.
  But there is widespread agreement in Congress for ensuring with this 
bill that medical decisions are being made by doctors based on medical 
need and not by company bureaucrats whose primary concern is profit 
margin. I believe that if we continue to agitate on a bipartisan basis 
now to bring this bill to the floor, we will eventually have success.
  Now I wanted to point out, if I could this evening, what the 
Republican leadership did during the break in concert with the HMOs or 
the insurance companies, with these special interests, to try to kill 
the Patients' Bill of Rights and those who might be interested in 
supporting it, again, both Democrats and Republicans.
  I am just reading, if I could, or making mention of an article that 
was in Congress Daily, which is a publication that circulates on 
Capitol Hill. This was an article that was in the Congress Daily during 
the break, Thursday, August 19.
  It says: ``Insurers business target Norwood Dingell supporters.'' 
They are again making reference to the bipartisan bill. ``Health 
insurers, health plan and business groups today unveiled the 
advertising campaign they will target at States and House districts 
where members have cosponsored or are leaning towards supporting 
managed care reform. Health Insurance Association of America President 
Charles Chip Kahn said cosponsors of the bipartisan managed care bill 
authored by Representative Charles Norwood, Republican of Georgia, and 
Commerce ranking member John Dingell, Democrat of Michigan, will rue 
the day,'' this is a quote, ``will rue the day they decide to endorse 
it. During the next two weeks, the HIAA will spend $250,000 airing 60-
second radio ads that will run in Buffalo, Elmira and New York City, 
New York, Miami and West Palm Beach, Florida, Chattanooga and 
Knoxville, Tennessee, Philadelphia and Casper, Wyoming, where GOP 
Representative Barbara Cubin is a cosponsor of the Norwood-Dingell 
plan. Including HIAA's advertising campaign over the next two weeks, 
Kahn said, health plans and business groups opposing managed care bills 
will spend more than $1 million working towards a cacophony of 
criticism of the bills. The health benefits coalition, a group of 
employer-based organizations opposing the managed care bills, is 
ramping up its spending for the last two weeks of the break, said an 
official with one of the groups. The coalition will launch television 
and heavy radio ads and heavy grassroots pressure against about 35 
Republicans who either have signed or might sign on to the Norwood-
Dingell plan. The ads are pretty tough and they are intended to provoke 
a backlash, the official said. We are going after members who are soft 
but gettable.''
  Basically what they are doing is spending their time during the 
break, spending money, trying to persuade, particularly Republicans in 
this case, not to cosponsor the now bipartisan Patients' Bill of 
Rights.
  It is not just this group, the HMOs. ``The American Association of 
Health Plans will launch a TV ad campaign aimed at 60 House Members, 
said spokesman John Murray. The ads will target Norwood-Dingell 
cosponsors as well as House Members still on the fence. Murray said, we 
are going to spend whatever it takes.''
  How do you like that? This is the problem that we face, the money 
that the special interests want to spend, and they are working with the 
Republican leadership, even against Republican Members who feel that 
they want to cosponsor the Patients' Bill of Rights and are supporters 
of what is good for the average American. ``The business roundtable 
also will launch radio ads during the remainder of the August recess,'' 
their spokesman said.
  Well, just to give you an example, it is not just during the recess. 
It continues this week in Congress Daily, which, again, is a 
publication that every Member of the House gets on a regular basis. 
Every day this week there has been a full page ad which was just sort 
of a white sheet, and in the middle of it there is this warning, like 
the kind of warning you would get on a cigarette package, that says, 
``Warning: The Dingell-Norwood Patients' Bill of Rights could be 
hazardous to your health care.''
  It does not really explain why. There is some fine print at the end 
that tries to explain why, which does not really make any sense. But 
this advertising campaign continues, and I have no doubt that it will 
continue throughout the fall and way beyond to try to target and 
dissuade not only Democrats, but, even more importantly, now 
Republicans, who want to sign on to the bipartisan Patients' Bill of 
Rights.
  I mentioned before though and I will mention again that supporters, 
both Democrats and Republicans, of the Patients' Bill of Rights can 
take solace in the fact that the average citizen, as well as all the 
health care professional organizations, pretty much now are solidly 
behind our HMO reform.
  Another thing that came out within the last month that I thought was 
particularly interesting was a survey that showed just how much managed 
care frustrates physicians and how physicians and health care 
professionals in

[[Page 21134]]

general feel that they cannot really properly take care of their 
patients because of the abuses of managed care.
  This was also in Congress Daily, and it says, talking about this new 
survey, that nearly 90 percent of physicians say health plans have 
denied their patients recommended care during the last two years, and 
in some cases those denials occur as often as every week.
  The survey was released by the Kaiser Family Foundation and the 
Harvard School of Public Health. Kaiser Foundation President Drew 
Altman expressed surprise about the pervasiveness of problems reported 
between providers and insurers. ``Some tension is to be expected,'' 
Altman said, ``but the degree of conflict reflected in this survey 
suggests we are in a new world, and it is hard to argue it is good for 
the health care system.''
  According to the survey, the most common denials were for 
prescription drugs. Sixty-one percent of physicians said they had a 
patient experience a denial weekly or monthly with regard to 
prescription drugs. Denial of diagnostic tests, 42 percent of patients 
have been denied a test weekly or monthly. Forty-two percent of the 
patients said that they had had some kind of denial, weekly or monthly; 
hospitals stays, 31 percent weekly or monthly; referrals to 
specialists, 29 percent weekly or monthly. This is the physicians 
relating what happened to their patients.
  Depending on the problem, between one-third and two-thirds of 
physicians said a denial resulted in a somewhat or very serious decline 
in patients' health. So, again, we are talking about what is happening 
in the real world. We are talking about the abuses and the problems 
that people have on a regular basis.
  The physicians, according to that survey, see these problems, see 
what is happening to their patients, and feel it is having a really 
negative impact on the quality and delivery of health care that people 
receive in this country.

                              {time}  2115

  Now, before I conclude tonight, I wanted to spend some time talking 
briefly about our new bipartisan approach, our new Patients' Bill of 
Rights, which, as I said, is supported by almost every Democrat and at 
least about 20 Republicans at this point, but continues to be opposed 
by the Republican leadership. That is why we have not been able to get 
it to the floor.
  If I could just explain some of the commonsense proposals that are 
part of this new bipartisan Patients' Bill of Rights, I have a summary 
that basically divides it into access to care, information about care, 
protecting the relationship between the physician and ourselves as 
patients, and the basic accountability.
  I will start with the issue of access to care, because I think for 
most people that is the biggest problem, the denial of different kinds 
of treatments or hospital stays or equipment that they experience.
  Most important, we try to address the problem with emergency 
services. Individuals should be assured that if they have an emergency, 
those services will be covered by the plan, that they do not have to 
call before they can go to an emergency room if they feel that they do 
not have the time to do that because their health is at risk; that they 
do not have to go to a particular emergency room rather than the one 
that is closest to them because they feel that they do not have time to 
go to the one that is further away.
  The bipartisan bill says that individuals must have access to 
emergency care without prior authorization in any situation that a 
prudent layperson would regard as an emergency. So if you as the 
average person think that when you have chest pains that you should be 
able to go to the local emergency room, the HMO cannot say you have to 
go further away or you need prior authorization.
  Let me talk about specialty care. Patients with special conditions 
must have access to providers who have the requisite expertise to treat 
their problem. Today in this day and age people increasingly have to go 
to specialists for particular problems. Increasingly what we find is 
that patients in HMOs have a problem getting referral to a specialist, 
or there is not a specialist within the HMO network who can take care 
of their problem.
  This bipartisan bill, our bipartisan bill, allows for referrals for 
patients to go out of the plan's network, doctors who are not in the 
network, for specialty care at no extra cost if there is no appropriate 
provider available in the network for covered services.
  Chronic care referrals. For individuals who are seriously ill or 
require continued care by specialists, plans under our bipartisan 
Patients' Bill of Rights, plans must have a process for selecting a 
specialist as a gatekeeper for their condition to access necessary 
specialty care without impediments.
  In other words, if you have a chronic condition, this specialist you 
can go to on a regular basis, he becomes almost your primary care 
provider so you do not have to constantly go back to the primary care 
provider to continue to be able to see the specialist.
  Our bipartisan bill provides direct access to OB-GYN care and 
services. With regard to children, the bill ensures that the special 
needs of children are met, including access to pediatric specialists 
and the ability for children to have a pediatrician as their primary 
care provider.
  Again, continuity of care. I have found a lot of people during the 
break and who continue to complain to me about how if their doctor is 
dropped by the network, that all of a sudden they are not with the 
physician that they have used for a long time. Under our bipartisan 
bill, patients are protected against disruptions in care because we set 
up guidelines for the continuation of treatment in circumstances where 
the doctor is no longer part of the network, for example.
  There are special protections for pregnancy, terminal illness, and 
individuals on a waiting list for surgery.
  Let me also talk about the drug formularies. One of the biggest 
issues with regard to HMOs is that HMOs oftentimes provide for 
prescription drugs, which is an important part of why people sign up 
for an HMO, in many cases. What we are saying with our bill, with our 
bipartisan bill, is that prescription medication should not be one-
size-fits-all. If a plan uses a drug formulary, beneficiaries must be 
able to access medications that are not on the formulary when the 
prescribing physician says that that is necessary.
  Again, what we are doing is leaving this decision up to the physician 
because he or she is in the best position to know what is best for the 
patient.
  Choice of plans. People want to, in certain circumstances, to be able 
to go outside the network and choose a physician who is not part of the 
HMO network. Choice is a major component of the bipartisan bill. It 
says that individuals can elect a point of service option when their 
health insurance plan does not offer access to non-network providers.
  What that means is that in the beginning if you are working and your 
employer provides health care, the employer has to allow you to elect a 
point of service option, where you can go outside the doctors in the 
network. But you have to make that decision initially when you sign up 
for your health care plan, for your HMO, and you also have to pay the 
extra cost of going outside the network.
  So again, we are not destroying the basic idea of managed care, which 
is that it is a closed panel network of physicians and health care 
providers, but we are saying this for people who want to in the 
beginning, they can choose the point of service option.
  Those are the access issues that are primarily addressed by our 
bipartisan Patients' Bill of Rights, but I would like to now talk about 
the information issue, briefly, because many people are concerned that 
they do not really know what they are getting into when they sign up 
for an HMO.
  What we say is that we require managed care plans to provide 
important information, and that is information that allows them to 
understand their health plan's policies, procedures, benefits, and 
other requirements.
  I would like now to go into the issue of grievances and appeals, 
because one or really the hallmark, if you will, of

[[Page 21135]]

the Patients' Bill of Rights and the whole effort towards Medicare 
reform is to make sure that the decision about what type of care you 
are going to get, the decision about what is medically necessary for 
you as a patient, is based not on what the health insurance company 
wants and what the health insurance plans want to cover, but rather is 
based on what your physician, the health care professional, thinks that 
you should be provided with.
  So what we are basically saying, and the thread that sort of runs 
through the whole Patients' Bill of Rights, is that the issue of 
medical necessity should be decided by the physician and the patient, 
not by the insurance company, and that if there has been a denial of 
care, then that decision to appeal that denial of care and overturn it, 
if necessary, should be made by an independent group not appointed and 
not under the control of the HMO, and that ultimately you should be 
able to go to court if you are not satisfied, as well.
  What we have in our new bipartisan bill is it basically lays out 
criteria for a good utilization review program, physician participation 
in the development of raw criteria, administration by appropriately 
qualified professionals, and timely decisions within 14 days for 
ordinary care up to 28 days if the plan requests additional 
information, and the ability to appeal these decisions.
  So we want the health care professionals to be involved in making the 
decision of what kind of care you get and that there is a timely appeal 
if you have been denied that care by the insurance company.
  There are really two processes in terms of the grievances and 
appeals. One is internal and one is external. Patients should be able 
to appeal plan decisions to deny, delay, or otherwise overrule doctor-
prescribed care and have those concerns addressed in a timely manner. 
So we require an appeals system that is expedient, particularly in 
situations that threaten the life or health of the patient.
  Other than the internal appeal, though, there also should be the 
opportunity for external review if the health care plan ultimately says 
no, we are not going to allow you this care. What we say is that the 
health care plan has to pay the cost of the external review, and that 
the decision by the external reviewer is binding on the health care 
plan.
  If a plan refuses to comply with the external reviewer's 
determination, the patient may go to Federal court to enforce the 
decision. I will get a little more into that a little later, about if 
you are denied through the regular administrative process, that you can 
go to court.
  Let me just talk a little bit, though, before I get to that ultimate 
issue of accountability, talk a little bit about how we try to protect 
the physician-patient relationship.
  One of the things that is most shocking to my constituents is when 
they come in and tell me that their physician is not allowed to tell 
them about a particular type of medical care or treatment that the 
physician thinks that they should be receiving.
  We call it basically the gag rule; in other words, the HMO tells the 
physician that he or she cannot tell the patient about a procedure that 
they will not cover. So if the plan will not cover a particular 
procedure, equipment, operation, then the physician is basically 
forbidden from talking about it to the patient.
  That is ridiculous. Consumers should have the right to know about 
their treatment options. What we say in our bill is that we prohibit 
plans from gagging doctors and from retaliating against physicians who 
advocate on behalf of their patients. It basically protects the 
physicians in these situations from retribution. It also prevents plans 
from providing inappropriate incentives to physicians to limit 
medically necessary services so that physicians do not have a financial 
incentive, which they often do now with HMOs, to not recommend certain 
services.
  With regard to physician selection, which physicians are in a plan, 
the insurers cannot discriminate on the basis of a license in selection 
of a physician. In other words, they cannot discriminate based on 
license, location, or patient base.
  The HMOs can basically decide which doctors are going to be in the 
network, but if the doctor meets objective standards with regard to 
licensure, then they cannot say that his particular license is not 
acceptable. They also cannot discriminate because of the location of 
the physician or the patient base of the physician.
  With regard to payment of claims under our bill, health plans should 
operate efficiently and pay providers in a timely manner. The bill 
would require that claims be paid in accordance with Medicare 
guidelines for prompt payment, because what we have found is a lot of 
the HMOs do not pay the physicians. They delay payment in order to save 
money, or to save the interest rate.
  We also have a provision for paperwork simplification in order to 
minimize the confusion and complicated paperwork that providers 
physicians face. This bill would require that the HMO industry develop 
a standard form for physicians to use in submitting a claim.
  The last thing I wanted to mention this evening is this whole issue 
of accountability. The main thing that the bipartisan Patients' Bill of 
Rights does is to provide accountability if you have been denied care. 
I talked about the internal and external review, that it has to be done 
by a group that is not beholden to the HMO.
  But I think that beyond that, there has to be the ability to go to 
court and sue for damages if all else has failed. I think many people 
realize, although a lot of my constituents still do not realize it, 
that under existing Federal law called ERISA, the Employee Retirement 
Income Security Act, State laws are basically preempted. So, therefore, 
if you are in an ERISA plan, which is basically a plan where your 
employer is self-insured, any kind of self-insured plan, which millions 
and millions of Americans particularly in large companies fall under 
these types of self-insured plans, because that is what larger 
employers tend to do, they fall under ERISA and Federal preemption, 
which means that the HMO cannot be sued.
  That makes no sense. The HMOs, as we discussed this evening, are 
basically making medical decisions. If they make a decision about what 
kind of care you can receive or how long you can stay in a hospital, 
for example, and they make the wrong decision, then they should be held 
accountable. You should be able to sue them.
  Our bipartisan bill would remove the ERISA preemption and allow 
patients to hold health plans accountable according to State laws, so 
if the State law allows it you would be able to sue and you are not 
preempted by the Federal law.
  The one thing that we did do, and this was I think important and 
makes sense, is that the new bipartisan bill says that if a plan, if a 
health insurance, if an HMO complies with an external reviewer's 
decision, they cannot be held liable for punitive damages. So if when 
you go to an administrative review the decision is to deny you care and 
then you appeal and you go to court, the court decides that the 
independent review was wrong, you cannot receive punitive damages, 
because in that case the HMO did in fact act in good faith and go to 
the external review process.

                              {time}  2130

  The other thing I wanted to mention because I know that part of the 
criticism, if you will, that the insurance companies are making in 
their advertisement about the Patients' Bill of Rights, they say that 
employers can be sued, and that because employers can be sued, then a 
lot of employers will simply not cover their employees; and the number 
of people who have health insurance will decline because of the 
Patients' Bill of Rights.
  Well, I want to explain and emphatically state that the Patients' 
Bill of Rights, the bipartisan Patients' Bill of Rights, which I have 
been discussing tonight, does not in any way create liability for the 
employer.
  In the bill, we have a provision that protects employers from 
liability when

[[Page 21136]]

they were not involved in the treatment decision. It explicitly states 
that discretionary authority does not include a decision about what 
benefits to include in the plan, a decision not to address a case while 
an external appeal is pending, or a decision to provide an extra 
contractual benefit.
  What that essentially translates to mean is that there is nothing in 
our bill that would in any way extend the liability of the employer and 
allow them to be sued because of the denial of care other than whatever 
the existing law is right now.
  I wanted to mention one more thing before I close, and that is what 
we constantly get from the Republican leadership in opposing the 
Patients' Bill of Rights, the bipartisan Patients' Bill of Rights, and 
what we constantly get from the insurance companies and the HMOs in 
their attacks and their ads and their multimillion dollar campaign 
against the Patients' Bill of Rights, I think could be basically summed 
up in what the Health Insurance Association of America put in sort of 
the fine print in this ad that was in Congress Daily that I mentioned 
before.
  It says that ``the Patients' Bill of Rights currently being 
considered will cause us a lot of unpleasant side effects, more red 
tape and more regulations that the patients can expect, and patients 
will end up paying the bill. Health care costs would increase.''
  They basically stress the fact that what we will see with this 
Patients' Bill of Rights is a huge increase of costs and that that will 
make it more difficult for both individual as well as employers to 
provide health insurance. Nothing can be further from the truth.
  The reality is probably best summed up by making reference to the 
State of Texas. About 2 years ago, the State of Texas passed a law that 
has been in effect, I should say, for about 2 years, which is very 
similar to the bipartisan Patients' Bill of Rights that I have been 
advocating tonight.
  As a result of that Texas law which allowed people to bring suit, the 
number of lawsuits that have actually been brought within the last 
month, over that 2-year period, only two lawsuits have been brought 
because of the change in the Texas law that provides patient 
protections.
  In addition to that, it was estimated that the premiums have gone up 
about 30 cents a month during the 2-year period that the Texas patient 
protections have been in effect. That 30-cent increase could have 
occurred because of inflation or whatever, but the bottom line is it is 
insignificant. Any consumer, any constituent of mine would gladly pay 
an extra 30 cents a month to have the kind of protections that are in 
place here.
  I think that in their advertising campaign the HMOs said that health 
care costs could increase as much as $200 per family, forcing small 
employers to drop their health insurance all together. The Texas 
experience shows very emphatically that that is simply not true. There 
really is not any significant added cost, because what the Patients' 
Bill of Rights does is to provide for prevention.
  Now that the HMOs cannot allow the kind of abuses now that they are 
threatened with the right to sue and the external review, they take the 
proper precautions; and lawsuits don't occur, and costs really do not 
go up significantly.
  So I am going to end this evening, Mr. Speaker, but I wanted to point 
out that the new session has begun. The fall session has begun. Those 
of us who advocate the Patients' Bill of Rights are going to be out 
there on a daily basis saying that we want the Republican leadership to 
bring this bill to the floor.
  We have a majority of Members of the House that now support us. Most 
of the Democrats. At least 20 Republicans. I think the number of 
Republicans are going to continue to rise, because they realize, 
Members of this House realize in a bipartisan basis that this kind of 
reform is needed.
  I am just calling again on the Republican leadership and will 
continue to call on them to allow this bill to come to the floor. If it 
does, we will pass it overwhelmingly, and we will finally see 
protections within the context of HMOs that Americans are crying out 
for.

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