[Congressional Record (Bound Edition), Volume 145 (1999), Part 17]
[House]
[Pages 24187-24198]
[From the U.S. Government Publishing Office, www.gpo.gov]



                              {time}  1100

    PROVIDING FOR CONSIDERATION OF H.R. 2990, QUALITY CARE FOR THE 
UNINSURED ACT OF 1999, AND H.R. 2723, BIPARTISAN CONSENSUS MANAGED CARE 
                        IMPROVEMENT ACT OF 1999

  Mr. GOSS. Mr. Speaker, by direction of the Committee on Rules, I call 
up House Resolution 323 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 323

       Resolved, That upon the adoption of this resolution it 
     shall be in order without intervention of any point of order 
     to consider in the House the bill (H.R. 2990) to amend the 
     Internal Revenue Code of 1986 to allow individuals greater 
     access to health insurance through a health care tax 
     deduction, a long-term care deduction, and other health-
     related tax incentives, to amend the Employee Retirement 
     Income Security Act of 1974 to provide access to and choice 
     in health care through association health plans, to amend the 
     Public Health Service Act to create new pooling opportunities 
     for small employers to obtain greater access to health 
     coverage through HealthMarts, and for other purposes. The 
     bill shall be considered as read for amendment. The previous 
     question shall be considered as ordered on the bill to final 
     passage without intervening motion except: (1) two hours of 
     debate equally divided among and controlled by the chairmen 
     and ranking minority members of the Committee on Commerce, 
     the Committee on Education and the Workforce, and the 
     Committee on Ways and Means; and (2) one motion to recommit.
       Sec. 2. At any time after the adoption of this resolution 
     the Speaker may, pursuant to clause 2(b) of rule XVIII, 
     declare the House resolved into the Committee of the Whole 
     House on the state of the Union for consideration of the bill 
     (H.R. 2723) to amend title I of the Employee Retirement 
     Income Security Act of 1974, title XXVII of the Public Health 
     Service Act, and the Internal Revenue Code of 1986 to protect 
     consumers in managed care plans and other health coverage. 
     The first reading of the bill shall be dispensed with. All 
     points of order against consideration of the bill are waived. 
     General debate shall be confined to the bill and shall not 
     exceed three hours equally divided among and controlled by 
     the chairmen and ranking minority members of the Committee on 
     Commerce, the Committee on Education and the Workforce, and 
     the Committee on Ways and Means. After general debate the 
     bill shall be considered for amendment under the five-minute 
     rule. The amendments printed in part A of the report of the 
     Committee on Rules accompanying this resolution shall be 
     considered as adopted in the House and in the Committee of 
     the Whole. The bill, as amended, shall be considered as read. 
     No further amendment to the bill shall be in order except 
     those printed in part B of the report of the Committee on 
     Rules. Each amendment may be offered only in the order 
     printed in the report, may be offered only by a Member 
     designated in the report, shall be considered as read, shall 
     be debatable for the time specified in the report equally 
     divided and controlled by the proponent and an opponent, and 
     shall not be subject to amendment. All points of order 
     against the amendments printed in part B of the report are 
     waived except that the adoption of an amendment in the nature 
     of a substitute shall constitute the conclusion of 
     consideration of the bill for amendment. The Chairman of the 
     Committee of the Whole may: (1) postpone until a time during 
     further consideration in the Committee of the Whole a request 
     for a recorded vote on any amendment; and (2) reduce to five 
     minutes the minimum time for electronic voting on any 
     postponed question that follows another electronic vote 
     without intervening business, provided that the minimum time 
     for electronic voting on the first in any series of questions 
     shall be 15 minutes. At the conclusion of consideration of 
     the bill for amendment the Committee shall rise and report 
     the bill, as amended, to the House with such further 
     amendments as may have been adopted. The previous question 
     shall be considered as ordered on the bill, as amended, and 
     any further amendment thereto to final passage without 
     intervening motion except one motion to recommit with or 
     without instructions.
       Sec. 3. (a) In the engrossment of H.R. 2990, the Clerk 
     shall--
       (1) await the disposition of H.R. 2723;
       (2) add the text of H.R. 2723, as passed by the House, as 
     new matter at the end of H.R. 2990;
       (3) conform the title of H.R. 2990 to reflect the addition 
     of the text of H.R. 2723 to the engrossment;
       (4) assign appropriate designations to provisions within 
     the engrossment; and
       (5) conform provisions for short titles within the 
     engrossment.
       (b) Upon the addition of the text of H.R. 2723 to the 
     engrossment of H.R. 2990, H.R. 2723 shall be laid on the 
     table.

  The SPEAKER pro tempore (Mr. Bonilla). The gentleman from Florida 
(Mr. Goss) is recognized for 1 hour.

[[Page 24188]]


  Mr. GOSS. Mr. Speaker, for the purpose of debate only, I yield the 
customary 30 minutes to the gentleman from Texas (Mr. Frost), pending 
which I yield myself such time as I may consume. During consideration 
of this resolution, all time yielded is for the purpose of debate only.
  Mr. Speaker, today the Republican majority makes good on its promise 
of a full and fair debate on health care reform. We have acceded to the 
requests of both sponsors, the gentleman from Georgia (Mr. Norwood) and 
the gentleman from Michigan (Mr. Dingell), by separating the two major 
issues in the managed care debate. This rule ensures that both parts of 
the debate, the affordable access part and the patient protection part, 
receive the attention they deserve separately.
  Under the rule, we will first debate the access bill, H.R. 2990, 
introduced by the gentleman from Missouri (Mr. Talent) and the 
gentleman from Arizona (Mr. Shadegg). Because of the tax provisions 
within H.R. 2990, we have offered the minority a substitute, which I 
understand they have declined to offer, as well as the traditional 
motion to recommit.
  The rule provides for an ample 2 hours of general debate on this 
access bill, to be equally divided between the three committees of 
jurisdiction.
  After consideration of the access bill, H.R. 2990, we will proceed to 
separately debate H.R. 2723, the so-called Norwood-Dingell bill. We 
provide for 3 hours of general debate, again to be equally divided 
among the three committees, the Committee on Commerce, the Committee on 
Education and Work Force, and the Committee on Ways and Means.
  Because of the comprehensive nature of this legislation, the rule 
makes in order only full substitutes to Norwood-Dingell, the underlying 
bill. There are three such substitutes. Each of the three substitutes 
will receive an hour of debate time. We have made in order every 
substitute offered to the Committee on Rules, and a great many of the 
more than 50 or so perfecting amendments we heard in the Committee on 
Rules are addressed in one way or another in all of these substitutes. 
We believe this will ensure timely and full consideration of all points 
of view on this very important issue.
  After considering these substitutes and voting on the underlying 
bill, the rule provides that the two bills, the access bill and the 
patient's rights bill, will be enrolled and sent to the Senate 
together. Since this was precisely the process that the base bill 
sponsors had requested, we were surprised when the minority objected 
last night at the last minute to this fair process and even threatened 
to bring down the rule over it. It should be clear to any objective 
Member that we have kept our word and prevented so-called ``poison 
pill'' amendments from even being offered.
  I am concerned that by last minute moving of the goalposts and by 
their statements in opposition to this approach, that the minority now 
has a desire to have a partisan political debate, rather than to solve 
a real and growing problem that Americans are asking us to deal with.
  Access and affordability are as important as improving patient 
protection, and we fairly provide for both under this rule, as we have 
pledged we would do. At the Committee on Rules on Tuesday I was struck 
by something the gentleman from Michigan (Mr. Dingell) said on this 
topic, and I quote him: ``A right without enforcement is no right at 
all.'' While he was referring to the patient protection side of this 
debate, I believe those words are even more appropriate in the context 
of the debate over the uninsured.
  This week the Census Bureau reported that the number of uninsured 
grew by 1 million last year. It is now one in six Americans that do not 
have health care insurance. This should be devastating news to all 
Americans, particularly those in the small business community. None of 
the important patient protections we will debate later today or 
tomorrow mean anything to those 44 million Americans living without 
insurance. In this case, to paraphrase my friend from Michigan, a right 
without insurance is no right at all.
  That is why I am pleased that our first order of business today is a 
well-crafted bill to increase the number of insured, not through more 
bureaucracy, not ``big brother'' mandates, but through market reform 
and long overdue tax equity. For the mom and pop and other small 
business employees in my district in Florida, that means that they can 
afford quality health care insurance, they can stop using the emergency 
room as their only source of health care, and they can finally enjoy 
the same health care advantages that the employees of the IBMs of the 
world currently have. I will speak in greater length about the patient 
protection piece during the amendment process. I intend to offer a 
substitute, along with the gentleman from Oklahoma (Mr. Coburn), the 
gentleman from Arizona (Mr. Shadegg), the gentleman from California 
(Mr. Thomas), and the gentleman from Pennsylvania (Mr. Greenwood) to 
the Norwood-Dingell bill.
  Put simply, our approach seeks to find the responsible middle ground 
between limited liability for health plans and a trial lawyer bonanza. 
Our message is simple: If you are harmed, you deserve to be made whole. 
But we should encourage patients to get the care they need up front 
from quality medical providers, with a lawsuit as a last resort, not 
the first choice. I am encouraged by the amount of support we have 
received, and I look forward to a vigorous debate when the time comes.
  Mr. Speaker, I want to finish by reminding all Members what this rule 
does and does not do. This rule does provide for separate votes on 
access and patient protection, as requested by the sponsors. This rule 
does not make in order any poison pill amendments intended to sink the 
underlying bill.
  This is a fair process, and I encourage my friends on the other side 
of the aisle to keep their word, vote for the rule, and help us improve 
the quality and affordability of health care for all working Americans.
  Mr. Speaker, I reserve the balance of my time.
  Mr. FROST. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this rule is a classic case of caveat emptor, or perhaps 
it is a pig in a poke. Whatever it is, this rule is a not-too-cleverly-
disguised attempt by the Republican leadership to derail meaningful 
reforms in the managed care industry, reforms that will benefit 
millions of Americans who are counting on us to help them.
  Mr. Speaker, the gentleman from Florida (Mr. Goss) has told the House 
that this is a fair rule, a rule which will allow the House to debate a 
full range of health care issues.
  Mr. Speaker, I must respectfully disagree with my friend. While this 
rule may well allow the House to debate both managed care and a means 
to expand health care to some 44 million Americans who today have none, 
this rule is purposefully structured to keep either of those goals from 
being reached.
  It is therefore my intention to oppose the rule. I would hope that 
the House will defeat this rule so that the Committee on Rules can 
adopt a new rule to permit the House to pass a real managed care reform 
package that stands a real chance of becoming law.
  Mr. Speaker, clever packaging is often used to disguise the fact that 
consumers get much less than they pay for, and this rule is just as 
deceptive.

                              {time}  1115

  Thus, I must repeat that this rule is a case of caveat emptor. In 
this case, Members may think they are getting two for the price of one, 
but I would submit, Mr. Speaker, that this rule is designed to cheat 
those of us who are looking for real value.
  Mr. Speaker, the Republican majority on the Committee on Rules has 
recommended to the House a very peculiar procedure which was never 
supported by the minority. This very peculiar procedure ties together 
two vastly different topics under the guise of a wide-ranging reform of 
health care in this country.
  Members have to follow the bouncing ball of what they have done. 
After passage of both bills, presuming both pass,

[[Page 24189]]

the access bill and HMO reform, the rule provides that the two bills 
will be combined in the engrossment, thus making the two bills one, 
without a vote to do that. Let me repeat, after these two separate 
bills have been passed on separate days, then the Republicans, by 
operation of this rule, would tie them all together and send them to 
conference with the Senate, without actually voting on that 
proposition.
  They know, they know that by doing this, this will jeopardize any 
piece of legislation from ever emerging from a conference with the 
Senate. They do so in a very cynical way.
  Mr. Speaker, over and above this question about tying the two bills 
together without a vote to do that, the rule does not allow the House 
to consider an amendment which would pay for the costs associated with 
managed care reform. The authors of the Patients' Bill of Rights, the 
gentleman from Georgia (Mr. Norwood) and the gentleman from Michigan 
(Mr. Dingell) have proposed an amendment to their bill which would 
offset the cost of higher employer deductions for worker health 
insurance.
  Mr. Speaker, this should be a very simple proposition. Republicans 
have for days and days on the floor of the House been crying great 
crocodile tears about not wanting to invade the social security 
surplus. What happens? Democrats and Republicans who support this bill 
come to the Committee on Rules and say, make in order an amendment so 
we do not have to invade the social security surplus, and the 
Republicans say no. No, we cannot do that. We do not want to invade the 
social security surplus, and we say that every day four or five times 
here on the floor, but if you actually give us the chance to vote on 
that subject, we do not want to vote on it, and we will prevent the 
House from voting on that. That is why this is a flawed rule, Mr. 
Speaker.
  Mr. Speaker, the reasoning in all of this is somewhat tortured. I do 
not want to belabor the House. I would only point out that last night 
on the subject of tying the two bills together, I asked the chairman of 
the committee, the gentleman from California (Mr. Dreier), I said, why 
are we doing this? Why are we combining these two bills at the end 
without a vote? Is there some rule of the House that requires us to do 
that? The chairman said, no, there is not a rule of the House, we just 
want to do it.
  Mr. DREIER. Mr. Speaker, will the gentleman yield?
  Mr. FROST. I yield to the gentleman from California.
  Mr. DREIER. I thank my friend for yielding to me.
  Mr. Speaker, the gentleman is correct. As the gentleman knows, that 
is the prerogative of the majority, to set forth these guidelines. But 
it is very clear that if we are going to address the question that my 
friend has accurately raised, the fact that we have gone from 1992, 
when the President was elected and 38 million Americans were uninsured, 
to the report we just received this week, that 44.3 million Americans 
are uninsured, we believe very strongly that unless we provide those 
things that are in the access bill, that we will not be able to address 
the concerns of those who will become even more uninsured if we simply 
have the kind of legislation that the gentleman supports. That is the 
reason we want to tie these bills together.
  Mr. FROST. Reclaiming my time, Mr. Speaker, I thank the chairman for 
his comments, because the question I raised last night was, is there 
some reason, some legal reason here on the House floor that we have to 
do this, in the rules of the House? He said no, it is because they want 
to.
  I would suggest that wanting to may well doom final passage out of a 
conference committee of either one of these provisions, which may well 
have merits on their own as separate pieces of legislation, but when 
combined under one package, no, particularly because the access bill is 
also not paid for. The Republicans have done nothing to provide the 
money to pay for the access bill. The estimates are that that bill 
could wind up costing $40 billion or $50 billion. So we are not paying 
for anything under the rule that is presented here today. All we are 
doing is voting on some very nice pieces of legislation.
  Democrats are asking that the Patients' Bill of Rights that we have 
been advocating for years now, and it is final reaching the floor, that 
we be given the opportunity to offer an amendment which would pay for 
this bill so that the Republicans could honor their word and honor 
their pleas of not invading the social security trust fund.
  Mr. Speaker, we have a lot of Members who wish to speak at this 
point. Members I know feel very strongly about passage of a strong 
Patients' Bill of Rights. We are to the point hopefully where we can do 
that, but we should do it in an honest way. We should be honest with 
the American public. I would urge defeat of this rule so we may have an 
honest procedure here on the floor of the House of Representatives.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GOSS. Mr. Speaker, I yield myself such time as I may consume.
  Surely the gentleman from Texas, Mr. Speaker, is not implying that we 
are doing anything dishonest on this side of the aisle. We have the 
press gallery watching. We have the whole world watching. There is 
nothing going on here except a clear, transparent debate on what I 
believe is a very good rule, which provides for full and fair debate, 
which is what we have promised.
  Mr. Speaker, I yield 3 minutes to the gentlewoman from Ohio (Ms. 
Pryce), a distinguished member of the Committee on Rules.
  Ms. PRYCE of Ohio. Mr. Speaker, I thank my good friend, the gentleman 
from Florida, for yielding time to me.
  Mr. Speaker, I rise in support of this very fair rule. I would like 
to take this opportunity to congratulate the gentleman from Florida 
(Mr. Goss) on all his hard work to bring people together to find some 
middle ground on this emotionally charged issue. It was certainly no 
small feat, and his success will give the House the opportunity to vote 
on consensus legislation that offers all the patient protections that 
we agree on without the excessive litigation and Federal regulation 
that the Norwood-Dingell bill promises.
  I hope all my colleagues on both sides of the aisle will give the 
Goss substitute their very serious consideration.
  Mr. Speaker, I have to say that I find it very curious that my 
Democratic colleagues are opposed to this rule, which I believe is 
eminently fair. I think all fair-minded people will agree with me when 
I explain why.
  The Democrat leadership and some of our Republican colleagues asked 
the Republican leadership to bring managed care reform legislation to 
the House floor for debate. Today, with the passage of this rule, we 
will be able to. Mind you, we are not bringing just any old managed 
care bill to the floor. We are taking up the bipartisan bill with so 
much Democrat support, the Norwood-Dingell bill. This is the base bill 
under this rule.
  Then my Democrat colleagues ask us not to allow any poison pill 
amendments. We complied by making in order only full substitutes under 
this rule. But that was not enough. Then they asked us not to add any 
Republican amendments to the Norwood-Dingell bill that would provide 
greater affordability and access. We did not.
  Now my Democratic friends are upset that we did not save them from 
themselves, because apparently they just realized that their bill will 
increase premiums. I am glad that the Democrats have come to terms with 
reality.
  One would think that they would be pleased that this rule allows us 
to debate another bill that addresses affordability and access, but 
apparently they are still not satisfied. Now they use the politically 
charged rhetoric that the Norwood-Dingell bill will spend social 
security. It is a bit of a stretch, but I guess, in a political pinch, 
it will do.
  So now, at the last minute, the Republican leadership is supposed to 
fix their policy flaws by adding a last-minute $7 billion tax increase 
to the Norwood-Dingell bill? I realize we have

[[Page 24190]]

been accommodating, but that is just a little bit too much for us to 
swallow. Frankly, their protests are beginning to ring a bill hollow.
  If my colleagues are truly concerned about health care policy, I 
suggest they support this fair rule. This rule will allow the House to 
debate various proposals to provide patient protections, as well as a 
bill that will help uninsured Americans and those that will eventually 
find themselves without insurance when the premium increases in the 
Norwood-Dingell bill price them out of the market.
  Mr. Speaker, this process is eminently fair. It gives all viewpoints 
a chance to be heard on the important health care issues facing our 
Nation. I urge my colleagues to vote for the previous question and the 
rule.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentlewoman from the 
Virgin Islands (Mrs. Christensen).
  Mrs. CHRISTENSEN. Mr. Speaker, by asking us to pass a rigged rule to 
finally allow a vote on managed care reform, the majority has once 
again demonstrated that they are out of touch with the American people, 
and that they are even out of touch with Members of their own 
Republican conference.
  Over 20 Republicans have signed on as cosponsors of the Bipartisan 
Consensus Managed Care Improvement Act because they recognize that 
physicians and their patients, not HMO bureaucrats, should be the ones 
making the decisions on what kind of care we should receive.
  The rule before us is a bad rule that is designed to kill the 
Norwood-Dingell bill and prevent any chance of us having real, 
meaningful health managed care reform this year. We must defeat this 
rule so supporters of managed care reform on both sides of the aisle 
can have the opportunity to have a clean up or down vote on real 
managed care reform, the Norwood-Dingell bill.
  This is not about providing access to care, as the opponents of the 
Norwood-Dingell bill would have us believe. This rule is about having 
no access to care even for the insured, and no managed care reform at 
all.
  The American people have told us they want the Norwood-Dingell bill. 
Vote no on this rule.
  Mr. GOSS. Mr. Speaker, I am happy to yield 2 minutes to the 
distinguished gentleman from Iowa (Mr. Ganske).
  Mr. GANSKE. Mr. Speaker, I am back on the floor of the House of 
Congress. I have been here night after night with my colleagues from 
the other side and colleagues from this side of the aisle, too, in 
pushing that we finally get a vote on patient protection legislation.
  I went before the Committee on Rules with the gentleman from Michigan 
(Mr. Dingell) and argued forcefully for the amendments that concern the 
Democrats on the pay-fors. I understand their concern about that. What 
we need, though, is we need a vote on access.
  I have some concerns about some of the access provisions. I am going 
to speak about that. We need a vote also on patient protections. I will 
tell the Members what, we are going to have to run a gauntlet to get 
the Norwood-Dingell bill passed. The rule is tough, it is really tough, 
for us to win. At the end of the day, if either of those bills pass, 
then they go to conference.
  I think this is the best we can do. I think it is time that we need 
to move to this debate. I understand my colleagues on the other side, 
their concern on this rule, but I honestly think that we can have a 
good debate in the next 2 days on both the access provisions and things 
in that access bill that can send a message to conference.
  I intend to do that. I intend to work my hardest to get the 
bipartisan consensus managed care bill passed that will be in the best 
interests of the people in this country, and will help us move this 
process along. So I will vote for the rule, but I understand fully the 
concerns of Members on the other side.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentleman from Texas 
(Mr. Doggett).
  Mr. DOGGETT. Mr. Speaker, the House Republican leadership has awarded 
this fellow in the fedora on the cover of Forbes magazines and all the 
tax shelter hustlers that he represents a great victory because this 
rule denies the right to pay for this legislation by calling on tax 
dodgers. As the gentleman from Georgia (Mr. Norwood), our Republican 
colleague, told the Rules Committee in urging an end to this tax 
dodging, ``there is a difference between a tax increase and stopping 
bogus tax loopholes.'' Bogus loopholes, indeed. This is a bogus rule 
that blocks the shutdown of abusive of corporate tax loopholes.
  Additionally, this rule represents fiscal irresponsibility at its 
worst. These bills are not paid for. It is wrong to dip into Social 
Security when the corporate tax dodgers should be paying for this 
legislation. While the costs of managed care reforms have been greatly 
exaggerated, all of us committed to patient protection believe this 
must be a fiscally prudent pay-as-you-go approach. The approach we 
sought in the Rules Committee was to pay for our reforms.
  Finally, this so-called Republican access bill is really access to 
the U.S. Treasury. It would open access to up to $50 billion of tax 
loopholes to be financed right out of social security. This is wrong, 
and the rule should be rejected.

                              {time}  1130

  Mr. GOSS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I find it a little puzzling that the gentleman who just 
spoke and the distinguished gentleman from Texas (Mr. Frost) both 
signed a discharge petition that would have precluded the opportunity 
to discuss this, and now they seem to be very upset with what they 
signed.
  Mr. Speaker, I yield 4 minutes to the distinguished gentleman from 
Oklahoma (Mr. Coburn).
  Mr. COBURN. Mr. Speaker, I thank the gentleman from Florida for 
yielding me this time.
  Mr. Speaker, I think it is very important the American public really 
gets to see how we got in the mess we find ourselves in with health 
care. In America today, we have a Soviet-run government-mandated health 
care system which has resulted in the loss of freedom of choice for 
millions of Americans. This rule to provide access is hopefully a step 
in moving back in that direction.
  But I also want to make sure that the American people understand the 
two extremes on this debate. On one side, we have corporate America and 
small business who is afraid that the costs are going to go through the 
roof if we change anything. On the other side, we find the legal 
profession licking its chops to take money away from people who 
normally act responsibly.
  We are going to hear all sorts of things during this debate. The one 
thing that we are going to hear claimed said many times is we are doing 
this for patients. We are going to find out if we are really doing this 
for patients, if we are really trying to restore freedom of choice, if 
we are really trying to restore accountability, and we are trying to do 
that at the same time that people do not lose their health care.
  The partisanship of this body is terrible, the claims made on the 
basis of some premier principle when they are really a veiled partisan 
dig for a political purpose.
  We are going to find out if one group or another really cares about 
people. We are going to find out on these votes if my colleagues really 
want to have a compromised piece of legislation that solves the problem 
of accountability, that restores choice and does not bankrupt the 
payroll of the American people who are supplying health care in this 
country.
  We are going to get to hear all the stories that will touch our 
hearts that say why we should go one way. We are going to hear all the 
threats about why we cannot go another because health care is going to 
be taken away.
  But in the long run, what it really comes down to is not the next 
election, which is what we are going to hear most about but nobody is 
ever going to say, what it really comes down to is will we have the 
courage to look and risk our seats to do what is in the best

[[Page 24191]]

interest of patients in this country, not what is in the best interest 
of the Democratic party, not what is in the best interest of the 
Republican Party, but what is in the best interest of the people of 
this country.
  That rings hollow to members who have been here; I understand that. 
But the only true measure of whether or not we have done our job well 
is that when we look in the eye of somebody that is out in our district 
and say, You have more freedom, you still have your health care, and 
you are still going to get it when this debate is all over.
  By the way, access is in the Senate bill. So anything we would merge 
is already there, and the opposition knows that. So the claim rings 
very hollow. Without access, no matter which bill in terms of Patients' 
Bill of Rights is passed, without access provisions, fewer people will 
have insured coverage in America tomorrow than have it today.
  This access bill is not perfect. AHPs are a terrible idea when we 
think about what it is going to do to disrupt the private insurance 
market regardless of the fact that the National Federation of 
Independent Businesses wants it. We make no adjustment for high-risk 
pools in the States.
  The gentleman from Arizona (Mr. Shadegg) is actually right. One 
cannot do AHPs unless one is willing to put something else back there 
to help take care of the risk.
  But, politically, the bill that comes out, although needed, is not in 
the best interest of patients either. So let us quit playing the game 
of partisan politics, and let us define this debate back down about 
what we are really supposed to be here for is the people who need and 
should get care and choose, and not take it away by something we might 
foolishly do either for the trial lawyers or for big business.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentleman from 
California (Mr. Stark).
  Mr. STARK. Mr. Speaker, I thank the gentleman from Texas for yielding 
me this time.
  Mr. Speaker, George W. Bush said it yesterday, that his party is 
putting too much emphasis on economic wealth and too little on social 
problems, and their candidate is not whistling Dixie.
  The gentleman from Oklahoma (Mr. Coburn), the previous speaker, said 
that we are going to break the payroll of this country. They are not 
going to break the payroll; they are going to break Social Security 
system. Because what the Republicans have done is the most dishonest, 
obscene attempt at almost fascist power to defeat a bill that they know 
would pass if they allowed the Members of the House to vote to pay for 
it.
  To force Members to be fiscally irresponsible as a Republican ploy to 
win what they cannot win through honest debate is shameful. To suggest 
that access is in their bill is sheer nonsense.
  Thirty-two million of the 45 million uninsured are in the 15 percent 
bracket or less, which means they get less than the $700 discount from 
a $5,000 bill, if they had $5,000 to buy insurance in the first place. 
Absolute nonsense and drivel.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentleman from 
Arkansas (Mr. Berry), a cosponsor of the bill.
  Mr. BERRY. Mr. Speaker, I urge my colleagues to vote against this 
unfair and unreasonable rule, a rule so cynical, so calculated that 
there is no question of its intent, which is to kill the bipartisan 
Norwood-Dingell managed care bill.
  When we went to the Committee on Rules this week, we presented an 
amendment version of our bill that included offsets to pay for it. That 
is right. We wanted to do the fiscally responsible thing and pay for 
what we proposed.
  The Committee on Rules refused to allow us to pay for our bill. What 
is even more impossible to understand is the Committee on Rules will, 
if our bill is passed, stick on to it a $48 billion so-called access 
bill that is also not paid for.
  This is a disgrace. Surely the gentleman from Texas (Mr. DeLay) and 
his colleagues cannot suppose that the American people will be fooled 
by this nonsense. Just this morning the gentleman from Texas is quoted 
in the Washington Post as saying, ``We are at a defining moment in the 
direction of this country. It is the classic battle of tax and spend 
versus balanced budget and fiscal restraint.''
  Ironically, the gentleman from Texas indicated that his leadership 
was not one to tax and spend.
  I refuse to vote for this rule and this $48 billion sound bite. If my 
colleagues care about balancing the budget, vote no on the rule.
  Mr. FROST. Mr. Speaker, I yield 2 minutes to the gentleman from 
Michigan (Mr. Dingell).
  Mr. DINGELL. Mr. Speaker, it is with real sorrow that I rise to 
oppose the rule on H.R. 2723, the Bipartisan Consensus Managed Care 
Improvement Act of 1999 of which I am a cosponsor, and proudly so, with 
the gentleman from Georgia (Mr. Norwood).
  I was initially pleased that the Republican leadership would actually 
schedule our bill for consideration on the floor, so it is with 
considerable regret that I find myself in the awkward position of 
opposing the rule. I do so for a number of real and valuable reasons.
  First, the Committee on Rules has chosen to include a requirement to 
link H.R. 2990, a bill dealing with Medical Savings Accounts and other 
discredited insurance reforms, which I oppose and which I am certain 
will trigger a veto, with H.R. 2723, a bill which would protect the 
rights of patients. All of the tax cuts in H.R. 2990 are unpaid for.
  I would note for the benefit of my colleagues that the access 
provisions here, and this is the reason that they did not make these 
cuts subject to being identified or subject to being paid for, amount 
to about $50 billion. So we cannot blame my Republican colleagues for 
hiding those numbers.
  While the House will vote separately on each bill, the rule has 
determined that these two bills must be joined into a single bill when 
they are sent to the Senate. No reason for that except, I suspect, 
politics. In effect, if the first bill prevails, the rule would send 
the patients' rights bill to the Senate with it attached, like a kind 
of a ticking time bomb, and unless it is disarmed in conference, the 
likelihood of enacting patient protections and having them signed by 
the President into law is highly diminished.
  I also oppose the rule because the bill sponsors were not allowed to 
include a package of revenue offsets, which we tried to offer in the 
Committee on Rules. I would like to just observe that I thought the 
Committee on Rules' meeting was a good one. Regrettably, it was all on 
the surface and not within the real discussions.
  Although the revenue offsets are relatively small, about $6 billion 
and less according to the Congressional Budget Office, they should be 
paid for so that we do not dip further into Social Security.
  Similarly, none of the three substitutes for our bill are paid for. 
Instead, the rule waives the Budget Act for each substitute.
  I have been to the floor in the past to speak of the need for patient 
protection legislation, but today I want to emphasize the fact that I 
am proud to be here with a bill that is truly bipartisan. For too long 
our fight on behalf of the rights of patients has been characterized as 
partisan. When I joined with Charlie Norwood on this bill, along with 
22 Republican cosponsors, I think we put that myth to an end. We spent 
long hard hours reaching a compromise, but we did so because we wanted 
to put patients ahead of politics.
  I would hope that we could defeat this rule, which is full of 
gimmicks and get on to helping patients. Let's feed our patients 
protection from their HMO, not a poison pill.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentleman from 
Maryland (Mr. Wynn).
  Mr. WYNN. Mr. Speaker, I thank the gentleman from Texas for yielding 
me this time.
  Mr. Speaker, I rise in opposition to this rule and express my support 
for the bipartisan Dingell-Norwood bill.
  Someone said in trying to defend this rule, well, it is not exactly 
dishonest. Well, maybe it is not dishonest; but it is clearly 
disingenuous, it is clearly cynical, and it is clearly raw 
partisanship.

[[Page 24192]]

  It is clearly an attempt to block bipartisan legislation that will 
provide real HMO reform for American citizens that would give them the 
right to sue when they are aggrieved.
  Now, this rule has two flaws. First of all, we wanted to pay for the 
Dingell-Norwood bill. We had the offsets. They ruled the offsets out of 
order, forcing us or attempting to force us to dip into the Social 
Security Trust Fund.
  Second, they attach the access bill. It has some merits. But why is 
it attached? It is not paid for. It has some undesirable aspects; and 
it is designed, once again, for one sole purpose, and that is to help 
kill the bipartisan Dingell-Norwood bill.
  This vote today may be the most important in our legislative session. 
I hope we can defeat this rule and push for real HMO reform.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentleman from Texas 
(Mr. Stenholm).
  Mr. STENHOLM. Mr. Speaker, I am a little bit puzzled, and I rise very 
strongly opposed to the rule for my puzzlement. I am going to ask the 
gentleman from Florida (Mr. Goss) a question in just a moment, or the 
chairman of the committee.
  Last week, my colleagues were criticizing we Democrats for spending 
Social Security Trust Funds. Last week, we had threats of 
advertisements being run against several of us. This week we come to 
the floor, and we only ask for a rule allowing all of the bills to be 
paid for. My colleagues deny it. Why do my colleagues choose to deny 
the right of this body to pay for that which we will discuss today?
  Mr. GOSS. Mr. Speaker, will the gentleman yield?
  Mr. STENHOLM. I am happy to yield to the gentleman from Florida.
  Mr. GOSS. Mr. Speaker, we did not deny it. In fact, what we did is 
respond to the petition, the discharge petition which, in fact, would 
have precluded it.
  Mr. STENHOLM. Mr. Speaker, I reclaim my time. Why would the gentleman 
from California (Mr. Dreier) at this time not go back to the Committee 
on Rules and give the minority an opportunity to pay for that?
  Mr. DREIER. Mr. Speaker, will the gentleman yield?
  Mr. STENHOLM. I am glad to yield to the gentleman from California.
  Mr. DREIER. Mr. Speaker, I thank the gentleman for yielding to me. As 
the gentleman from Texas understands the rules of the House very well, 
he understands germaneness. It is not germane to do that. The gentleman 
signed the discharge petition in the well, I suspect, with a lot of 
people. If that would have moved forward, it would not have been made 
in order.
  Mr. STENHOLM. Mr. Speaker, I did not.
  Mr. DREIER. Well, I know the gentleman from Texas (Mr. Frost) did and 
several other Members. It is not germane.
  Mr. FROST. Mr. Speaker, I yield myself 15 seconds.
  The gentleman from California (Mr. Dreier), chairman of the Committee 
on Rules, knows that the Committee on Rules can waive germaneness at 
any time and often does when it is to the convenience of the majority. 
We are only asking that it be waived once for the minority.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GOSS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, it would probably be worth noting at this point in the 
discussion that we had a whole bunch of amendments. If we made room for 
one, we would have had to make room for a whole bunch more as well. We 
made, I think, a very wise decision to have a full fair debate. I am 
sorry that the folks who are upset about this, paying for what they 
want to do at the last minute did not think of it a lot sooner. We 
congratulate them for finally thinking about paying for it.
  Mr. Speaker, I yield 2 minutes to the distinguished gentleman from 
Arizona (Mr. Shadegg), who has been an instrumental player in this.
  Mr. SHADEGG. Mr. Speaker, I rise in strong support of this rule; and 
I want to point out, as one of the original cosponsors with the 
gentleman from Missouri (Mr. Talent) of the access bill which provides 
access, affordability, and choice for the American people; that what we 
are hearing from the other side is that they do not like our provision, 
but they do not have one of their own.
  There is a saying around this town, one cannot beat something with 
nothing. Yet, in the area of access, affordability, and choice, the 
other side tries to beat something that we Republicans are doing for 
the uninsured with nothing. My colleagues will not hear them today talk 
about their bill to help the uninsured get access to care.

                              {time}  1145

  Mr. Speaker, we will not hear them talk about their bill to bring 
down the cost of insurance and make it more affordable. We will not 
hear them talk about their bill to give those who are insured choice.
  I want to stop at this point and talk about the second issue we will 
hear a lot about today, which is pay-fors. We did not pay for our bill. 
We cannot afford this legislation. I want to point out that the 
opposite is true. We simply cannot afford to go on not paying for, that 
is, not giving care to the uninsured in America.
  We are already paying for them. Has everyone lost sight of that in 
this debate? The uninsured are getting care in emergency rooms all 
across America. The uninsured are getting care in hospitals all across 
America, and there is cost shifting to pay for that.
  So when we hear the argument that, oh, this is not paid for, this 
will bust the budget, please recognize that that is a ruse. That is not 
true because we are already paying for their care. Long ago, 
fortunately, this society decided that those who are in need should not 
go without care.
  There are 44 million uninsured Americans in this country. The vast 
majority of those work for small businesses who cannot afford to offer 
them coverage. Our legislation, the legislation that the gentleman from 
Missouri (Mr. Talent) and I wrote, gives those people access to care 
and it makes it more affordable. It gives them a deduction they do not 
now have. It allows small businesses to pool together.
  Do not let nothing beat something. I urge my colleagues to support 
this very fair rule.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentleman from New 
Jersey (Mr. Pallone).
  Mr. PALLONE. Mr. Speaker, I heard my Republican colleagues talk about 
fairness. There is nothing fair about this rule. This is a killer rule.
  Basically, what they are doing is abusing their majority position to 
rig the procedure here today. And I know why. Very simply, if I am a 
Member and I want to support the Norwood-Dingell bill, which I 
certainly do, I am forced under this rule basically to vote in favor of 
spending Social Security money. At the same time I am also forced to 
vote for MSAs, medical savings accounts, health marts, and all these 
other poison pills that basically break the insurance pool and increase 
the cost for the uninsured.
  The Republicans say that their access bill is going to help the 
uninsured. Exactly the opposite; it is going to make it more difficult 
for people who are uninsured to buy health insurance. That is the 
poison pill.
  They are rigging this rule. They are making it impossible for those 
of us who want to support managed care reform and true reform to vote 
for it because we would have to vote for all these awful other things 
that will hurt the uninsured, and make it more difficult also because 
of the fact that we are going to be spending Social Security money. It 
is unfair.
  Mr. GOSS. Mr. Speaker, I yield 2 minutes to the gentleman from 
Missouri (Mr. Talent), who will be managing the access bill.
  Mr. TALENT. Mr. Speaker, I thank the gentleman for yielding me this 
time. Mr. Speaker, in the Baltimore Sun this morning appeared an 
article which begins as follows: ``She has stood in front of the mirror 
trying to practice her new smile because Linda Welch-Green can't afford 
the dentist. She has lost three front teeth. And Bell's palsy has 
paralyzed the right

[[Page 24193]]

side of her face, so she struggles to pronounce words that start with 
``P.'' She never used to miss annual medical checkups, but now she 
pretends not to notice when the dates slip by. Green, 50, hasn't had 
health insurance for two years. Even though she's working full time as 
a cashier at a downtown garage, the Baltimore woman can't afford the 
$200 a month to cover herself and her 13-year-old son.''
  Mr. Speaker, there are 44 million Linda Welch-Greens around this 
country whose future depends on passing the accessibility bill that 
this rule is going to allow us to consider today. We cannot afford not 
to pass this bill.
  Talking about this in terms of what it is going to cost the Federal 
government has an air of unreality about it. These people are out there 
suffering. They are paying for it and we are paying for it in the 
illnesses that they have. We cannot afford not to pass this bill.
  I am told the 5-year cost, and it is the arcane way we figure cost 
out here, is $8 billion. And even the President agrees that we have 
well over $100 billion over 5 years to spend on tax relief without 
getting into the Social Security surplus. There is no Social Security 
surplus issue here.
  The other issue regarding linkage of this with health care reform is 
that health care reform does not do much good if an individual does not 
have health insurance. That is a linkage in common sense, not a linkage 
as a result of this rule. So, please, do not say that we are not doing 
anything for the uninsured, we are going to try to defeat the other 
side's attempts to do anything for the uninsured, and if the other side 
manages to succeed to do something for the uninsured, notwithstanding 
our opposition, we are going to kill the health care reform bill too.
  That is not the right attitude. Let us help the Linda Welch-Greens in 
this country. We cannot afford not to do that. This is a good rule; it 
is a natural rule. Let us pass it and then pass this legislation.
  Mr. FROST. Mr. Speaker, I yield 2 minutes to the gentleman from New 
York (Mr. Rangel).
  Mr. RANGEL. Mr. Speaker, I went before the Committee on Rules to try 
to get an answer to how the health access bill, which is just as much a 
tax bill as it is a health bill, how it could possibly get to the 
Committee on Rules without ever seeing the light of day in the tax 
writing committee.
  I know that the Committee on Appropriations can vote on earned-income 
tax credits, but it has reached the point now on important legislation 
that the committees of jurisdiction do not even have an opportunity to 
review the bills. There is one thing that we have appreciated in our 
committee, unlike the majority on the floor, is that whether someone is 
a Republican or a Democrat, the gentleman from Texas (Mr. Archer) has 
made certain that those bills are paid for. At least he says that he 
will.
  Now, by any standard this bill, this package, would cost some $43 
billion over 10 years. Somebody said, well, it should not make any 
difference, we are paying for it anyway. Well, we can use that argument 
by not investing in education and transportation and research and 
development. There are a variety of things we can say that we are 
paying for it anyway. But there is no way in the world to believe that 
the majority is serious about health access by combining it with the 
Dingell-Norwood bill.
  It is clear that when we have a rule like the majority has fashioned 
today, that for those of us who have worked so hard as Republicans and 
Democrats, who have tried to work together to get a decent bill, and 
the fact that so many Republicans have seen the light and walked away 
from the leadership saying they would rather have a good bill than just 
good will, that now the majority has done this; they have tried to 
think of ways just to overthrow this thing.
  And what did the majority come up with? Did they give us a fair rule 
where we can debate the issue? No, they had to think of another bill 
that is unrelated and attach it and to put it in the rule. So that 
those of us who just want to support Dingell-Norwood would have to 
support a bill that has never seen our committee.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentleman from New 
Jersey (Mr. Andrews).
  Mr. ANDREWS. Mr. Speaker, I rise in strong opposition to the rule.
  Republicans and Democrats came together behind the Norwood-Dingell 
bill and a clear majority of this House supports it. Virtually a 
unanimous vote of this House supports the idea that the cost of that 
bill should be paid for without raiding Social Security money. Now, 
common sense would tell us we would, therefore, have on the floor the 
Norwood-Dingell bill with offsetting provisions to make sure it is paid 
for without touching Social Security. That is what common sense would 
tell us. But that is not what we are permitted to do here today, and 
that is what is wrong with this rule.
  This rule is a conscious attempt to subvert the will of the majority. 
It is the tyranny of the minority. In urging my colleagues to oppose 
this rule, I am not certain that we are going to succeed, and perhaps 
the minority will succeed in having its views prevail today; but I 
assure my colleagues, Mr. Speaker, the majority of the American public 
will prevail in the end and this bill will become law despite their 
best efforts.
  Mr. GOSS. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from California (Mr. Thomas), a member of the subcommittee 
and a very strong player in this matter.
  Mr. THOMAS. Mr. Speaker, I thank the gentleman for yielding me this 
time. I will do my best in the short time I have to cut through the fog 
that has been laid and walk through the crocodile tears that have been 
shed in terms of this particular rule.
  Number one, the Congressional Budget Office has not scored any of 
these bills, so we do not have an official cost. For months, the 
Norwood-Dingell group said their bill did not cost anything. They are 
now complaining because, notwithstanding not knowing what it really 
costs as scored by the Congressional Budget Office, a tax provision 
that has never been looked at by the Ways and Means was not made in 
order.
  Some of us on the Committee on Ways and Means have looked at that tax 
provision. One portion of that tax provision says that the government-
forced wage rate, called Davis-Bacon, would be required to be imposed 
on every school district in the United States. That probably ought to 
go through committee so that we can determine if that is an appropriate 
policy or not. But they do not need to attach dollars to their bill 
because it has not been scored.
  Secondly, when we take a look at their argument about the access 
provision, it is not married. Watch the vote. The gentleman from New 
Jersey (Mr. Pallone) rings his hands over the problem of having to vote 
for access and then dealing with the patient provisions. Very simple. 
He will vote ``no'' on access, and he will vote ``yes'' on his choice 
in terms of patient protection. This rule allows that. The House will 
work its will.
  And what about that access bill? Those tax provisions that the 
gentleman from New York has said he has not seen, I will have to remind 
him he voted ``no'' on all of them in committee and on the floor in 
terms of the comprehensive tax package.
  What are some of those tax provisions on access? For the first time 
people who work for an employer, when the employer does not pay their 
health insurance, will be able to deduct the cost of that insurance. 
The uninsured will be covered with these access provisions. I thought 
that is what we were supposed to be all about.
  Mr. FROST. Mr. Speaker, I yield 2 minutes to the gentlewoman from New 
York (Ms. Slaughter).
  Ms. SLAUGHTER. Mr. Speaker, I thank the gentleman for yielding me 
this time.
  Mr. Speaker, I am very sad this morning, because I am persuaded by 
this rule that this House will never touch insurance reform. This bill, 
the underlying bipartisan bill, has been doomed to fail after years of 
work by

[[Page 24194]]

large numbers of Members on both sides.
  Nothing should be clearer to each of us than the fact that our 
constituents want medical decisions made by medical practitioners and 
not by their insurance carriers. But the right of action against an 
insurance company dooms this bill.
  State after State has enacted legislation that allows the right of 
action this bill intends, and it has created no massive rush to the 
courts. Texas has had four cases in several years under this 
legislation. Now, if an individual lives in one of those States, then 
that is good for them, but they are not going to get the protection in 
the United States if they do not.
  Now, why should insurance companies who are culpable to damages be 
immune from redress? Doctors are not, hospitals are not, ancillary care 
is not. But insurance companies have to have the immunity.
  Never mind about those questions, the clever construction of this 
rule will once again thwart the people's will.

                              {time}  1200

  We have waited a long time for this day, only to see it lost in this 
dance of legislation. I urge my colleagues to defeat this rule so that 
we may try to have a second chance to give Americans what they want and 
what they deserve for the first time this year.
  Mr. GOSS. Mr. Speaker, I am happy to yield 2 minutes to the gentleman 
from Illinois (Mr. Weller).
  Mr. WELLER. Mr. Speaker, I rise in support of this rule. I also rise 
in support and plan to vote for several of the initiatives to make 
health care more affordable and to provide protections for patients.
  It is interesting, my colleagues on the other side use a code word 
called ``pay-fors.'' What the code word ``pay-fors'' really means is 
tax increase. They always want to increase taxes. That is their first 
choice every time.
  My colleagues, there are a number of facts out here that are so 
important. In my home State of Illinois, 15 percent of the workers and 
families and people of my home State lack health insurance. It is an 
increase over last year. And if we look at it from a national 
perspective, 44 million Americans do not have health insurance. That is 
an increase of 1 million over last year. And the question is, why? And 
the answer to that question is because health care coverage is not 
affordable and they also do not have access.
  In fact, they say that for every 1 percent increase in health care 
costs 400,000 Americans lose their coverage. And if we look at those 44 
million Americans who do not have coverage, 85 percent of them are 
self-employed people or workers for small businesses unable to find 
affordable rates of insurance.
  That is why this rule is so important, because the access in choice 
legislation of quality care through the uninsured legislation provides 
answers and solutions that have been debated over the years in this 
House but never signed into law. We make it easier for small businesses 
to go together and in a cooperative fashion purchase health insurance 
in greater numbers, bringing their rates down through a cooperative 
purchasing effort, making it more affordable, and helping their workers 
have health care coverage.
  We give something to the self-employed that corporate America already 
has. We allow the self-employed under this legislation to deduct 100 
percent of their health insurance premium costs. We also give uninsured 
workers who do not have coverage provided by their employers a 100-
percent deduction for their health insurance premium costs, too. That 
is fair.
  I was pleased that the Committee on Ways and Means in the House and 
Senate voted to do this earlier this year. Unfortunately, the President 
vetoed it.
  My colleagues, let us make health care more affordable and more 
accessible. Vote aye on the rule.
  Mr. FROST. Mr. Speaker, I yield 2 minutes to the gentleman from 
Missouri (Mr. Gephardt), the Democratic leader.
  Mr. GEPHARDT. Mr. Speaker, I rise reluctantly to ask Members to vote 
against this rule. This is a very important day, perhaps the most 
important day in the Congress that we are involved in.
  We have a chance now, in a bipartisan way, to pass a very good 
Patients' Bill of Rights, something that I think is desired by all of 
the American people. I want to commend the gentleman from Michigan (Mr. 
Dingell) and the gentleman from Georgia (Mr. Norwood) and the gentleman 
from Iowa (Mr. Ganske) and many others on both sides of the aisle who 
have worked so hard to get to this point. They have worked together. 
They have worked admirably on a very tough set of issues. And what I 
wanted to pass this bill today.
  Unfortunately the rule, in my view, is lacking in fairness, for two 
reasons. One, it does not allow an amendment that was desired by both 
Republicans and Democrats to pay for the patients. Unfortunately, the 
Congressional Budget Office has said that this bill will cost about $7 
billion over 5 years.
  Members on both sides of the aisle wanted a chance to pay for this so 
that they were not seen as voting for something that would invade the 
Social Security Trust Fund and break the caps and causes budgetary 
problems. But that amendment which was desired by proponents of 
Dingell-Norwood was not allowed to be made.
  Secondly, the access bill, which is now going to be taken up even 
though we did not take it up in committee, does not have pay-fors, as 
well. So if it passes and becomes part of this bill, we have another 
section of the bill that costs money in the budget and is not paid for. 
I just think this is unnecessary.
  First of all, the Patients' Bill of Rights should be on its own, 
should not be subsumed under some other bill for access which was not 
really the subject of this matter to begin with.
  Second, if it is going to be subsumed under it, we should be allowed 
to figure out a way to pay for it. Thirdly, we ought to be able to pay 
for the Patients' Bill of Rights. None of that is allowed in the bill.
  My fear is that, at the end of the day, even if Dingell-Norwood 
survives, the votes are not going to be there to pass the bill because 
of these other matters that were not dealt with properly in the rule.
  I ask the majority leadership to rethink this matter and to try to 
get us a rule or a procedure that will allow a fair consideration of 
patients.
  I guess I just end with saying, putting all of this procedural 
wrangle aside, let us all try to remember what this legislation is 
about. It is about helping people, children, seniors, women, men, who 
want to have an enforceable right to have the decisions about their 
health care made by the doctors and them together to be able to do 
that, to have an enforceable right that they can bring against their 
health insurance company or their HMO. That is what is at stake here.
  We have a chance as a House of Representatives, in a bipartisan way, 
to do something that is deeply desired by the American people. I hope 
that this rule in its present form will be defeated, and I hope we will 
find a procedure and a rule that will allow fair consideration of this 
very, very important legislation.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentlewoman from 
Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I do not know what it will 
take for my colleagues on both sides of the House to acknowledge, as I 
said earlier this morning, that more than 83 percent of the American 
people are asking us to vote for a freestanding, upstanding HMO reform 
bill today. And I think one of those is little Steve Olson, a 2-year-
old who went hiking with his parents. As he was hiking he fell ill, 
went to an emergency room, and was treated for meningitis. But the 
little boy still experienced pain, could not express himself. They went 
back to that emergency room, but they could not get any more care, they 
could not get him to do a brain scan because the HMO denied it. And now 
this little boy, because he had a lump on his brain, has cerebral 
palsy.
  The American people are asking us to stop the parliamentary maneuvers 
that

[[Page 24195]]

would not allow us to have a freestanding bill on managed care, access 
to emergency rooms, the sanctity of the physician-patient relationship; 
and the American people are asking us to deal with the uninsured in a 
separate manner because there are working poor who cannot pay for their 
insurance and this bill does not do it. The American people have asked 
us to have an amendment on $7 billion to ensure that we pay for this.
  Mr. Speaker, I just conclude by saying, my colleagues, let us join 
together and get a real HMO reform bill, the Dingell-Norwood bill.
   Mr. Speaker, I rise to strongly oppose the rule for today's managed 
care bills. The rule is a sham and seeks to undermine these two vital 
health bills.
  Instead of providing a fair and open rule for considering the 
patients' bill of rights, the majority has written an unreasonable rule 
that combines the managed care bill with a measure riddled with special 
interest ``poison pills'' designed to kill the measure. This rule 
guarantees that we will not be able to offset any potential revenue 
losses from the measure, and we will not be able to establish the 
health care services that we hoped to provide for the citizens of this 
country.
  The majority has shown a grave error in judgment by including special 
interest provisions in the managed care bill. This act is fiscally 
irresponsible because no funding is provided for these provisions. 
Worse yet, this rule denies a bipartisan group of members from offering 
an amendment to pay for this bill.
  Because the access bill and managed care bill are combined in one 
rule, managed care reform may be defeated through parliamentary 
maneuvering. This is untenable.
  Merging these bills into one rule is unacceptable because it combines 
a bill that helps those who need health care, H.R. 2723, with a bill, 
H.R. 2990, that simply helps the Nation's most healthy and wealthy, and 
not the uninsured. We must separate these two bills so we can ensure 
that H.R. 2723 provides new patient protections, sets nationwide 
standards for health insurance, and expands medical liability. These 
issues are vitally important to all of the American people, not just 
the privileged.
  Yet, these bills, these once glimmering symbols of managed care 
reform that sought to stretch their healing arms around each of our 
citizens, have now been twisted and manipulated into one hideous, 
unrecognizable heap of special interest slag. In particular, poison 
pill amendments have been offered to the Bipartisan Consensus Managed 
Care Improvement Act of 1999. The Boehner amendment benefits the 
healthy and wealth instead of the uninsured, those who need the most 
help. The Goss-Coburn amendment weakens patient protections, cap non-
economic damages, and guts enforcement provisions. The Houghton-Graham 
amendment provides far too weak federal remedies and internal reveiw 
procedures.
  An open rule would allow us to correct these problems. But by 
providing only one rule for both HMO bills, we prevent ourselves from 
doing any good today. Do we want to tell the American public that it 
will not receive the managed care reform it has so desperately sought 
because of a procedural bar?
  The sobering truth is that our citizens need health care reform--
especially those living in poverty. Over one-third of the U.S. 
population was living in or near poverty in 1996. The majority of 
African-American (55 percent) and persons of Hispanic origin (60 
percent) lived in families classified as poor or near poor. In the 
southern portions of the United States, the poverty rate is 15 percent. 
My home State of Texas had poverty rate over 16 percent. Of those 
suffering from poverty, 44.1 percent are uninsured. 44.4 percent of 
African-Americans in poverty are uninsured, and 58.7 percent of 
Hispanics in poverty are uninsured. These numbers are sobering, and we 
must do something about them.
  People living in poverty, and many minority citizens, simply cannot 
afford health insurance, and, in turn, cannot obtain quality health 
care. Their lack of access to quality health care has devastating 
effects because many minority groups and people living in poverty are 
particularly susceptible to health problems. Racial and ethnic 
minorities constitute approximately 25 percent of the total U.S. 
population, yet, they account for nearly 54 percent of all AIDS cases. 
For men and women combined, blacks have a cancer death rate about 35 
percent higher than that for whites. The age-adjusted death rate for 
coronary heart disease for the total population declined by 20 percent 
from 1987 to 1995; for blacks the overall decrease was only 13 percent.
  The Bipartisan Consensus Managed Care Improvement Act of 1999 is also 
important due to the reforms it provides because even when people do 
have insurance, quality health care is not guaranteed. Take for 
instance, Steven Olson--a once healthy, thriving two-year old child. 
After falling on a stick while hiking with his parents, two-year-old 
Steven was rushed to the emergency room where he was treated. His 
mother returned him a week later because he was in great pain. He was 
treated for meningitis and sent home. Steven continued to complain 
about pain, but despite his parents' protest, the HMO doctors refused 
to perform a brain scan, even though it was a covered benefit. Steven 
eventually fell into a coma due to a brain abscess that herniated. He 
now has cerebral palsy. An $800 brain scan would have prevented this 
tragedy.
  In an even more tragic case, a woman attempted to switch doctors when 
it became clear that her original doctor would not fully examine a 
growing and discolored mole on her ankle. Paperwork and bureaucracy 
resulted in a six-month wait. Once the woman finally visited a second-
doctor, she was immediately sent to a dermatologist who determined that 
the mole was a malignant melanoma. The woman died one year later.
  Both sides of the aisle should be working together to ensure that 
these stories never surface ever again. Yet, this rule encourages 
special interest ``gutting'' of the bill, and negates any amendment 
that would provide the necessary $7 billion in offsets for revenue 
losses estimated to result from increased deductions for higher medical 
premiums.
  Over 200 organizations support the Bipartisan Consensus Managed Care 
Improvement Act of 1999--including AIDS Action, the American Academy of 
Pediatrics, the American Heart Association, the American Medical 
Association, and the National Association of Public Hospitals. But 
these organizations cannot support the bill as offered. The special 
interest additions and weakened bill language undermine the goals of 
these groups. Without an open rule that would allow us to correct these 
problems, we will essentially slam the door on the very groups who can 
provide us with the greatest support and resources.
  This rule does not penalize the minority side; it penalizes the very 
people we represent--the American taxpayers. We need an open rule that 
will permit the enactment of effective managed care reform.
  I urge my colleagues to vote ``no'' against this unfair rule and 
against this distorted version of the bill.
  Mr. FROST. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, the gentleman from California (Mr. Thomas), a member of 
the Committee on Ways and Means, just appeared on the floor and made a 
statement that there was a provision relating to Davis-Bacon in the 
amendment the Democrats sought in order.
  I have consulted the Committee on Ways and Means staff. That is not 
true. There is nothing in the amendment that was offered by the 
Democrats relating to Davis-Bacon.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GOSS. Mr. Speaker, I take great pleasure in yielding 1 minute to 
the distinguished gentleman from Florida (Mr. Shaw), a member of the 
Committee on Ways and Means.
  Mr. SHAW. Mr. Speaker, I thank my friend for yielding this time to 
me.
  Mr. Speaker, when the gentleman from Missouri (Mr. Gephardt) was on 
the floor talking about wishing that the pay-fors were in the bill, I 
would like to point out that both he and the gentleman from Michigan 
(Mr. Dingell) have signed a discharge petition asking that this bill in 
its form that it is going to be made in order under this rule be 
brought directly to the floor.
  In that bill, there were no pay-fors. If they would attempt to put a 
paid-for in as an amendment, it would be nongermane. So they have 
already asked by way of a discharge petition that this bill be brought 
to the floor without any pay-fors.
  Now, regarding the pay-fors that were requested in the Committee on 
Rules, one of those, and the largest one of which, has never had a 
hearing before the Committee on Ways and Means. It is a tax increase.
  As long as I have been in this Congress, both under Democrat control 
and under Republican control, I can never remember a single time when 
this Congress was so irresponsible as to bringing a tax increase 
directly to the floor without even so much as a hearing before the 
Committee on Ways and Means. That would be irresponsible on

[[Page 24196]]

our side, and it would be equally irresponsible on the Democrats' side.
  Mr. FROST. Mr. Speaker, I yield 1 minute to the gentleman from 
Massachusetts (Mr. Tierney).
  Mr. TIERNEY. Mr. Speaker, I thank the gentleman from Texas for 
yielding me the time.
  Mr. Speaker, the American public is not going to be fooled by clever 
tactics. This has been a long-standing process with the Patients' Bill 
of Rights, and the American public is aware of that.
  In the 105th session we talked about coming forward with a meaningful 
Patients' Bill of Rights, and that was put off by people who were 
carrying water for the special interests and the insurance groups.
  We fought all the way through that. We found a way to build a 
coalition with Republicans and Democrats that were bold enough and 
strong enough to step forward and give real patients' rights, talking 
about the idea that insurance companies would be no longer the ones to 
determine what is medically necessary just on the basis of cost; but we 
would take this out of that venue and leave it to doctors and patients 
to decide the issue of medical necessity.
  This Patients' Bill of Rights will allow people to determine if they 
need to go to a specialist and get that care. We have right after right 
in there that, finally, we have enough Republicans and almost all the 
Democrats on it that it will pass. And it is at that point in time that 
the leadership of the majority decides that they now have to get 
clever.
  It is not enough to try to fight it on its merits. It is not enough 
to try to fight it on a fair rule. It is not enough to bring it forward 
for a straight up or down vote. Because they know now the political 
pressure in this country demands Patients' Bill of Rights in the form 
of Norwood-Dingell. They refuse to do it. They are being clever. The 
American public will certainly not be fooled by that.
  Mr. GOSS. Mr. Speaker, I am very happy to yield 1 minute to the 
distinguished gentleman from Tennessee (Mr. Bryant).
  Mr. BRYANT. Mr. Speaker, I thank the gentleman for yielding me the 
time.
  Mr. Speaker, there are two bills, I might remind my colleagues on the 
floor. One bill that we will discuss later today and tomorrow will 
consider various ways to provide patient protection to people in 
America. And many of us support that.
  But right now what we are talking about is a rule that also covers an 
access bill which we are going to debate immediately after this rule. 
What this access bill does is it provides an opportunity for 44 million 
people who do not have insurance right now who do not have anything to 
do with that second bill because they do not have any insurance. They 
do not need protection from anything.
  What we need to do now in this rule and in this bill is pass this so 
we can deal with those 44 million people and provide them access, the 
opportunity to see a doctor, go to a hospital, and get good quality 
care at affordable prices.
  What this bill will do, it will not set up another Government 
entitlement; but it will provide incentives to private businesses, tax 
deductions, tax credits, and opportunities to pool together in areas 
that will be able to get them to affordable, quality, insurance 
coverage.
  These folks do not care about this other thing right now until they 
get that coverage.
  Mr. FROST. Mr. Speaker, I yield 2 minutes to the gentleman from Texas 
(Mr. Green).
  Mr. GREEN of Texas. Mr. Speaker, I am surprised that we have this 
rule here on the floor today and hear the debate talking about the 
access bill that will allow 44 million people to have insurance.
  We have had a Republican majority for 6 years, and it is the first 
time I have heard concern for that 44 million. My colleagues talk about 
these bills did not have a hearing in the Committee on Ways and Means 
at any time was a decision by the Republican leadership not to have a 
hearing on any of these bills.
  I worked for years on the Committee on Commerce so I could deal with 
health care. None of the bills had hearings that we are debating today 
in the decision to bring them to the floor. It is becoming increasingly 
clear that the leadership does not reflect the views of the majority of 
this House on many issues.
  The Republican leadership is using the Committee on Rules to defeat 
legislation supported by majority Members of the House and attempting 
to defeat by subterfuge what they cannot defeat on a straight up or 
down vote.
  The Republican leadership cannot defeat the bipartisan Norwood-
Dingell proposal, so it attempts to change the proposal so that it is 
unacceptable to the bipartisan Members who support a real strong 
Patients' Bill of Rights. That is why this rule is so wrong. That is 
why it should be defeated.
  By denying the gentleman from Georgia (Mr. Norwood) and the gentleman 
from Michigan (Mr. Dingell) the right to finance the small portion of 
their legislation, the Republican leadership is trying to create a 
situation that they can claim that a vote for a Patients' Bill of 
Rights is an effort to spend the Social Security surplus.

                              {time}  1215

  That is not the intent. Hopefully, before the day is through, we will 
have a chance to pass a clean Norwood-Dingell bill. It is what the 
people want, what 83 percent of the people in a most recent poll said. 
I know at all the town hall meetings that I have they say that. They 
want patient protections just like, Mr. Speaker, we enjoy in Texas for 
our constituents under Texas law. We need them for all the Americans.
  Mr. GOSS. Mr. Speaker, I yield myself 1 minute.
  Mr. Speaker, I would point out that all but one of the speakers on 
the other side, according to my records, signed a discharge petition to 
bring this matter forward, the original bill, the underlying bill, to 
our attention, without the pay-fors in it.
  I would point out that this is a procedure that is designed to end-
run the committee system and point out particularly, as one looks at 
the discharge petition, that the first two signatures on it are the 
gentleman from Michigan (Mr. Dingell) and the gentleman from Missouri 
(Mr. Gephardt).
  If that does not send a message that this is being done in a way to 
end-run the regular order and put a partisan aspect to it, I do not 
know what does.
  The other thing I would like to point out is that we have crafted a 
rule that does, in fact, provide for a full debate on liability, which 
is the nugget of the patient protection.
  We have also done something in this rule, and that is provide for 
worrying about those Americans who do not have health care insurance, 
and it is time somebody did worry about them and the Republican 
majority is doing that and providing a way to help them. That is 
worthwhile, and if anybody says that is unfair they have a warped sense 
of what is fair in this country.
  Mr. Speaker, I reserve the balance of my time.
  Mr. FROST. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, we signed a discharge petition. That is the only way to 
get the attention of the majority. They have to be hit right between 
the eyes. It happens all the time around here. When we were in the 
majority, they signed discharge petitions. We are in the minority. We 
sign discharge petitions, and that was a successful effort which forced 
them to bring a bill to the floor they did not otherwise want to bring 
to the floor.
  Mr. Speaker, I yield 1 minute to the gentleman from Texas (Mr. 
Turner).
  Mr. TURNER. Mr. Speaker, I was proud to join in signing that 
discharge petition because the truth is, we would not be here today had 
some of us not been willing to sign that discharge petition to allow 
this very critical issue to be brought to the floor of this House.
  The truth of the matter is, even after it has become apparent to 
everyone in this body that a majority of the Members of this House, if 
given the opportunity on a straight up or down vote,

[[Page 24197]]

will vote for the Norwood-Dingell bill, the Committee on Rules has 
crafted a very complicated rule that most American people will never 
understand, whose sole purpose is to try to once again defeat the 
opportunity to pass strong patient protection legislation.
  The trick they have used is to attach another bill that has a nice 
ring to it, a bill to provide access to health care, that just happens 
to have a $40 billion to $50 billion price tag on it, a bill that never 
had any hearings in the Committee on Ways and Means, attached to the 
Norwood-Dingell bill in the complicated rule that is before this House, 
simply to weigh it down and try to get some of the folks that are 
supporting the bill to vote no.
  It is not going to work. At the end of the day, we will prevail 
because the American people want to see strong patient protection 
legislation.
  Mr. FROST. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, all we ask is for an opportunity to consider this 
legislation under a fair rule. For months and months and months the 
other side has decried and shed great tears about efforts to invade the 
Social Security trust fund. All we ask is for an honest approach to 
this legislation, which would permit this legislation not to take a 
penny out of the Social Security trust fund.
  This is a good bill. Everyone agrees this is a good bill. Let us have 
this bill considered under a fair procedure so that we can get to the 
merits of the legislation. Let us not take money away from Social 
Security in so doing, and let us pass a strong patient protection piece 
of legislation.
  We will oppose the rule and ask for a fair rule on this floor.
  Mr. Speaker, I yield back the balance of my time.
  Mr. GOSS. Mr. Speaker, I yield such time as he may consume to the 
gentleman from California (Mr. Dreier), the distinguished chairman of 
the Committee on Rules.
  Mr. DREIER. Mr. Speaker, I want to congratulate the gentleman from 
Florida (Mr. Goss) for the fine job that he has done on this issue.
  It is not often that I stand in this well somewhat saddened over the 
debate that we have gone through. This is one of the first times that I 
can remember that the gentleman from Florida (Mr. Goss) used the word 
``warped.'' Last night, he pounded on the table upstairs.
  If there is any kind of unfairness, it is coming from the rhetoric 
that we have gotten from the other side of the aisle, using words like 
``cynical'' and ``calculated'' to describe what we are doing here.
  One hundred and eighty-four Members signed the discharge petition. I 
have to tell my friends on the other side of the aisle, that is not 
what it takes to force a bill to the floor.
  We very much want a deal, with the fact that there are 44.3 million 
Americans who do not have insurance, and we want to increase 
accessibility for them. We also want to make sure that people are 
accountable when there are problems out there, and that is exactly what 
we are doing with the reform measure itself. We also want to make sure 
that affordability is out there, and that is what we are doing with 
this measure.
  This is a very fair bill. My colleagues are screaming about one 
amendment on the other side of the aisle. Fifty-nine amendments were 
submitted to our committee. Forty-three Republicans were denied, and 
the Members on the other side are saying this is an unfair rule because 
of the six amendments the Democrats submitted, one of them was not made 
in order. Well, that to me is unfair rhetoric.
  We are about to proceed with what I think is going to be a very fair, 
fair debate. In fact, we have to go back a quarter of a century, 25 
years, to the debate in 1974 on the ERISA act to find a rule that is 
more fair.
  Now a lot of people have been complaining, saying that this bill ties 
together the reform package and the access package. It does not do 
that. At the end, after the votes are taken, they are engrossed and 
will be sent to the other body for a conference, which we hope will 
address each issue.
  So if someone does not want to vote for the access bill, they do not 
have to vote for the access bill. They can still vote for the reform 
bill and only after both measures pass will they be engrossed and sent 
to the other side of the Capitol.
  So I happen to believe very strongly that we are going to begin an 
important debate. Everyone acknowledges that there are problems with 
our health care, in spite of the fact that we have the best health care 
system on the face of the earth. People come from all over the world to 
enjoy it, but there are still problems. They need to be addressed and 
this bill, with three balanced substitutes, will allow for an open 
debate, a fair debate; and I urge my colleagues to support it.
  Mr. COSTELLO. I rise today in strong opposition to the process 
imposed in the House today by the Republican leaders. Once again the 
Republican-led Congress has made in order a rule they know will defeat 
the bipartisan Norwood-Dingell bill, the only bill that could provide 
real managed care reform for 32 million Americans. This is the 
Republicans clever way of fooling the public into thinking they would 
like to pass a real managed care bill.
  Mr. Speaker, the rule does not allow the bipartisan Norwood-Dingell 
bill to be offered in its original form and then links it with another 
poorly crafted bill that will deny access to the 32 million uninsured 
individuals in the lowest income bracket. This scheme is unacceptable, 
the Republican leadership should be ashamed.
  The ``access bill'' that will be tied to the real managed care bill 
is for the healthiest and wealthiest of individuals. By expanding 
Medical Savings Account (MSAs), the access bill discourages preventive 
care, and undermines the very purpose of insurance. When we voted on 
the Kennedy-Kassebaum Health Insurance Portability Protection Act in 
1996 I supported the MSA demonstration project. However, this 
demonstration project turned out to be a failure. Of the 750,000 
policies available only 50,000 have been sold. In my own congressional 
district in southwestern Illinois my constituents do not have access to 
these policies.
  This access bill and the rule is just another attempt by the 
Republican-led Congress to undermine a bipartisan bill that could 
provide relief for millions of Americans. I am outraged that the Rules 
Committee denied Representative Dingell's request to offer an amendment 
to pay for this legislation. As a general rule the Republican 
leadership demands that legislation not bust the budget caps imposed in 
1997. While the Norwood-Dingell bill was not expected to require 
additional spending, the Congressional Budget Office estimated it would 
cost $7 billion. Representative Dingell offered to offset the bill so 
that Members like myself who wish to protect Social Security could cast 
their vote in support of real managed care reform while ensuring the 
Social Security Trust Fund would not be touched.
  As a cosponsor of the Bipartisan Consensus Managed Care Improvement 
Act--legislation strongly supported by doctors and by the American 
Medical Society and the Illinois State Medical Society--I believe it is 
the only real reform bill that will provide a comprehensive set of 
consumer rights that includes guaranteed access to emergency care and 
specialists, choice of providers, and strong enforcement provisions 
against health plans that put patients' lives in jeopardy. I am pleased 
the bill protects our small business owners by excluding businesses 
from liability if they do not make the decisions. This bill contains 
provisions that create safe harbors to ensure that no trial lawyer will 
accuse an employer of making a decision by simply choosing what 
benefits are in a plan or providing a patient benefit not in a plan. I 
am encouraged by the State of Texas who gave their citizens the right 
to sue HMOs for the past 2 years. In that time there have only been 
four cases filed.
  I urge my colleagues to oppose this rule and support real managed 
care reform legislation. Vote for the bipartisan Norwood-Dingell 
legislation.
  Ms. MILLENDER-McDONALD. Mr. Speaker, our day has been consumed with 
debate on a desperate rule drafted to derail the bipartisan managed 
care reform bill. This disheartens me because the Norwood-Dingell bill 
is a good bill. It is such a good bill; the three alternatives have 
used it as their base. Why is that? Maybe because over 260 medical 
organizations have endorsed it. Maybe because many of our constituents 
want us to pass it. Whatever the reasons may be, they are all for 
naught if this good bill has to be joined with the poison pill train 
that the rules committee placed on our tracks.

[[Page 24198]]

  The Norwood-Dingell bill allows women to obtain routine ob/gyn care 
from their ob/gyn without prior authorizations or referral. This is a 
good step in the right direction. As a staunch advocate for women, I 
prefer women having the opportunity to designate their ob/gyn as their 
primary care provider but--that is another battle for another time.
  Norwood-Dingell also looks out for our children. Parents now have the 
opportunity to select a pediatrician as a primary care provider. This 
provision gives parents a level of comfort knowing that their child's 
doctor understands the health needs of children.
  Mr. Speaker, this bill needs a straight up or down vote. It should 
not be joined and we should not be forced to vote on both bills. When a 
straight up or down vote--without poison pills--is allowed, I urge my 
colleagues to vote ``yes'' on the Norwood-Dingell bipartisan managed 
care reform bill.
  Mr. GOSS. Mr. Speaker, I yield back the balance of my time, and I 
move the previous question on the resolution.

                          ____________________