[Congressional Record (Bound Edition), Volume 145 (1999), Part 16]
[House]
[Pages 23067-23073]
[From the U.S. Government Publishing Office, www.gpo.gov]



                          MANAGED CARE REFORM

  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. Madam Speaker, tonight I would like to talk about the 
Patients' Bill of Rights, the managed care reform legislation which 
will be considered on the floor of the House of Representatives next 
week.
  My happiness, if you will, over the fact that the Republican 
leadership in the House of Representatives has said that they will 
allow a debate on HMO reform next week that will include the Patients' 
Bill of Rights is somewhat tempered by my concern that the way they may 
set up the procedure for the debate and the consideration of managed 
care reform, or HMO reform, may in fact be nothing more than a way to 
try to kill effective HMO reform and essentially end up with a bill 
that passes the House and that goes to the Senate that does not 
accomplish the goal of providing real patient protections.
  I just wanted to mention very briefly, if I could, why we need the 
Patients' Bill of Rights and why my concern about what the Republican 
leadership may try to do is legitimate.
  My colleagues know that I have been on the floor and in the well here 
many times over the last several years talking about the need for the 
Patients' Bill of Rights, and the reason for that is there are so many 
abuses with patients, with constituents that I have, with Americans, 
who have their health care delivered with HMOs or with managed care, 
and those abuses have come to light with our constituents calling us 
up, coming to our office, testifying at various hearings that we have 
had, particularly those with our Democratic health care task force.

                              {time}  1830

  I would say, if I could, to summarize the problems in our attempt to 
address the problems, basically fall into two broad categories. One is 
the issue of medical necessity. Too many times HMOs simply do not allow 
the particular patient to have the operation that their doctor thinks 
they need or to stay in the hospital for the length of time that their 
doctor thinks they should stay or to sometimes even to be able to have 
the information provided by their doctor about what kind of care that 
they need, and the reason that is true is because the HMOs increasingly 
make those decisions. Rather than decisions about what kind of 
operation you have or how long you stay in the hospital being made by 
your physician, which was the traditional way and the logical and 
sensible way for health care to proceed, HMOs increasingly have those 
decisions made by the insurance company in an effort to try to save 
costs.
  We need to correct that. The decision about what is medically 
necessary, what kind of care you need, should be made by the physician 
and the patient, by the health care professional and the patient, not 
by the insurance company, and that is what we seek to do with the 
Patients' Bill of Rights is to turn that around and give that decision 
about what is necessary for your health back to the physician and to 
you.
  The second thing we do and the second most important area where there 
is abuse is that if a decision is made that you cannot have an 
operation, for example, that your physician and you think that you 
need, you should be able to appeal that, and right now that is almost 
impossible because most HMOs define on their own what is medically 
necessary, what kind of operation you are going to have. And then if 
you seek to appeal, the only appeal is to an internal review board 
which they control. And what we say in the Patients' Bill of Rights is 
that there should be an independent review, an external review, by 
people that you can appeal to who are outside the control of the HMO, 
independently will decide whether or not the HMO's decision was wrong 
and can be overturned.
  And failing that, if that fails, that you should be able to sue and 
enforce your rights in a court of law which is not the case now because 
many people, most Americans actually, fall under a Federal preemption 
called ERISA that says that if their employer is essentially self-
insured, which most employers are these days, that then you cannot sue 
the HMO for damages or to overturn a bad decision about what kind of 
care you should receive.
  The Patients' Bill of Rights has a lot more aspects to it. And some 
of my colleagues who are here tonight and joining me, I am glad to 
hear, will go into the details about that. But the bottom line is that 
if we were allowed the opportunity, which hopefully we will next week, 
to bring up the Patients' Bill of Rights, which is now a bipartisan 
bill. Most every Democrat supports it, and we have a number of 
Republicans, about 20 or 30, that also support it, but the Republican 
leadership still very much is opposed to it.
  Madam Speaker, I just want to say one more thing preliminarily here 
tonight before I yield to my colleague

[[Page 23068]]

from Texas and that is that what I am fearful is going to happen, and 
we have already heard today the Speaker had a press conference and he 
indicated that he was going to bring up another piece of legislation, 
which I think is nothing more than an effort to muck up the Patients' 
Bill of Rights and create a situation where the bill that finally 
passes next week is something that cannot pass the Senate, cannot get 
the President's signature.
  And basically what he has proposed is what he calls an access bill 
that would provide more access to insurance for people who are 
uninsured. And let me just say very broadly I have looked at that so-
called access bill; it is not an access bill. It is a bill that 
basically will make it more difficult for most Americans to get 
insurance and make the cost of insurance even higher, and the reason 
why it does that is very simple. It puts in the so-called poison pills, 
medical savings accounts, the MEWAs, the health marts; these are 
nothing more than vehicles that essentially allow wealthy and healthy 
seniors to opt out of the regular insurance pool, if my colleagues 
will, and make the costs for those people who are left and who are not 
healthy or wealthy, who are poor or middle class or who cannot be so 
sure that their health is going to be that great over the next few 
years, it makes the costs for those people of going out and buying 
insurance even greater.
  So let us not let anyone, as my colleagues know, kid ourselves about 
what the Republican leadership is trying to do here next week. They are 
going to allow the Patients' Bill of Rights to come to the floor as an 
option, but they are going to make every effort to try to screw around 
with that bill, add things that will make it so that that bill either 
does not pass here in the House, cannot pass in the Senate or cannot 
become law, and we have to put a stop to that and demand a clean 
Patients' Bill of Rights that will provide adequate patient 
protections.
  Madam Speaker, I yield now to the gentlewoman from Texas and say 
that, as my colleagues know, your State, as my colleague knows, and I 
am sure you and others will comment tonight, has already put in place a 
Patients' Bill of Rights which is very effective but unfortunately does 
not cover everyone because of the Federal preemption. And I note you 
have been here many times in your background as a nurse, you know very 
much what we are talking about in commonsense terms, not only as a 
Congresswoman, but also on a daily basis, and I yield to the 
gentlewoman.
  Ms. EDDIE BERNICE JOHNSON of Texas. Madam Speaker, I have not yet 
understood why there is such concern from the HMOs that people not have 
the right to complain when they feel that they have been harmed by the 
rules of an HMO. They must not have any confidence in the quality of 
care which they are making sure that are offered to patients.
  In today's Washington Post there is a story on the Texas bill, and we 
are still waiting for the sky to fall, and it has not fallen, but the 
insurance people continue to say: But it will fall. Out of 4 million 
members of an HMO in Texas, I think they have had 4, maybe 5 lawsuits, 
and one was very recent, and it all has to do with the care. Now when 
HMOs offer quality care, there should not be any fear.
  This bill in Texas was not carried by a partisan Democrat. It was a 
conservative Republican member that I served with in the Texas Senate 
who carried this bill, and, as far as I can tell, they are very pleased 
with having access because it does challenge HMOs to give more 
attention to the quality of care.
  I still have a hard time understanding what the fear is. All the 
horror stories that were envisioned by the health insurance industry 
just has not happened, and while it is too early to see the full effect 
on my State, it is evident that the implementation of this legislation 
has had a dramatic effect on resolving complaints between the patients 
and their health plans before they go to the courthouse, which is where 
it should be.
  But I have a real problem with us saying in a democracy that people, 
patients, do not have a right to challenge any institution that is in 
charge of their health care. It is ironic that the HMOs will tell 
physicians exactly what they can do and what they cannot do, and 
physicians are held accountable, but they refuse to hold themselves 
accountable when many of them really are not physicians but simply some 
bureaucrats that are interested in their bottom line.
  The legislation enacted in Texas acted as a prime motivator for HMOs 
to settle their disputes with their patients, and regrettably, the vast 
majority of Americans do not have this option which I think is 
unconscionable in a country that practices the greatest democracy in 
the world.
  I have a feeling that what we are facing even next week might not be 
the kind of approach to the whole problem that we have worked so hard 
for.
  We do have bipartisan support for a very good Patients' Bill of 
Rights. I would like very much to see that bill to come to the floor 
and let us debate it and let us vote and let the votes fall where they 
may, as we do in many other situations.
  I am a little suspect though. I do not believe that it will happen 
quite as easily.
  But I do strongly believe that the Texas experience has offered a 
real example of what will happen or what can happen. I believe that if 
the sky was going to fall, it has had time to fall. I believe that if 
patients were just looking for someplace to file a suit, they can 
certainly find it without subjecting themselves to poor health care. I 
just do not believe that we are going to find the kind of uprising that 
we hear in a scare tactic.
  Anything that we do short of making sure patients have an adequate 
and fair chance of good health care is not fair to the American people. 
At best, this bill that they are talking about bringing to the floor 
simply nibbles around the corners of the health care debate. It 
provides for health care savings plans and a 100 percent deductibility 
for individual insurance premiums for the self-insured and uninsured. 
But as my colleagues know, we have so many people that do not have 
access to insurance, and that will not mean anything to them.
  And as my colleagues know, the insurance that we are talking about 
here will not touch most of the low-income people because they simply 
cannot afford to have that type of money set aside for a savings 
account for their health care insurance.
  I think that option is one that perhaps ought to be there for those 
who can afford it, but what we are looking for is insurance that all 
Americans would have access to and can expect in return a decent 
practice of medicine by their own standards of medical practice that 
physicians are educated and trained to render and do not really need an 
insurance plan to tie their hands when they are the ones who have 
gotten this education.

                              {time}  1845

  One size really does not fit all. People really are different. When 
you are 7 years old and you have the same diagnosis, it can act up on 
the body quite differently than if you are 70 with the same kind of 
diagnosis.
  Just to be discussing this in America at this time is something that 
puzzles me. I just simply cannot understand why we are going through 
this kind of debate of denial of people of their right to decent 
healthcare.
  It is clear that managed care has brought about some lowering of 
costs, so I do not think we should throw the whole plan out, but I do 
feel strongly that patients have a set of basic rights they should be 
able to depend upon. They should have access to some specialist to see 
what that condition really is, second opinions, emergency room care, 
and, certainly, of all things, a physician who is taking orders from 
this plan should not be subjected any more to the risk of a lawsuit 
than the plan that is dictating what he does, because very frequently 
if a physician is placed in that position, he often has to do things 
that are against really his better judgment. That is really not fair to 
the physicians.
  If these plans feel so comfortable and so confident with what they 
are offering, there should not be any fear of

[[Page 23069]]

lawsuits. People are not seeking lawsuits when they go to the doctor or 
go to a hospital. They are seeking care. I will tell you from personal 
experience, if everyone who went to a hospital would file a suit, it 
would be a very different pattern than what we are seeing in this 
country and a very different picture. Even hospital administrators and 
persons who work at hospitals will tell you that people do not really 
come looking for a way to file a lawsuit. They can find that more often 
than what they give attention to.
  But the culture of denial that is going around in some of these plans 
is so very disappointing, to the point where it brings about a great 
deal more suspicion and a great deal more anger among people that know 
the difference in having access to some reasonable, decent healthcare, 
versus having a touch and a wipe across the top, so-to-speak, of a 
wound. It makes all the difference in the world of how a patient will 
get along, how long their convalescence will be, how long their illness 
might be.
  All of us know that most of the time if a patient can get access to 
care quickly, with adequate and proper medication, that the illness can 
be shorter, and especially if they have confidence in the plan. But if 
they have got to go through a great deal of hassle, a great of 
emotional upheaval, and still not know for sure whether they are 
getting the best care, that within itself interferes with the healing 
process.
  It seems to me that we have allowed ourselves to get so divided on 
this issue that the insurance companies have lost sight of what we are 
trying to do. They have lost sight of the fact that we are talking 
about human beings. They are only really seemingly interested in 
protecting their pockets and trying to be sure that people do not have 
the right to complain and get redress when they feel they have been 
harmed.
  That is so very unfortunate. But, under the circumstances, we all 
must stand up as tall as we can and stand with the American people to 
be sure that, to the best of our ability, they have access to the care 
that they paid for, and that they get the quality care that we 
certainly can offer in this country.
  I thank the gentleman for continuing to bring this issue to the 
forefront. It is one that will not go away. Every person in this 
country is interested in having access to quality care, and it is 
possible, without the world falling. I think my state of Texas has 
proven that.
  Mr. PALLONE. I want to thank the gentlewoman. I am glad that you and 
our next colleague to address us are from Texas because of that article 
in the Washington Post today. You talked about the Texas experience and 
how that has shown over the last 2 years that there is not really any 
significant litigation, that there is not any significant cost increase 
in having patient protections, but that article today in the Washington 
Post really pointed out how true that is.
  The best thing, I just have to mention this particular paragraph from 
the article, because, as the gentleman from Texas (Mr. Green) knows 
also, we have been talking about how the threat of the lawsuit and the 
reason why we believe that there are so few lawsuits in Texas is 
because of the fact that there is the threat of being able to sue, so 
the HMOs take a lot of preventative actions and do the prevention type 
things so they do not get sued.
  There was a perfect quote in there where there were health plan 
administrators and physicians across Texas saying they have an 
intuitive sense that the threat of lawsuits has made HMOs more 
accountable. It says, ``Joe Cunningham, an internist in Waco, had asked 
an HMO a year ago to allow a patient to undergo an overnight study to 
find out if he had some kind of disorder. At first the HMO official 
balked, but when Cunningham said he worked in Texas, he was told, oh, 
well, you can do the test.''
  That is a perfect example, that they know that they allow the test to 
take place, so they do not have a problem and they do not have any 
lawsuits. That is what I think is happening in your state.
  Ms. EDDIE BERNICE JOHNSON of Texas. And the cost is not soaring.
  Mr. PALLONE. I think we have figures that say the cost over the last 
2 years since this was in place in Texas was about 30 cents more per 
month, which a lot of states have more than that. That is one of the 
lowest cost increases of any state. So I want to thank you again.
  I yield to the gentleman from Texas (Mr. Green).
  Mr. GREEN of Texas. I thank the gentleman. It is a pleasure to be 
here and follow my colleague from Dallas. I know people who watch C-
SPAN or Members on the floor may know, Congressman Johnson and I were 
elected to the Texas legislature together when we were, I think we were 
only 25 years old at that time, in 1972, and served together, both as 
state representatives and state senators and now in Congress. It is my 
honor to follow Congressman Eddie Bernice Johnson from Dallas. In 
Houston typically we do not like anything in Dallas, but we appreciate 
the colleagues that we have. So Eddie Bernice, it is good to follow you 
on the floor.
  Let me just start off, because last week we had an event here which 
was a bipartisan press conference over at the Cannon Office Building, 
and there were lots of Members. If fact, there were Republicans and 
Democrats talking about the need for a Patients' Bill of Rights. Of 
course, it was hosted by Congressman Norwood and Congressman Dingell, 
our ranking member on our Commerce Committee, and I had the distinction 
to follow a Republican Member from New Jersey. All of us were giving 
our 30 second or one minute speech, and she said, ``Even Texas provided 
this.''
  Well, let me follow up on that a little bit. I got to follow her and 
say, ``You know, in Texas we like to think we are leaders.'' I have to 
admit there are some things I do not want to be the leader on that we 
are the leader on, but in managed care reform we are, and I am proud 
that in today's newspaper, as we saw here, it was in the Houston 
Chronicle, said that the Governor of California just signed some 
managed care reform legislation, a number of bills, that would do lots 
of things, including the accountability that is so important in our 
legislation, and also for some of the issues you have talked about. So 
California passed the legislation.
  In Texas we passed it in 1997. A Republican state Senate and 
Republican state representatives passed this legislation. It meets the 
criteria, and all we have talked about is trying to do is use the 
examples of the states that have had success with these reforms, and, 
if it did not work, we did not want to adopt it.
  It worked in Texas, because we have had that law now for over 2 
years, and I think we reported there are four lawsuits that are filed, 
and I do not know if one of them is the one that the insurance industry 
challenged the law on, so that may be one of them.
  But the most important part is that there are so many things, and I 
will get to it in a few minutes, about what we need in a Patients' Bill 
of Rights, not only accountability. If someone is standing in place of 
that physician, then they should also be accountable, just like that 
physician is. That is part of both the Texas and California law.
  But the reason we have not had those lawsuits is we have a really 
strong outside appeals process, where it is swift and a person can go 
without having to go to court, to hire a lawyer and go through all the 
problems and delays. They can go there, because they want healthcare. 
They can have an outside appeal by an independent body. They will say 
yes, that particular treatment is needed. In Texas, in the two years 
over the number of appeals that have been filed, the insurance carriers 
have lost 50 percent of them. They have lost half of them.
  You know what that makes me realize, is that if we had not had an 
appeals process under Texas law, then half of those people would not be 
receiving the healthcare that they paid for and that they need, and I 
use this as an example. If I was a baseball batter, you know, and if I 
batted .500, that would

[[Page 23070]]

be great, if I batted 50 percent, but I would hope we would have a 
better percentage than flip of a coin when we are dealing with 
healthcare decisions.
  Again, the outside appeals process, if it is strong, you will not 
have to have the court battles, because people want healthcare. They do 
not want to necessarily go to court and wait 2 years-plus to be able to 
receive some type of care, because they need the healthcare.
  What I am concerned about is what has happened last session and what 
we are going to see next week, and I am glad the Speaker has set the 
time for the House to consider the Patients' Bill of Rights. The fear I 
know they have is it increases costs and opens employers to unfair 
lawsuits, both of which are supposedly to force the employers to drop 
coverage. That has not been the experience in Texas.
  What worries me is those two scare tactics and half-truths. Sure, I 
do not want my employers to drop their healthcare coverage, because 
that is so important, to have that third-party benefit that is part of 
an employment package. Particularly I do not want to have increased 
costs.
  To follow up what, as you and my colleague from Dallas mentioned, is 
in Texas, I do not know if it was 30 cents a month, because what we 
showed over the period of the year or the year-and-a-half that we can 
look at the numbers is that there were no cost increases for health 
insurance in Texas that were not matched by other states that did not 
have these protections.
  Prescription drugs went up. Certain costs were going up already for 
HMOs, so even though the Congressional Budget Office said that it would 
cost about $2 a month for the Patients' Bill of Rights, so, you know, I 
have heard the example that the cost for a Happy Meal you could get 
these protections. Well, in Texas it does not even cost the amount of a 
Happy Meal. So even if it was $2 a month, to be able to get fairness 
and protection and accountability for our health insurance, it is worth 
it.
  Again, Texas passed it. It included the external appeals and the 
liability provisions, the accountability provisions, and, again, the 
only premium increases were attributed to higher costs of prescription 
drugs, which is another issue that our House hopefully will work on.
  Moreover, there has been no exodus by employers to drop their 
insurance coverage because of the fear of employer lawsuits. There has 
not been one in Texas in 2 years. We have a pretty aggressive trial 
bar, having been a member of it before I came to Congress, and, believe 
me, if they had the opportunity, they would sue an employer, 
particularly a deep-pocket employer. But they are not, because 
employers are not being sued under this. Employers are not making the 
medical decisions and are not the ones liable for it. It is the 
insurance carriers and the people that they hire that are making these 
decisions.
  What Texas residents do have is healthcare protections they need and 
deserve and the provisions in the Patients' Bill of Rights that should 
be extended to every American.
  Again, my colleague from Dallas talked about it. The Texas law and 
the California law and whatever state law that may pass only covers 
insurance policies licensed by that state. They do not cover 60 percent 
of my constituents who receive their healthcare under ERISA or self-
insurance programs. They come under Federal law. So that is why Texas 
and California and the other 48 states could pass it, but we still have 
to pass it on this floor of the House, to make sure that all Americans 
have the same protections, including eliminating gag clauses to where 
physicians are free to communicate with their patients, open access to 
specialists for women and children, the chronically ill, so they do not 
need to get a referral every time.
  If I have heart trouble or have cancer, then hopefully I can go back 
to my oncologist or my cardiologist without having to every day go back 
or every time go back to my gatekeeper to get permission. So that way 
you speed up that healthcare. An external and binding and timely appeal 
processes that guarantees that patients have a timely review of those 
decisions. I talked about that earlier. The coverage for emergency care 
so families cannot be required to stop at the pay phone and get 
preauthorization before they get to the emergency room, and they do not 
have to pass up an emergency room to go to the one that is on their 
list, that they can go and get stabilized and if they need to have 
continued emergency care once they get stabilized, they can be 
transferred to whoever that HMO made that contract with.
  Also hold the medical decision-maker accountable. Again, that is one 
of the most important parts of any legislation. This is not a shift of 
medical decisions to the court, nor is it to put employers at risk. It 
will ensure that the people who may recklessly in some cases deny 
coverage are accountable for their decisions.
  I tell this story, and I have done it on the floor of the House and 
done it a number of times. I happen to be fortunate, my daughter just 
started medical school over a year ago, and so two weeks into her 
medical school career I spoke to the Harris County Medical Society and 
said she is not quite ready to do brain surgery, she has only been in 
the school two weeks.
  During the question and answer period I had a physician who is now 
serving as our president of our Harris County Medical Society say, 
``You know, your daughter after 2 weeks in medical school has more 
training than people I have to call to treat you or your 
constituents.''

                              {time}  1900

  That is what is the problem. That is why we have to have 
accountability, not to the physician, but to the people who are making 
the decisions for that physician.
  Instead of recognizing the affordability and the value of the 
Patients' Bill of Rights, I am concerned that the Republican leadership 
may talk about a push to half fixes with loopholes in it.
  To be honest, after what we went through last year with the Patients' 
Bill of Rights here on this floor, I am concerned. Although, this year, 
we have a different Speaker. One does not serve in Congress if one is 
not an eternal optimist. We will see things change this year to where 
we will have a fair run with a decent bill like the Norwood-Dingell 
bill, I see the gentleman from Iowa (Mr. Ganske) here, that has, like 
the gentleman from New Jersey (Mr. Pallone) said earlier, almost every 
Democrat and a host of Republican Members, and how that is important.
  My concern, again, is that we do not have some rule. Again, earlier, 
we heard the gentleman from Texas from the Committee on Rules come in 
and talk about some of the rules that the Committee on Rules may put on 
us and limit our ability to actually pass a real strong Patients' Bill 
of Rights, or maybe add things to it that may not even be germane.
  Sure, I would like to have a tax deduction for health care insurance 
premiums, not just for sole proprietors, but for everyone. Because I 
have a district where a lot of our employers, particularly for lower 
wage workers, maybe $7 or $8 an hour, they may not pay the whole 
insurance premium for their employees. So the employee has no tax 
deduction for that.
  But we need to stop stonewalling and support the Patients' Bill of 
Rights and give us a fair run on the floor without any poison pill 
amendments that will make it so much worse.
  I know campaign finance reform, 2 weeks ago, we beat back every 
amendment that was, quote, a poison pill on campaign finance reform; 
and we passed a strong campaign finance reform to the Senate. I would 
hope we would use that as a guideline at least and pass a strong 
Patients' Bill of Rights that will provide those protections for all 
Americans, and not just those who happen to have a policy that is 
licensed by the State of Texas or licensed by the State of California.
  I thank the gentleman from New Jersey for this special order tonight. 
He must have worn out lots of pairs of shoes standing where he is at 
over the last 3 years. I appreciate him allowing us to participate in 
it.

[[Page 23071]]


  Mr. PALLONE. Mr. Speaker, I just wanted to mention if I could, before 
I move to the gentlewoman from Connecticut (Ms. DeLauro), that what we 
are getting from the insurance companies, from the HMOs, and the 
gentleman from Texas (Mr. Green) effectively refuted each of the three 
arguments, one, they are saying that the patient protections are going 
to cost too much. Clearly, the Texas experience shows that that is not 
true.
  Secondly, they are saying that there are going to be too many 
lawsuits, which, again, the Texas experience shows dramatically that 
that is not true. Four or five lawsuits in 2 years, that is incredible.
  The third thing I just wanted to elaborate on a little bit, and that 
is this latest notion, which we have been getting really in the last 
few weeks or last few months, this idea that the employers are going to 
be sued, and, therefore, they are going to drop coverage. Nothing can 
be further from the truth.
  There is specific language had the bipartisan Patients' Bill of 
Rights, which is the Norwood-Dingell bill, that would specifically say 
that employers cannot be sued.
  If I could just very briefly say that, the provision that is in the 
bipartisan bill protects employers from liability when they were not 
involved in the treatment decision. It goes beyond to even define that 
more explicitly by saying, explicitly, that discretionary authority, in 
other words, the situation where the employer would be somehow 
implicated and involved, if you will, in the decision, 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.
  Now, that sounds a little like a lot of legal jargon, but the bottom 
line is what they are saying here is that the employer cannot be 
involved because they are not involved in the treatment decision, and 
they are not even involved in a decision about what kind of benefits to 
include, whether or not to avoid an external appeal, whether to provide 
some kind of extra contractual benefit.
  So I really cannot imagine any situation where an employer is liable 
under this provision. It has been put in there specifically to address 
that concern.
  Mr. GREEN of Texas. Mr. Speaker, if the gentleman will yield just 
briefly, during the memorial week break, I spoke to a lot of large 
employers in my district. It was organized by the National Association 
of Manufacturers. During the question and answers, that question came 
up. I said if they write the language, we could put it in the bill.
  I know there have been efforts by, not only the office of the 
gentleman from New Jersey (Mr. Pallone), but also the main sponsors of 
it to ask for that language. So we do not have employers being sued for 
health care decisions unless they are the ones making those decisions.
  So far, all we hear is that they would rather oppose the bill; and I 
think that is wrong. It has worked in Texas, and it is going to work in 
California, and I know it will work throughout our country.
  Mr. PALLONE. Mr. Speaker, I yield to the gentlewoman from Connecticut 
(Ms. DeLauro) who, again, as the other two that have spoken tonight 
were here, I think it is at least 3 years now that she has been on the 
floor talking about the need for these patient protections. I am 
pleased that she is here with us tonight.
  Ms. DeLAURO. Mr. Speaker, I thank the gentleman from New Jersey (Mr. 
Pallone) for yielding to me, and I thank him for continuing to bring us 
all together. I think there is no greater champion in the House for 
patients' rights than the gentleman from New Jersey (Mr. Pallone).
  I am delighted to be here with him, with our colleagues from Texas, 
because I think the proof is in the pudding; and Texas has led the way 
in this effort. It is working. So we have the example.
  Oftentimes, we can speculate as to what will happen or what will not 
happen with a piece of legislation, and those are legitimate concerns. 
But we have something that is working, it is working for the State of 
Texas, for the people of Texas; and it has not caused the kind of 
either chaos or increase in health care costs that a number of nay 
sayers said that it would.
  I also would just reinforce another thing that my colleagues have 
said tonight, is that, in fact, the wonderful effort, the bipartisan 
effort that has been put together in the piece of legislation that we 
are talking about, that employers cannot be sued; and that this notion 
that they are liable in some way is a way in which to really derail 
what has been such a very, very well-crafted piece of legislation by 
folks who are genuinely concerned about what is going on in managed 
care today.
  It is almost a historic moment because people have been working on 
this for such a long time that, after years of fighting for health care 
reform, we are on the verge of victory, of a great victory.
  A number of our Republican colleagues, including a number of doctors, 
and the gentleman from Iowa (Mr. Ganske) is on the floor here tonight, 
Republicans have joined with Democrats to support a real Patients' Bill 
of Rights. We have a good chance of passing bipartisan HMO reform this 
year. It is very, very exciting.
  But, as we stand on this doorstep of victory, if you will, there are 
some in this body that will continue to want to shut the door on that 
kind of reform.
  As a footnote, we have been able to pass good, solid legislation in 
this House that has come from bipartisan effort of Democrats and 
Republicans throughout the history of this country. We are on the verge 
of being able to do that again if they will give us the opportunity to 
do it.
  I would just say that, today, the Republican leadership put its stamp 
of approval on a new health care bill that has been referred to 
tonight, talked about tonight; and that, in fact, is nothing more than 
an attempt to kill HMO reform this year.
  If the Republican leadership, and not the rank and file, because 
there is tremendous support from rank-and-file Democrats and 
Republicans to support the Dingell-Norwood bill, but if the Republican 
leadership wants to improve health care, please join with this effort 
to pass a Patients' Bill of Rights. It is legislation that has been 
endorsed by doctors, nurses, patient advocates, consumer groups. It is, 
in fact, the very best way to put power back into the hands of doctors 
and patients where it belongs.
  Instead, we have, at this 11th hour, a decision to produce a piece of 
legislation for next week's debate. It is called the Quality Care for 
the Uninsured Act. The stated goal of the legislation is to improve 
access to health insurance, which is a worthy goal.
  But no matter what its stated intention is, the fact is that this 
piece of legislation that has been crafted is a bill that could kill 
HMO reform for another year. The bill is not just bad because it hurts 
our chances to pass HMO reform, but it is bad on its own merit as well.
  The gentleman from New Jersey (Mr. Pallone) talked about this a 
little bit earlier. The Republican bill is dangerous because it 
includes risky Medical Savings Accounts. Study after study tells us 
that the MSAs are going to skim the healthy and the wealthy out of the 
health care system, leave everyone else in a weakened system, which 
will only drive up health care costs. This is not the way to fix our 
health care system.
  The Republican bill is a budget buster. It was recently revealed that 
the Republican Congress has already dipped into the Social Security 
Trust Fund to the tune of $16 billion. So, perhaps, the notion is, 
``well, what the heck, let us go back for some more.''
  What this bipartisan bill, the Dingell-Norwood bill, says is that let 
us fully pay for what we are talking about; that we are not going to 
take money from the Social Security Trust Fund.
  The so-called health care bill is a poison pill. It weakens the 
Patients' Bill of Rights. It invites a veto from the President. It took 
us 9 months, 9

[[Page 23072]]

months of fighting to be able to get a debate on Patients' Bill of 
Rights. We are out the door. Let us do it right. Let us do the right 
thing. Let us have a fair debate, an open debate about Patients' Bill 
of Rights. Then let us have a fair and open debate on how to improve 
access to health care for all Americans. Let us not use one issue to 
kill the other. That would be a tragedy for the American people.
  I would just say about this bill that has just seen the light of day 
today that it does not address the liability issue, the right to sue, 
the right to some accountability in the process. We know that there is 
not any accountability in the process today for HMOs, a place to turn 
if an HMO is involved in making a medical decision, and it might go 
wrong. Where do people turn?
  I was in Hamden, Connecticut this weekend where I did office hours, 
and two people came and talked to me and just begged for the 
opportunity to have an appeal process, a place to go, a place for 
accountability.
  A gentleman lost his wife. We do not know all the particulars of the 
case, but she was in the hospital. She went home. She was told she had 
to go home. There was no one to monitor the toxics in her bloodstream . 
She was put back into the hospital, and she wound up passing away. The 
man just pleaded with me. He said, ``Where do I go? Who do I turn to?''
  We are all asking for some accountability in the process; that is 
all. It is not unreasonable. This piece of legislation that has been 
proposed today does not allow for any accountability. What the 
gentleman from Michigan (Mr. Dingell) and the gentleman from Georgia 
(Mr. Norwood), which Republicans and Democrats have come together on, 
would do is put accountability into this process. It is critical that 
it exists.
  We need to reform HMOs. We need improve health care access. We need 
to help those with insurance who have lost control of their medical 
decisions. We need to help those who are without any insurance, we need 
to help them to gain entry into the system.
  Next week, we have the opportunity to do the right thing, to pass a 
bipartisan Patients' Bill of Rights that could truly make a difference 
in the lives of the people that we represent.
  My cry, I know the gentleman from New Jersey, I know my Republicans 
who have joined in this effort, our colleagues from Texas and all over 
the country, let us do it together. Health care is not a partisan 
issue. It is an issue that is on the minds of every American family in 
this country. Let us do the right thing next week.
  I thank the gentleman from New Jersey (Mr. Pallone) for the role that 
he has played in this effort.
  Mr. PALLONE. Mr. Speaker, I just wanted to follow up on what the 
gentlewoman from Connecticut (Ms. DeLauro) said, particularly about 
this latest initiative, if you will, that the Speaker put forward 
today. I am going to be harsher than she is in saying that I have 
absolutely no doubt that this new proposal that was put forward is 
nothing more than an effort to try to kill the Patients' Bill of 
Rights.

                              {time}  1915

  And it is amazing to me the theme of the proposal that the Republican 
leadership put forward today, which is that somehow the Democrats are 
not doing the job because we are focusing on managed care reform which 
only impacts people who actually have health insurance, who are in 
HMOs, and that the Republican leadership, the Speaker, is not concerned 
so much with the people who have insurance who are in HMOs but the 
people who do not have insurance, the uninsured.
  The hypocrisy of that is so blatant. We as Democrats, and President 
Clinton and Vice President Gore, have spent the last 5 or 6 years 
putting forth proposals to address the problems of the uninsured, 
starting with the President's universal health care coverage, then the 
kids' health care initiative, the effort to try to address the near 
elderly, which would let people 55 to 65 buy into Medicare. There have 
been so many proposals to try to deal with the problem of the 
uninsured, and all of them have either been put aside, the Republicans 
have not let them come up; or maybe after they had been kicked and they 
were screaming, after we pushed and pushed and pushed, as in the case 
of the kids' health care initiative, we were finally able to get to the 
floor, but those were Democratic initiatives.
  I also just wanted to say very briefly that what the Republican 
leadership is trying to do is to say that managed care is unimportant, 
let us focus on the uninsured. That is a false premise. We have been 
spending a lot of time over the last year trying to say that we need to 
address managed care reform. Let us do that now. I am more than willing 
to deal with the problem of the uninsured later.
  I just wanted to say, if I could, that I find this so ironic, because 
I brought with me today a document that I used in the last debate on 
HMO reform where the Republican leadership tried to kill the Patient 
Protection Act. This is from July of 1998, about a year ago, and that 
was at the time when the House Republican leadership announced their 
response to the then Dingell-Ganske bill.
  And our colleague, the gentleman from Iowa (Mr. Ganske) is here 
tonight. This is just from a statement that I made. It says, ``In an 
attempt to mislead supporters of the Dingell-Ganske Patients' Bill of 
Rights, the House Republican leadership has called for new 
legislation.'' They called it the Patient Protection Act. ``However, a 
more apt title would be the Insurance Industry Protection Act. It not 
only excludes many key provisions that are essential for consumer 
protection, but vehemently opposed by the insurance industry, but also 
includes a number of provisions that would reduce current consumer 
protections and destabilize the insurance market.''
  The three things that are in this bill that the Speaker put forward 
today, rather than bringing more people into the ranks of the insured, 
would make it virtually impossible for those who do not have insurance 
to buy insurance, and I just wanted to mention the three things. The 
gentlewoman from Connecticut has mentioned them already.
  One is the health marts. The Republican plan creates health marts 
under the guise of offering choice to individuals in small business. In 
reality, health marts would be able to selectively pick what areas they 
offer their product in, avoid State consumer protection laws, and 
selectively contract with providers to avoid enrolling people in 
certain areas. These entities would skim the healthy out of the 
insurance market leaving everyone else with increasingly unaffordable 
premiums.
  The next thing are the MEWAs, the multiple employer welfare 
arrangements. These, again, make it so that whoever is left in the 
system has to pay more and cannot get insurance.
  And the last thing, the medical savings accounts, again, we have had 
these medical savings accounts on a demonstration basis for a couple of 
years now. Nobody wants them. Nobody even enrolls in them. But if the 
healthy and wealthy do enroll, that just leaves the sicker and poorer 
people out there with no insurance and the inability to buy because the 
cost goes up.
  So all I am trying to say is that what the Speaker proposed today is 
not going to help the uninsured, it is going to make it more difficult 
for the uninsured to get insurance. It does just the opposite.
  Ms. DeLAURO. The gentleman has just made so many accurate points 
here. The whole notion of this new piece of legislation at the last 
moment, at the same time, really is deja vu all over again. Because we 
are at a moment when we can pass something that is meaningful, and the 
Republican leadership has come up with something that is flawed in so 
many ways.
  But I think it is so interesting that the Speaker seems to be 
suffering from short-term memory. The Democrats joined with President 
Clinton in 1993 to try to offer universal coverage to people in this 
country. The fact of the matter is at that time Republicans joined with 
the insurance industry to kill the legislation. This is revisionist 
history when we take a look at a document that talks about dealing with 
the uninsured.

[[Page 23073]]

  We have stood here night after night after night for the last several 
years talking about medical savings accounts. This is why they call it 
skimming. When they pull out the people who are the healthiest and the 
wealthiest, the most frail are thereby left in the system, which only 
drives the costs up.
  This is a kind of a bolt from the side here to throw into the mix at 
the last moment, in the same way, quite frankly, campaign finance 
reform was handled a few weeks ago. It was an effort to put up 
something that was spurious, that in fact would wreck and kill campaign 
finance reform. This is the same thing; trying to kill HMO reform. I do 
not think that they will get away with it, because there is good solid 
bipartisan support for a Patients' Bill of Rights.
  And I know that my colleague from New Jersey and I will continue to 
be, our colleagues from Texas and California that just passed 
legislation in their Statehouse there, we are all going to be on our 
feet and talking about this and engaging the public in this debate.
  Mr. PALLONE. I thank the gentlewoman from Connecticut. This is just 
the beginning.
  I heard one of our colleagues from Texas on the other side talk about 
the rule and the Committee on Rules and how this managed care debate is 
going to be formulated. Obviously, we will keep our eye on this to see 
how the procedure goes. But every indication I have today from the 
Republican leadership, not from the Republicans that support the 
Patients' Bill of Rights but from the leadership, is that they are 
going to try to muck this up and make patient protections impossible.

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