[Congressional Record (Bound Edition), Volume 145 (1999), Part 19]
[House]
[Pages 28190-28200]
[From the U.S. Government Publishing Office, www.gpo.gov]



    MOTION TO INSTRUCT CONFEREES ON H.R. 2990, QUALITY CARE FOR THE 
                         UNINSURED ACT OF 1999

  Mr. DINGELL. Mr. Speaker, I offer a motion to instruct conferees on 
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; 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; and 
for other purposes.
  The SPEAKER pro tempore (Mr. LaTourette). The Clerk will report the 
motion.
  The Clerk read as follows:

       Mr. Dingell moves that the managers on the part of the 
     House at the conference on the disagreeing votes of the two 
     Houses on the Senate amendment to the bill H.R. 2990 be 
     instructed to insist on the provisions of the Bipartisan 
     Consensus Managed Care Improvement Act of 1999 (Division B of 
     H.R. 2990 as passed by the House), and within the scope of 
     conference to insist that such provisions be paid for.

  The SPEAKER pro tempore. The gentleman from Michigan (Mr. Dingell) 
and the gentleman from Virginia (Mr. Bliley) each will control 30 
minutes.
  The Chair recognizes the gentleman from Michigan (Mr. Dingell).
  Mr. DINGELL. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, we will be shortly appointing conferees to the 
bipartisan Managed Care Improvements Act. Earlier this month, the House 
by an overwhelming bipartisan vote of 275-151 approved a strong bill to 
protect patients' rights. Before voting on final passage, the House 
rejected three substitutes. We will shortly be going to conference with 
the Senate.
  It will be noted that a number of the conferees appointed by the 
Senate and perhaps by the Speaker may not have shared the position of 
the House and in fact have voted against the bill. That is why this 
bipartisan motion to instruct is so important. It is a reminder to our 
conferees that the House voted for strong protections for patients and 
rejected weaker ones. This instructs the conferees to support the 
position of the House.
  Specifically, it is a proposal that covers all health plans, not just 
a limited few. We want a bill that lets the doctors decide what is in 
the best interest of the patient, not health insurance bureaucrats. We 
want a bill that has a

[[Page 28191]]

strong independent review of HMO decisions. We want a bill that is 
going to address the unfortunate case when your HMO causes an injury or 
wrongful death, that the HMO will be responsible like any other 
business in America. The Senate bill does none of these things.
  The motion which I am offering jointly with the gentleman from 
Georgia (Mr. Norwood) and the gentleman from Iowa (Mr. Ganske) reminds 
our House conferee Members to insist on strong patient protections. The 
motion is also fiscally responsible. It instructs House conferees to 
assure that the bill will be fully paid for. The President said that he 
will not sign a bill which is not fully paid for. The House can do no 
less than to see to it that the bill we send to the President is fully 
paid for, as he insists.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BLILEY. Mr. Speaker, I yield myself 5 minutes.
  Last month, this House passed H.R. 2990, the Quality Care for the 
Uninsured Act, and I was proud to support this measure. I said before 
the final passage of this legislation that there was nothing of greater 
importance that this body can do in the area of health care than to 
help those who do not have health coverage gain access to affordable 
care.
  I continue to believe in and look forward to working with the Senate 
on our proposals to provide tax relief to the uninsured and to the 
self-employed. I also look forward to working on the proposals to 
provide new options for small employers to gain coverage through 
HealthMarts. The House also passed H.R. 2723, the bipartisan Consensus 
Managed Care Improvement Act of 1999, the so-called Norwood-Dingell 
bill.
  In accordance with the rule that governed floor consideration of 
these two measures, the text of H.R. 2723 has now been included in H.R. 
2990. The motion to instruct we are debating today seems harmless 
enough. It instructs conferees to insist on the provisions included in 
the House-passed managed care bill when negotiating with the Senate and 
also to insist that this measure be paid for.
  However, I must oppose this motion. First, we are sending a strong 
team in to negotiate with the Senate. I recognize there are significant 
differences between the two bills that need to be reconciled, but I do 
not feel it is appropriate to tie the conferees' hands in any way prior 
to entering those negotiations. What kind of a message does it send our 
Senate colleagues if we give last-minute instructions that may hinder 
our negotiating ability? This could be interpreted improperly as a vote 
of no confidence on behalf of the House and would seriously weaken our 
negotiating position.
  Second, as the contentious debate over the Norwood-Dingell bill last 
month indicated, there are significant policy differences that divide 
Members of this body in the area of patient protections. I did not 
support final passage of this measure because I believe it goes too far 
by allowing patients to sue their health plans in State courts. I also 
fear it will ultimately be very costly and cause the number of 
uninsured to grow even more.
  However, I do respect the will of the majority in passing the 
Norwood-Dingell bill. That said, I do not believe it is appropriate at 
this time to instruct conferees to insist that all the provisions of 
the Norwood-Dingell bill be included in the conference package. By its 
very nature, a conference requires compromise in order to be 
successful. Again, I oppose tying the hands of our conferees before we 
ever get to the negotiating table with our Senate colleagues.
  Mr. Speaker, I am anxious to begin our negotiations with the Senate 
to craft a reasonable bipartisan compromise of our respective managed 
care bills. I want these negotiations to be free of any unnecessary 
instructions that may limit Members' ability to engage in free and open 
dialogue with the Senate regarding these important policy decisions. 
For this reason, I oppose this motion and ask my colleagues to do the 
same.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentlewoman from California (Ms. Eshoo).
  Ms. ESHOO. I thank the distinguished ranking member of the Committee 
on Commerce for yielding me this time. Mr. Speaker, when we passed the 
bipartisan patients' bill of rights on October 7, we made a commitment 
to the American people to reform the managed health care system in our 
country. Webster's dictionary defines reform as, quote, ``to put an end 
to a harm by introducing a better method or course of action.''
  The Senate bill does not provide a better course of action. Rather, 
its weak consumer protections continue to allow HMOs to sacrifice 
quality and reliability for profits. As we go to conference with the 
Senate, we must insist that the basic consumer protections included in 
the House-passed patients' bill of rights are retained, the guaranteed 
access to specialists at no additional cost, the access to saving 
clinical trials, the assurances that medical decisions are made by 
physicians, not insurance bureaucrats, the direct access to OB-GYN 
services, the ability to hold our health plans accountable in court 
when its decisions to withhold or limit care cause injury or death. I 
urge my colleagues to vote yes on the Dingell motion to instruct 
conferees.
  Mr. BLILEY. Mr. Speaker, I yield 4 minutes to the gentleman from 
California (Mr. Thomas), chairman of the Subcommittee on Health of the 
Committee on Ways and Means.
  Mr. THOMAS. Mr. Speaker, I thank the Chairman, the gentleman from 
Virginia for yielding me the time. I just think that in case someone 
thinks that what we are doing here is significant and important, you 
have to understand under the rules that either body, the House or the 
Senate, in this case the House, can instruct its conferees; and this is 
a motion to instruct. It has no binding on a conference between the 
House and the Senate. It is an attempt on the part of the folks who 
offered the motion to try to tilt the relationship between the House 
and the Senate.
  Now, the measure that we are taking to conference was already debated 
and voted on in the House and we passed it, so the House's position is 
well known. The motion to instruct is to, in fact, insist on the 
provisions of the bipartisan Consensus Managed Care Improvement Act. 
But there is no way that this motion to instruct can make anything 
happen. Remember in the Constitution in article 1, coming from the old 
Connecticut compromise between the large States and the small States, 
that both were concerned about the powers, and so there was created the 
concept of two separate Houses, one based upon geography, two 
representatives, or Senators, from each State and one based upon 
population, which continues to grow. There is no limit on the size of 
the House; it is tied to the population of the United States. And so 
you have State interests; and remember, initially under the 
Constitution, those Senators were appointed by State legislatures.
  Now, the Senate is an entirely different body than the House. They 
have different rules. They are elected in a different way. And so when 
the House and the Senate come together in a conference, it is because 
the Constitution says that the House and the Senate have to agree 
exactly on the same piece of legislation that is then sent to the 
President; and if they cannot agree, then notwithstanding the effort in 
both the House and the Senate, the legislation passed in both the House 
and the Senate does not go anywhere.
  So our job as conferees will be to go over with the Senate and sit 
down, equal bodies, both with the same ability to pass a piece of 
legislation but both of us helpless if we cannot come together. The 
House-passed one cannot get to the President; the Senate-passed one 
cannot get to the President unless the House and the Senate agree. And 
you have already heard the significant difference between the Senate-
passed bill and the House-passed bill.
  So what we are going to have to do is something that is uniquely 
American in terms of the political environment.

[[Page 28192]]

That is, from the very beginning, decisions made in this country in 
part, because of the two fundamentally different houses, has been based 
on accommodation and compromise. We cannot go anywhere without 
accommodation and compromise. The Senate feels strongly about their 
position. They passed it. There is a majority backing their position.
  The House feels strongly about its position, those who voted for that 
measure. They had a majority backing them. But when we go to 
conference, if the House's position is, United States Senate, we don't 
care what you did, we're not going to look at what you're going to do, 
you have to accept everything in our bill, that is exactly the position 
that we take, and we ain't changing it. How successful do you think 
that is going to be? It is kind of absurd. So understand, this is a 
political exercise.
  There is no reason to vote this motion to instruct. We have the bill; 
let us get on with our work. Let us vote down the motion to instruct. 
Let us not insult the Senate the very first day we are supposed to sit 
down with them and try to reconcile the differences between the two 
bills. Let us live up to what the American people expect us to do, sit 
down, accommodate, compromise, produce a good product and get it to the 
President, instead of posturing as this motion to instruct clearly is. 
Vote ``no.''
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to my good friend, the 
gentleman from Iowa (Mr. Ganske), who has worked very, very hard on 
this matter.
  Mr. GANSKE. Mr. Speaker, I rise in support of this motion to 
instruct. I have always considered the Speaker of this House to be my 
friend and mentor, my coach. In urging him to run for Speaker, I did so 
because I considered him to be fair and to play not just by the letter 
of the rule but by the spirit of the rule as well. The Speaker and I 
are old wrestlers. One of the great things about wrestling is that you 
win or lose on the mat, not by selecting the referee.

                              {time}  1115

  If the Speaker as coach had a referee steal a deserved victory from 
one of his wrestlers, he would have lost respect for that referee. 
Well, the Patient Protection Act won on the mat 275 to 151. As the GOP 
authors of this bill, the gentleman from Georgia (Mr. Norwood) and I 
should be named conferees. To technically deny us our spots would be to 
violate the spirit of naming conferees. To not name us as conferees 
would be like a referee disqualifying a wrestler for a legal move.
  Mr. Speaker, your leadership rests on a small majority, and that 
rests on respect. If you deny the gentleman from Georgia (Mr. Norwood) 
and I our spots as conferees, you will be endangering that respect. 
Payne Stewart and Walter Payton's legacies rest just as much on the 
respect of their colleagues as honorable men as it did for their feats 
on the field.
  Two hundred years ago Thomas Jefferson said that democracy rested not 
on leadership's sleight of hand, but on the active participation of its 
citizens. The House has spoken unequivocally on which bill it prefers 
for patient protection. I would hope that the conferees you name would 
reflect that decision.
  It is rumored that not one of the GOP Members to be named as 
conferees voted for the Patient Protection Act. If that is the case, 
then, Mr. Speaker, you are relying on sleight of hand that Thomas 
Jefferson warned against.
  Mr. SHADEGG. Mr. Speaker, I yield 1 minute to the gentleman from New 
York (Mr. Lazio).
  Mr. LAZIO. Mr. Speaker, I think this motion to recommit should be 
defeated for the following reasons. I think the gentleman from 
California laid out some of the reasons in terms of giving the 
conferees the maximum flexibility to get the best possible bill.
  Let me give you one example as to why we need to provide flexibility 
for the conferees. Cancer patients have been waiting for years for the 
ability to have insurance companies pay for routine, routine, care for 
clinical trials. Under Dingell-Norwood the most important clinical 
trials that are conducted, FDA-approved clinical trials, fall outside 
the scope of the requirement for insurance companies to pay for routine 
care.
  The conferees need to have the maximum flexibility to strengthen and 
improve this bill. Nobody, Mr. Speaker, in the end has got a market on 
all the wisdom on health and insurance, HMO reforms. We have to give 
our conferees the maximum flexibility to get the best possible bill for 
cancer patients and for others looking for our guidance.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from California (Mr. Stark).
  Mr. STARK. Mr. Speaker, I thank the distinguished gentleman for 
yielding me time.
  Mr. Speaker, I am pleased that we are going to conference for the 
managed care reform bill. It is clearly the wish of the majority that 
the House bill as passed be enacted into law. Under the rules of the 
House, the Speaker is directed to appoint Members, and no less than a 
majority who generally supported the House position, as determined by 
the Speaker.
  It is quite clear what the House position was. The conferees have not 
been appointed according, to my understanding, to that rule, and that 
does in fact necessitate our insisting that we hold to the position of 
the House. That is what you do in a democracy. The winner's position is 
the law and people should obey it.
  The public wants this. They have spoken. Whatever the Senate or the 
other body may have or have not done is not our issue. We are here to 
see that we fulfill the wishes of the vast majority of this body 
representing the vast majority of Americans, I believe it is close to 
80 percent, who favor the strongest possible managed care control bill. 
The distinguished authors of this bill have done that, the House has 
worked its will, and it is our job to carry it out.
  It is my hope that the leadership will not frustrate this by slowing 
down, stalling, postponing the conference in other procedural moves, 
which is their prerogative. But I suggest they do so and they will 
incur the wrath of many Americans who are denied adequate and fair 
treatment from many managed care plans. They are the people who will be 
the losers if we do not insist on the House position and see that it 
prevails.
  Mr. SHADEGG. Mr. Speaker, I yield 3 minutes to the distinguished 
gentleman from Tennessee (Mr. Bryant).
  Mr. BRYANT. Mr. Speaker, I thank the gentleman for yielding me time.
  Mr. Speaker, reluctantly I must rise in opposition to this motion. I 
have a great deal of respect for the senior Member in this Congress, 
the gentleman from Michigan (Mr. Dingell), who cosponsored this bill 
with other people I have tremendous respect for, the gentleman from 
Georgia (Mr. Norwood) and other primary sponsors, the gentleman from 
Iowa (Mr. Ganske), who are undoubtedly experts in this area of health 
care.
  Likewise, I have great respect for other positions in this body who 
supported other measures, the gentleman from Oklahoma (Mr. Coburn), the 
gentleman from Florida (Mr. Weldon), the gentleman from Kentucky (Mr. 
Fletcher), and the gentleman from Arizona (Mr. Shadegg), a cosponsor of 
the Shadegg-Coburn bill which I voted for.
  There is no perfect bill. Norwood-Dingell is not a perfect bill. 
Shadegg-Coburn contained many good provisions I think that ought to be 
considered. One hundred-fifty Members supported that bill, and, as we 
move toward a conference, we have to look to the Senate and look at the 
bill that they have got. They have got some good ideas there too.
  My concern is that we all I think agree that we want to be able to 
have patients that are under managed care to receive the best quality 
treatment that they can get, and we want the managed care groups that 
manage this care and the costs associated with that to be accountable 
in some way. All of these bills do that.

[[Page 28193]]

  We want to do all these things, while making sure we do not make it 
so expensive that we chase employers, people who provide insurance to 
their employees, that we do not chase them out of the market and add 
more employees to that list of uninsured. Already in this country we 
have 44 million people who do not have medical insurance, and we do not 
want to add to that list. So we have a great balancing act that we must 
accomplish here, and, as we move towards conference, I think we can do 
that.
  I think we can make this bill a better bill. But we do not do that, 
and the reason I rise in opposition to this motion, is we do not do 
that by unduly restricting our negotiators, tying their hands, because 
there are other good ideas in this House, there are other good ideas in 
the Senate, and it is at that point that our rules provide that we sit 
down and negotiate in the interest of all Americans interested in 
health care, we do so on a good faith basis, not with our hands tied, 
and come up with a more perfect bill. I think we can do that if we do 
not pass this motion.
  I urge my colleagues to vote against this motion to instruct 
conferees, with the trust and assurance that we can make this bill an 
even better one for the American people.
  Mr. DINGELL. Mr. Speaker, I am happy to yield 2 minutes to the 
distinguished gentlewoman from New Jersey (Mrs. Roukema), who has 
displayed extraordinary courage and diligence and vigor throughout this 
matter.
  Mrs. ROUKEMA. Mr. Speaker, I thank the gentleman for yielding me 
time.
  Mr. Speaker, I rise in strong support of this motion to instruct. I 
want the people in this House to understand what we are doing here. We 
are saying we support the House bill, which covers 161 million 
Americans, that is all the Americans in this country who are covered by 
insurance plans whereas the bill from the Senate discriminates against 
our people based on the state from which you come. The Senate 
legislation only covers 48 million Americans. So remember that when you 
vote on this. That is one of the reasons this bill passed 
overwhelmingly with bipartisan support in the House. Lets not 
discriminate. We must cover all 161 million insured constituents.
  Finally, I just want to point out something. If you have any doubt 
about the backlash and the politics out there among your constituents, 
just look at this week's Newsweek Magazine (November 8, 1999). If you 
cannot see it, I will read it to you. ``The war over patient rights. 
HMO hell.''
  Then it says in the body of the article, ``From the Capitol to the 
kitchen tables, from frustration with HMOs to worries about health 
care, it is topic A, and the patients are ready to rumble.'' Again, 
reading from this Newsweek magazine, ``H.M.O. Hell: The Backlash.''
  Mr. Speaker, I say we have to support the House position and go to 
conference with this motion to instruct in the interests of our 
patients who are suffering a rationing of professional care.
  Mr. SHADEGG. Mr. Speaker, I yield myself 30 seconds.
  Mr. Speaker, I have the same edition of Newsweek Magazine and noted 
various things in it, including the fact that it pointed out that 
access to specialists is denied much more frequently by HMO plans than 
by fee-for-service plans. But I wonder if the last speaker, who is 
supporting the motion to instruct, understands that that motion to 
instruct puts fee-for-service plans under the same regulation as HMO 
plans? That is, they impose the same regulatory burdens on fee-for-
service, which is treating people well, according to this magazine 
article, as it does to HMOs.
  I suggest that sticking to the motion to instruct and tying our hands 
is not the right answer.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from New Jersey (Mr. Pallone).
  Mr. PALLONE. Mr. Speaker, there are two obvious reasons why this 
motion to instruct the conferees to support the Norwood-Dingell bill 
should be supported. The first is that the Norwood-Dingell bill 
provides meaningful patient protections, whereas the Republican 
leadership bill in the other body is a sham proposal designed to 
protect the insurance industry.
  The second is that the vote in the House on the Norwood-Dingell bill 
was one of overwhelming support and fairness demands that that vote be 
reflected in the conference.
  When it comes to the substance of the bills, my colleague from New 
Jersey pointed out that the partisan bill passed by the GOP in the 
other body excludes more than 100 million people from its provisions. 
It applies only to people in self-funded plans. These types of plans 
are typically offered only by large employers and cover only 48 million 
Americans. The Norwood-Dingell bill, on the other hand, applies to all 
161 million privately insured Americans.
  The differences between the bills though run a lot deeper than this 
gross disparity in the coverage. The protections in the Norwood-Dingell 
bill are vastly superior to those limited protections proposed by the 
GOP leadership in the other body.
  Just as some examples, the GOP leadership bill in the Senate provides 
no guarantees that if you have to go to the nearest emergency room in a 
situation where you have an emergency, that is going to be covered or 
you will not have to foot the bill yourself. In the Norwood-Dingell 
bill, if you go to the nearest emergency room, you are going to be 
covered.
  The GOP leadership bill does not guarantee direct access to OB-GYN 
for women. The Norwood-Dingell bill does. The leadership bill does not 
guarantee access to specialists out of the network, but the Norwood-
Dingell bill does. The GOP leadership bill allows HMOs to continue to 
define what type of care is medically necessary. The Norwood-Dingell 
bill allows doctors and patients to make that determination, not the 
insurance company bureaucrats.
  Finally, the GOP leadership bill does not provide for an independent 
external appeals process. The Norwood-Dingell bill does.
  In addition to that, the gentleman from Michigan (Mr. Dingell) 
mentioned that the GOP leadership bill does not allow you to sue your 
HMO because it leaves the ERISA exemption from liability in place. The 
Norwood-Dingell bill sides with the patients and lifts this preemption, 
giving individuals the right to sue their HMOs when they are denied 
needed care and their health suffers as a result.
  Support this motion to instruct the conferees.
  Mr. SHADEGG. Mr. Speaker, I yield 5 minutes to the distinguished 
gentleman from Oklahoma (Mr. Coburn), one of the co-authors of a bill 
which could not be considered if this motion to instruct were adopted.
  Mr. COBURN. Mr. Speaker, I thank the gentleman for yielding me time.
  Mr. Speaker, I have less than a year left in this body, and if I 
could make a change in anything, I would return it 150 years earlier so 
that the trick that we are seeing today would not be used. I have the 
greatest respect for the gentleman from Michigan (Mr. Dingell). He is a 
great politician, and rarely do I use that word in a positive sense in 
my lifetime. But I want to tell you what this motion does.
  What this motion does is it is going to allow the unions and the 
trial lawyers to run the hospitals, based on the clause that is in this 
as far as whistle blowers. It is a totally unneeded portion of the 
bill, but was put in to build constituencies and consensus.

                              {time}  1130

  It will ruin quality assurance in all the hospitals. There is no 
question in my mind about that.
  Number 2, the gentleman from Michigan (Mr. Dingell) said at the 
outset that we were mainly interested in patients. I happen to be 
qualified because I voted for the bill of the gentleman from Georgia 
(Mr. Norwood) and the gentleman from Michigan (Mr. Dingell) when it 
left the House. I am one of that 270.
  I voted for it for one purpose, I think we need to have some action. 
With this

[[Page 28194]]

motion to commit, there will be no health care bill for my patients. 
There will be no right to go after our HMO, if we follow this motion to 
commit, because there will be no combined bill, no compromise, and 
therefore, the President will never get to sign a bill out of this 
conference.
  If that is what we want to accomplish, and we want to use that as a 
political pawn in the next year's debate over who should be in control 
of Congress, then that is a legitimate thing. But it ought to be said 
that that is what it is for.
  That is not what a motion to instruct should be for. A motion to 
instruct should be, take out the whistleblower. Give the members of the 
committee, the conference committee, the ability to do what is right 
for our patients and for our country, not what is right for the 
Republican or the Democrat party.
  The gentleman from Georgia (Mr. Norwood) deserves a lot of credit for 
his work in this body. He worked, worked, worked. We have a health care 
bill on this floor because because of the courage of the gentleman from 
Georgia (Mr. Norwood); not for any other reason, because of the courage 
of the gentleman from Georgia. Let us not ruin a display of courage by 
making this a purely political ploy. That is what this is.
  I was not going to speak against it, but Mr. Speaker, my patients, 
the people in this country, the people in my district who are under 
HMOs who have no right of recourse today against unqualified medical 
personnel making decisions about their health care, they have no right, 
and this bill that we are going to have has no adequacy of network 
whatsoever in it.
  They do not even have to have an adequate network. The heck with 
specialists. They can say, I have a specialist, and they can have 1 and 
they need 200. This bill does not even address that. Do Members want to 
leave that that way in conference? No, they do not. I know they do not.
  Let us talk about what this really is. This is a political ploy, 
partly because of the inappropriate, and I will agree, the 
inappropriate naming of conferees on this bill. I agree with that. But 
it is the wrong way to accomplish the purpose.
  If we really care about patients, if we really want to solve the 
inequities in the health care system, and if we really want to solve 
the overall problem, which is opening up the market and allowing choice 
and markets to work in health care, Members will defeat this thing 
solidly.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentlewoman from Connecticut (Ms. DeLauro).
  Ms. DeLAURO. Mr. Speaker, I thank the gentleman for yielding time to 
me.
  Mr. Speaker, it is long past time for Congress to ensure that managed 
care means quality care for American families. Doctors and patients 
must make medical decisions, not insurance companies. If a patient is 
wrongly denied care, there must be some accountability. We expect 
individuals to take responsibility for their actions in this country. 
HMOs should be no different.
  We finally took up a Patients' Bill of Rights 4 weeks ago, but only 
after the Republican leadership was dragged there kicking and 
screaming. Republican leaders never wanted this debate because it was 
all too clear that they had chosen special interests over the national 
interest.
  Finally, after 4 weeks, the GOP leadership is bringing up a motion to 
go to conference on this bill. I hope that despite the maneuvering of 
the Republican leadership, that the common sense and the bipartisanship 
of this bill will prevail.
  Our colleagues from Michigan, Georgia, and Iowa teamed up to write a 
bipartisan balanced bill that protects patients' rights without undue 
burdens or threats to health care coverage. Now, after weeks of the GOP 
leadership's stall tactics, my good friend, the gentleman from 
Michigan, in conjunction with his Republican colleagues, is offering a 
motion to instruct that will insist upon the provisions of the 
bipartisan bill passed by the House on October 7, and upon offsetting 
the $7 billion on the House floor to fully pay for the bill.
  I urge my colleagues, vote yes on the motion to instruct. We need to 
ensure that patients have access to specialists, clinical trials, and 
OB-GYN services, among the many other patient protections that are 
found in the Norwood-Dingell agreement.
  We cannot allow the watered-down Senate provisions to prevail. Vote 
yes on the motion to instruct.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Ohio (Mr. Brown).
  Mr. BROWN of Ohio. Mr. Speaker, I thank the gentleman for yielding 
time to me.
  Mr. Speaker, today we call upon the conferees for H.R. 2990 to insist 
on the House-passed version of the Patients' Bill of Rights. That is 
the portion of H.R. 2990 that reminds health insurers that if they want 
to get paid, they must actually provide a meaningful health insurance 
product, not a cheap imitation.
  The Senate-passed bill may accomplish many things. It leaves out most 
Americans from coverage under the Patients' Bill of Rights. It may 
appease the insurance industry. It may provide cover for politicians 
who want to appear responsive to their constituents, when in fact they 
are too often catering to insurance industry lobbyists.
  What the Senate bill does not do is the one thing it is supposed to 
do. It does not ensure that employers and employees get what they pay 
for when they purchase insurance.
  In fact, there are HMO fingerprints all over the Senate version of 
the Patients' Bill of Rights. Pivotal reforms like the right to see a 
doctor outside the HMO network and the right to sue when a health plan 
acts in bad faith are simply missing. Other reforms have been watered 
down to such an extent that patients may be no better off with them 
than without them.
  Can anyone in this Chamber honestly say that that is what the public 
had in mind when it called for a Patients' Bill of Rights? If we ask 
the insurance industry which bill it prefers, there is no contest. The 
Senate bill would win. Managed care organizations take huge gambles, 
gambles they perceive as benign business decisions, with potentially 
harmful or even fatal consequences for their enrollees.
  I join my colleague, the gentleman from Michigan (Mr. Dingell), in 
urging the conferees to act in the best interests of the public and 
insist on the House-passed version of the Patients' Bill of Rights.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentlewoman from California (Mrs. Capps).
  Mrs. CAPPS. Mr. Speaker, I rise in strong support of the motion to 
recommit conferees. The gentleman from Michigan (Mr. Dingell), the 
gentleman from Georgia (Mr. Norwood), and the gentleman from Iowa (Mr. 
Ganske) demonstrate real leadership on protecting patients.
  I urge the House conferees to ensure that the Dingell-Norwood 
protections are included in the final bill. Patients and providers 
across this country have told us that HMO reform is their top priority.
  Congress now has a real chance to enact managed care reform and to 
improve patient care. But time is running out. With only a few days 
left before Congress adjourns, the time has come to put patients ahead 
of profits. The conferees need to meet before Congress goes out of 
session, and Congress should enact the Norwood-Dingell bill.
  Mr. SHADEGG. Mr. Speaker, I yield 5 minutes to the gentleman from 
Ohio (Mr. Boehner), the distinguished chairman of the Subcommittee on 
Employer-Employee Relations of the Committee on Education and the 
Workforce.
  Mr. BOEHNER. Mr. Speaker, I thank my colleague for yielding time to 
me.
  Mr. Speaker, I think all of us know that the motion before us is a 
nonbinding motion of the House.
  All of our colleagues understand clearly that this is an opportunity 
to have a political debate about the issue of health care reform in 
America. So let us have the political debate. But understand, this 
really does not mean anything.
  But as we have gone through the whole issue of reforming health care

[[Page 28195]]

over the last 7 years or so, the debate has grown. We have focused the 
debate away from the uninsured to accountability of HMOs. I do not 
think there is any Member of the House who does not believe that there 
is a way to bring accountability, more accountability, to managed care 
if it is done in a reasonable way.
  I think also we have learned over the last few years that when we 
start to bring accountability into the picture, we can get carried away 
with too much accountability that leads to less affordability for the 
American people, and we know that less affordability means less 
accessibility.
  While we all want managed care reforms and we want more 
accountability, we know that the far greater problem in America today 
is the fact that we have 44 million people who have no health insurance 
at all. We know that if we do things that are going to raise costs, we 
are going to drive down access.
  This is about a balance. We cannot consider access or accountability 
without considering affordability and accessibility. That is why the 
bill that left the House had a large access piece authored by my good 
friends, the gentleman from Arizona (Mr. Shadegg) and the gentleman 
from Missouri (Mr. Talent), that would help ensure we could address the 
growing problem of the uninsured in America.
  The bill that I think the House passed will lead to more uninsured if 
we do not do something about increasing the access provisions that were 
called for in the Shadegg-Talent access bill.
  Mr. Speaker, as we go to conference with the Senate, they have a 
completely different position, a much narrower bill. Some may argue 
they have a much more practical bill. What we as conferees have to do 
on behalf of the House is to find the right balance, find the right 
balance between accountability without driving employers out of the 
process, without driving up premium costs, and without driving more 
people into the ranks of uninsured, because what are these 
accountability measures going to mean to Americans if they have no 
health insurance? They mean nothing.
  Mr. Speaker, let us go work with the Senate. Let us find the right 
balance between accountability, affordability, and accessibility. I 
think that is what the American people expect of their representatives 
on both sides of the aisle, is to find that right balance.
  Mr. DINGELL. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from New Jersey (Mr. Andrews).
  Mr. ANDREWS. Mr. Speaker, I thank my friend for yielding time to me.
  Mr. Speaker, I rise in support of this motion. Mr. Speaker, if 
Members have ever lived in a neighborhood and they want to build a 
shopping center in the neighborhood, Members would understand why we 
are here making this argument today.
  If we have 100 of our neighbors together and two-thirds of them do 
not want the shopping center, and then we find out there is going to be 
a meeting at the town hall about whether to build the shopping center, 
and you have to pick seven of your neighbors to go represent your 
position, and someone says, let us take five people who want the 
shopping center and two who do not and send them to the meeting, I 
think most of us would say that that is ridiculous, the delegation we 
send from our neighborhood ought to reflect the sentiment of the 
neighborhood.
  On October 7, 275 of us voted strongly in favor of holding managed 
care plans accountable, over 60 percent of the Members of the House. We 
are going to go negotiate with the other body over a bill that does not 
have similar accountability provisions. As one of the prior speakers 
said, it should be self-evident what the House's position is, and it 
is. Over 60 percent of us believe that there ought to be accountability 
provisions, consistent with Norwood-Dingell.
  But we have every reason to believe that the delegation we are 
sending from our neighborhood is not going to reflect that point of 
view. It should reflect that point of view. The gentleman from Georgia 
(Mr. Norwood) should be one of those conferees, and the gentleman from 
Iowa (Mr. Ganske) should be one of those conferees. But it appears that 
will not be the case.
  The reason we are on the floor today is to tell our negotiating 
committee to keep in mind the sentiment of this neighborhood. We 
supported this legislation because the American people want 
accountability for health insurance companies. We are supporting this 
motion because the Members of this House want accountability from our 
conference negotiators. Support the motion.
  Mr. SHADEGG. Mr. Speaker, I yield myself 3 minutes.
  Mr. Speaker, the essence of this motion to instruct on its substance 
is very clear. It would bind the House conferees to the Norwood-Dingell 
version of the bill.
  I would like to ask a series of questions of whether we really want 
to do that.
  Let me begin with this one. The substitute offered on the House, one 
of the substitutes offered on the House side that did not pass allowed 
access to ambulance services. Norwood-Dingell did not. Would the 
proponents of this motion to instruct say we should not allow or 
guarantee access to ambulance services?
  The substitute offered external appeal timelines that were shorter 
than Dingell-Norwood, getting people more care even more quickly than 
Dingell-Norwood.

                              {time}  1145

  Do the proponents of this motion to instruct oppose an even shorter 
time period for special appeals, getting people care even more quickly?
  The substitute that we offered we called for binding arbitration for 
those who did not want to go to court. There was no similar provision 
in Norwood-Dingell.
  Did the proponents of this substitute which would bind us to Dingell-
Norwood and Dingell-Norwood only say that we should not allow binding 
arbitration?
  The substitute that we offered provided access to all cancer clinical 
trials, as one of the earlier speakers noted. That is much broader than 
Dingell-Norwood for cancer patients because Dingell-Norwood does not 
include FDA-approved clinical trials. Two-thirds of new cancer drug 
tests are FDA approved.
  Do the proponents of this motion to instruct say that we should not 
have the broader provision that does more for cancer victims on 
clinical trials?
  The Norwood-Dingell bill does not guarantee either pathology or 
laboratory services. The substitute did.
  Did the proponents say we should be bound to their version and not 
offer pathology or laboratories services?
  We created a panel to ensure network adequacy, to make sure that if a 
plan said they had a doctor, there were enough doctors with that 
specialty to actually service their patient base. Norwood-Dingell has 
nothing to cover network adequacy.
  This motion to instruct would commit us to a plan that does not even 
require network adequacy, and that indeed is one of the problems noted 
in the Newsweek article discussed earlier.
  We prohibit plans from considering FDA-approved drugs or medical 
devices as experimental or investigational. Norwood-Dingell does not do 
that.
  The proponents of this motion to instruct would tie our hands and 
say, yes, we can take a procedure that has been approved by the FDA, a 
drug or a medical device; and even though it has been approved, label 
it experimental or investigational. The motion to instruct would tie 
our hands to a series of provisions that are not near as strong for 
patients as the substitute that was offered here on the floor.
  I urge my colleagues to reject the motion to instruct.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Texas (Mr. Lampson).
  Mr. LAMPSON. Mr. Speaker, if our colleague, the gentleman from 
Oklahoma (Mr. Coburn), would read the experience of Texas, he would 
know that

[[Page 28196]]

his statements about unions and lawyers is false, and he would vote yes 
on this motion.
  Not long ago I spoke about a constituent of mine, Regina Cowles, who 
was diagnosed with breast cancer but was being denied payment of a 
treatment by her insurance company. Regina ultimately got some of the 
help that we wanted for her from her insurance company, but it was too 
little too late. I am sad to report that Regina died last week.
  Regina and my own daughter, Stephanie, who was also denied coverage 
until a big fight reversed a decision, brought to mind the problem we 
have in this country with access to health care. It is one thing to 
keep costs down, but it cannot be done at the patient's expense. If 
adoption of this motion is supported, that will ensure in the 
conference that medical judgments will be made by medical experts.
  Adoption of this motion to instruct will give people like Regina 
Cowles and Stephanie Lampson the health care they deserve. It is time 
for us to put our money where our mouth is and prove to the American 
people that this Congress can work together to address issues they 
really care about.
  Mr. DINGELL. Mr. Speaker, it is a great pleasure for me to yield 4 
minutes to the next speaker, the gentleman from Georgia (Mr. Norwood), 
a very distinguished, very courageous, very energetic man who has 
provided enormous leadership in this matter, and my good friend.
  Mr. NORWOOD. Mr. Speaker, on October 7, the House passed a patient 
protection bill, 275 votes; and if we listened to the argument today, 
it is very clear to me that those who did not vote for that bill want 
to go into conference and have the bill that they put up that failed be 
the bill before conference.
  The gentleman from Ohio and the gentleman from California have all 
made it very clear that this is not binding, though the gentleman from 
Arizona (Mr. Shadegg), says, well, this is binding; but it is not and 
we all know that. It is not legal.
  The gentleman from Tennessee stood up and said that well, this would 
restrict our negotiators, which is not true.
  We are going to send our Members into conference, and they are going 
to do the best they can to work against a Senate bill that is 
absolutely not worth the paper it is written on. Now, that is a tall 
order; but we are told by the gentleman from California that this is 
our effort to tilt the relationship between the House and the Senate, 
and we are told by the gentleman from Oklahoma this is a political 
ploy.
  Well, I will say what this really is. This is about rumors floating 
around from a conference that will not even allow the authors on the 
Republican side to be on the conference. That is what this is all 
about. This is about a conference that is going to put everybody on the 
conference from the Republican side who voted against the bill.
  Now I think we might ought to be concerned about what is going to 
happen in conference when we send everybody in there who voted against 
the bill. That is what we call tilting the relationship between the 
House and the Senate, and that is what we call a political ploy.
  I want to thank my friend, the gentleman from Michigan (Mr. Dingell), 
on the other side of the aisle, for having considered me for one of the 
seats on the conference committee since my own party as yet has not 
offered me a seat. I am grateful.
  I humbly declined, as I believe my outspokenness against my own 
party's position in this matter might become the issue, and the 
committee does not need any distractions from the real issues before 
us, and that is protecting patients. Therefore, as I remain free to 
continue my outspokenness, I implore my leaders to be aware of the 
political reality as they seek a final course of action on this issue.
  They have for the last 5 years opposed patient protections and 
publicly allied themselves in joint news conferences with HMO 
lobbyists. Under public pressure, we forced a vote on October 7. They 
have even refused to allow a single subcommittee vote on this 
legislation. This, in spite of the support by the majority of the 
House, and a third of the Republican caucus, the majority of patients 
in this country support it; the majority of doctors, the majority of 
hospitals, even the majority of employers.
  I feel these same opponents believe they can now subvert the 
conference committee to produce a report repugnant to the original 
legislation in order to force the House of Representatives to really 
reject the final report. These opponents believe a multimillion dollar 
public relations campaign can shift that blame to the other party.
  I say today that the fate of the next election is in the balance and 
that plan will fail. Because of their past actions and affiliations, 
our party has no credibility on HMO reform. All the clever commercials 
that money can buy will not change that fact, but that fact can and 
should change if our conferees act with courage to enforce the will of 
this House.
  That is what this motion is all about. Go into the conference and 
fight for the position of this House. It is in perfect concert with the 
will of the American people. I urge my colleagues to support these 
instructions, to insist on full unencumbered legal accountability for 
HMOs; true external appeals and the protections of all Americans, all 
Americans, with health insurance, not just the few who need this the 
least. I want both Republican and Democratic patients to win. To 
accomplish that, both parties need to honor the will of the people 
instead of the will of the lobbyists. As I recall, that is our job and 
that is our duty.
  Mr. SHADEGG. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Louisiana (Mr. Cooksey).
  Mr. COOKSEY. Mr. Speaker, the patients and the public deserve managed 
care reform. The patients and the public deserve protection from the 
overreaching of the HMOs. For those who have a real knowledge of health 
care and the problems of the overreaching of HMOs, we know that we need 
HMO accountability. For those who have been refused health care by HMO, 
CEOs and HMO clerks, they know about the overreaching of the HMOs. They 
know that we need HMO reform.
  Unfortunately, the proposed rule or the proposed motion to instruct 
is too restrictive and will result in no HMO reform this year. This 
Congress, in its wisdom, passed ERISA protections some years ago; but, 
as so often occurs, there was overreaching by the HMOs. So today when 
we vote we need to vote against this motion to instruct, because this 
motion to instruct again gives the appearance that, in fact, the HMOs, 
the lobbyists, the big insurance companies, the CEOs of the HMOs have a 
disproportionate amount of influence in this body.
  We need to do the right thing for the public, for the patients, for 
the Americans who are under HMO health care.
  Mr. DINGELL. Mr. Speaker, I yield 3 minutes to the distinguished 
gentleman from Missouri (Mr. Gephardt), the leader of the minority, and 
my good friend.
  Mr. GEPHARDT. Mr. Speaker, I urge a vote for this motion to instruct. 
The issue that we are dealing with here is not a political issue. It is 
not a partisan issue, and it is not a party issue. After we passed a 
very strong and good bipartisan Patients' Bill of Rights here a few 
weeks ago, I had people come up to me in my district, people that I saw 
around the country and they came up to me and they said, finally the 
Congress, the House, has stood against the special interests and done 
what is good for patients, what is good for doctors, what is good for 
people. I want to urge us to keep that effort going and to realize it 
in this conference.
  Too often we have seen strong bipartisan measures be watered down to 
kill the real intent of legislation. We cannot let the bipartisan 
Patients' Bill of Rights fall prey to a back-door attempt to derail 
meaningful reform.
  The Senate bill does not measure up. We need to get a final report 
that looks more like the House bill and contains the solid protections 
that it contains.
  The Senate bill fails to ensure that medical judgments are made by 
doctors and patients, in consultation with

[[Page 28197]]

their patients. The medical relationship that is important here is what 
goes on between doctors and patients. They are the ones that should 
make the decisions about medical care, not some bureaucrat thousands of 
miles away who is looking at the bottom line and not what is good for 
that patient.
  The Senate bill fails to allow patients to see an outside specialist, 
at no additional cost, when their specialist in the health plan fails 
to meet their needs.
  The House bill allows patients to do that. The Senate bill fails to 
hold managed care plans accountable when their decisions to withhold or 
limit care injure patients. The House bill holds plans accountable.
  If doctors are accountable, the people that are making half the 
decisions ought to be accountable. How can we have a system that says 
doctors are accountable for the decisions they make, but we let the 
bureaucrats in the health plans that are just looking at the bottom 
line and profit totally unaccountable for the decisions they make?
  The Senate bill applies only to 48 million people in private 
employment-based plans, where the employer self-insures. The House bill 
applies to all people with employment-based insurance, as well as 
people who buy insurance on their own.
  We have to get to work on this. It has been 4 weeks since we passed 
the bill here. We are going toward a recess where nothing can get done. 
Let me say what I have said before. If someone is in a health care plan 
and they need something that their doctor says they need and their life 
is on the line today, they need this bill now. They do not need to wait 
until next spring or next summer or next fall or not at all.
  If a loved one in their family is waiting to be able to get the right 
decision out of a health care plan that could save their life, they 
need this bill now.
  I urge the leaders of the Congress in the House and in the Senate to 
get this conference going, to get a bill that is more like the House 
bill than the Senate bill, and to get it done in the next 2 weeks 
before we leave this Congress. We owe that to the patients and the 
doctors and the medical professionals in this country. We can have a 
better health care system in this country, and this bill will go a long 
way toward doing it.
  I commend the physicians in this Congress in both parties who have 
stood tall for doing the right thing. God bless them for standing for 
their beliefs and their patients.

                              {time}  1200

  Mr. SHADEGG. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Ohio (Mr. Boehner).
  Mr. BOEHNER. Mr. Speaker, as I said earlier, this is not about a 
binding resolution, this is about having a political debate. The 
gentleman from Missouri (Mr. Gephardt), the minority leader, who just 
spoke realizes that the other body has a very different bill. In the 
legislative process, our jobs are to come to some consensus with the 
other body, some consensus that is good for the American people.
  Now, there is not a bill that came to this floor that did not provide 
for more accountability for those in managed care. There is not a bill 
that came to this floor that did not provide for more physicians' 
judgments in controlling the treatments that the patient was going to 
get.
  We all want more accountability. But we have got to do it in a way 
that will not drive millions of people into the ranks of the uninsured. 
I think all of my colleagues know that I believe that we can have more 
accountability without introducing unending and open-ended litigation 
into the process. Bringing trial lawyers and frivolous lawsuits into 
health care will do nothing more than drive up the cost and drive down 
access.
  We all know that today about 125 million Americans get their 
insurance through their employer. I realize that some want to change 
that. But today that is, in fact, the system. Every employee will tell 
us the number one benefit that they get from their employer is their 
health benefit. Why did we want to jeopardize the ability of employers 
to provide this benefit to their employees by opening up the health 
care system to an open-ended liability?
  Now, there is a great concern about the liability portion of the bill 
passed by this House, that in fact many employers will not open 
themselves up to that liability and will begin dropping coverage for 
their employees. Is that really what the House wants to do? I think 
what we need to do is to go to conference with the Senate and to find 
the right consensus for the American people.
  Mr. DINGELL. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Tennessee (Mr. Ford).
  Mr. FORD. Mr. Speaker, let us be honest here. The gentleman from Ohio 
(Mr. Boehner) said this is a political discussion. It is. What we do is 
deal with politics, and we have many of those on this floor. We flew 
back here Monday evening, not to vote on a budget, but to vote on a few 
political suspension matters. So let us be honest with what we are 
doing.
  The reality is my colleagues refuse to appoint the two folks in this 
House who, in many ways, personify and embody this issue for all 
America, not just Democrats, not just Republicans.
  We have another body on the other side that some of my colleagues on 
this side are essentially doing the bad work for, doing the homework 
for. They do not want campaign finance. They do not want managed care 
reform. They figure out the procedural games to play, and we figure it 
out on this side.
  We just had elections around the Nation yesterday in many localities, 
and congratulations to the winners throughout the Nation. Imagine 
having an election and the voters selecting someone, then the party 
leaders and the bosses in the party say, well, the people want this 
person; but this other fellow, he pretty much agrees with this guy on 
about 70, 80 percent of the stuff he wants, so the party leaders, we 
are going to pick the other guy even though the people want the guy 
that won.
  We passed an HMO reform bill here in this House of Representatives. I 
know the money chase is on. I know the Senate in their leadership may 
want certain things. But allow the will of this House to be heard in 
the conference. Allow the conferees, the gentleman from Iowa (Mr. 
Ganske) and the gentleman from Georgia (Mr. Norwood) to represent us. 
Allow the will of the people to be heard, not HMO bosses. I ask this 
House to support the motion to instruct conferees.
  Mr. SHADEGG. Mr. Speaker, I yield 1 minute to the gentleman from 
California (Mr. Doolittle).
  Mr. DOOLITTLE. Mr. Speaker, this is obviously an issue of great 
importance to the body, and I have great affection and esteem for the 
authors of the competing proposal.
  I think it is quite clear that we need some type of health care 
reform. What we need to decide upon is what is something we can agree 
upon between the two bodies and that can be signed by the President and 
become law.
  The Dingell-Norwood is not a perfect bill. Most bills here are not 
perfect; I will stipulate to that. I do not think we want to tie the 
hands of our conferees as they go in trying to produce a product that 
is acceptable to everyone.
  I would just point out, and I know it has been pointed out before by 
the author of the substitute, but I just want to reemphasize this, that 
the substitute, for example, allows access to ambulance services. The 
substitute has external appeal time lines that are shorter to allow 
expedited review.
  The substitute provides access to all cancer clinical trials. That 
provision is much broader than Dingell-Norwood for cancer patients 
because the Dingell-Norwood bill does not include FDA approved clinical 
trials.
  I urge my colleagues to vote no on this motion.
  Mr. DINGELL. Mr. Speaker, how much time remains?
  The SPEAKER pro tempore (Mr. Kolbe). The gentleman from Michigan (Mr. 
Dingell) has 4\1/4\ minutes remaining. The gentleman from Arizona (Mr. 
Shadegg) has 4\1/4\ minutes remaining.
  Mr. DINGELL. Mr. Speaker, I yield to myself 1 minute.

[[Page 28198]]


  Mr. Speaker, I want to express great pleasure at the way that this 
debate has been conducted. I also want to point out that we are now 
talking about what our conferees are going to do for the House as a 
part of their duties.
  The traditions of the House say that the conferees should be 
appointed by the Speaker, and the rules say so, too, to carry out the 
purposes of the House bill and to be supporters of the House bill.
  The traditions of the House say that the conferees should be 
supporters of the House bill. Quite honestly, 275 of our Members say 
that they should be the supporters of the House bill, as do millions of 
Americans in all walks of life say that we should be supporting the 
House bill, because that is the bill that the people want.
  Having said these things, we do not know who the conferees are going 
to be. We do not know what the Senate is going to do. But we can be 
pretty assured, on the basis of what we have seen, that we may not see 
either the gentleman from Georgia (Mr. Norwood) or the gentleman from 
Iowa (Mr. Ganske) or any of the other supporters on the Republican side 
being named as conferees on this bill.
  If that is true, it will tell us at the time we vote that we 
desperately have needed this bill. It is necessary that we should have 
had the instructions that we are now seeking to give to enable us to 
see that the conferees carry out the will of the House.
  Mr. SHADEGG. Mr. Speaker, I understand the gentleman from Michigan 
(Mr. Dingell) has the right to close.
  The SPEAKER pro tempore. That is correct.
  Mr. SHADEGG. Mr. Speaker, I yield to myself the balance of the time 
remaining.
  Mr. Speaker, I think this is a critically important debate. It is a 
debate that is reflected on thoughtful concerns across America, as 
pointed out in this week's edition of Newsweek, which talks about this 
issue about patients' rights. But we really are engaged in very much of 
a political discussion of what ought to occur from here forward.
  There is, indeed, no question but that the gentleman from Iowa (Mr. 
Ganske) and the gentleman from Georgia (Mr. Norwood) deserve credit for 
their hard work on this issue. Indeed, I would suggest quite clearly 
that of the two major bills before this House, they were written by 
four people, the gentleman from Iowa (Mr. Ganske), the gentleman from 
Georgia (Mr. Norwood), the gentleman from Oklahoma (Mr. Coburn), and 
myself. That is true of the bill on the other side, the Norwood-Dingell 
bill, and it is also true of the substitute which got the most votes on 
this side.
  I would also point out that there has been much made of the fact that 
perhaps some of the conferees will not have voted for the bill that 
passed the House. The bill that actually is in conference is H.R. 2990, 
and I believe every single one of the Republican conferees voted for 
H.R. 2990.
  Now, it is true that many of the conferees may not have voted for 
Dingell-Norwood, and I understand the concerns of those who have 
expressed that reservation, their belief that, indeed, there perhaps 
should be more Members on the conference committee who did vote for 
Dingell-Norwood.
  I do not know the full context of the conference committee, but I can 
tell my colleagues this, I for one am committed to the concept behind 
the major distinguishing point between Dingell-Norwood and the 
substitute; and that is that HMOs must be held accountable.
  But please make it clear that this debate is vitally important, and 
it is a political debate. It is a debate about whether we do something 
for the patients of America or whether we do nothing.
  The minority leader spoke about keeping the process moving forward. I 
urge every one in this House to work hard to keep the process moving 
forward, and I agree with him on that. But passing this motion to 
instruct, passing this set of instructions, announcing today that we 
are unwilling to compromise on anything but that which is in Norwood-
Dingell would be a tragic mistake, because if we abide by that 
position, make no mistake about it, if we adopt Norwood-Dingell and 
Norwood-Dingell only, there will be no health care reform for this 
country arising out of this bill this year or next year, because that 
bill cannot pass and will not pass because of its extreme positions on 
the issue of liability.
  Now, its health care provisions, quite frankly, are not quite as good 
as ours, but they are very close. But the issue here, the fundamental 
question here is that we must come to a compromise.
  My colleagues on the other side of the aisle and the President have 
announced they want to do absolutely nothing about access to insurance 
for the uninsured and absolutely nothing about the cost of insurance 
and absolutely nothing about choice for those who have insurance, 
because their bill, Dingell-Norwood, did nothing for access, it did 
nothing for choice, it did nothing for cost. I say that we must move 
them on that issue. They must compromise, or we will not help the 
American people.
  My other colleagues on the other side who say immunity works, we 
should leave the HMOs absolutely immune when they injure or kill 
somebody, I suggest to them that if we take that stand, then, indeed, 
there will be no legislation this year to help the American people.
  This is too critical a moment in time, vastly too important for the 
lives of the American people for us to sit on our hands and take either 
an extreme position on that side in which we do nothing about access, 
nothing about choice, nothing about affordability, or an extreme 
position which says we do nothing about making health care plans 
accountable.
  This is a critically important moment in time, and the proponents of 
this motion to instruct would have us pass it by. They would save this 
issue for a political fight in the next election campaign. I believe 
that would be a tragic mistake.
  What must happen in this conference committee is that the Senate must 
move, because its bill is inadequate; and what must happen in the 
conference committee is that the House must move, because we do not get 
good legislation for the American people if we do not compromise.
  I believe that this motion to instruct, which would leave us bound to 
one position and one position only and would abandon the notion of 
compromise, would be a tragic mistake for the American people for that 
reason.
  I urge my colleagues to give the conferees the option to compromise 
on good legislation so we can pass and enact health care reform this 
year.
  Mr. DINGELL. Mr. Speaker, I yield 3\1/4\ minutes, the balance of the 
time, to the distinguished gentleman from Arkansas (Mr. Berry) for 
purposes of closing.
  Mr. BERRY. Mr. Speaker, it is absolutely amazing that 275 Members of 
the House of Representatives voted for the worst bill. I rise in 
support of this motion to instruct conferees.
  I do agree with the gentleman from Oklahoma who referred to the 
distinguished gentleman from Michigan (Mr. Dingell) as a politician. 
But I would add to that that he is also a great statesman, along with 
the distinguished gentleman from Georgia (Mr. Norwood) and the 
distinguished gentleman from Iowa (Mr. Ganske). It is an unbelievable 
miscarriage of the will of this House that they would not be conferees 
on this conference committee.
  When my colleagues and I brought this legislation to the Committee on 
Rules, we brought it with a manager's amendment that would have allowed 
the bill to be paid for. We did so because all of us are concerned 
about the budgetary impacts of policies that are not paid for. 
Unfortunately, the Committee on Rules did not allow our bill to be paid 
for, and even worse added on a $48 billion tax package that was not 
paid for.
  This motion to instruct conferees requires the conference committee 
to find a way to pay for the compromised legislation.
  Given the fact that some in Congress voted just last week to borrow 
more from the Social Security Trust Fund,

[[Page 28199]]

given the fact that the nonpartisan Congressional Budget Office has 
certified that some in Congress have already dipped into the Social 
Security Trust Fund by 17 billion more dollars, given the fact that 
none of us want to spend what belongs to Social Security, I urge my 
colleagues to support this motion.
  Our job is to get the best deal we can for the American people. We 
should follow the will of this House. The gentleman from Iowa (Mr. 
Ganske) and the gentleman from Georgia (Mr. Norwood) should be 
conferees.
  If my colleagues care about Social Security, and if my colleagues 
care about HMO reform, and if my colleagues care about the American 
people getting a good deal, being treated fairly, and having access to 
good health care under their HMOs, I urge my colleagues to support this 
motion.
  Mr. CLAY. Mr. Speaker, I rise in support of the motion to instruct 
conferees regarding the bipartisan consensus Managed Care Improvement 
Act.
  Since this bill passed overwhelmingly almost one month ago, the 
Republican leadership has delayed the appointment of conferees, thereby 
generating concern that it was seeking to either kill the bill by 
running out the clock, or undermine the strong support for patient 
protections and enforcement reflected by the House vote.
  Because of this, the Members of this body need to once again send a 
strong message that Americans want the freedom to choose their health 
care providers, to have treatment decisions made by physicians and not 
insurance company bureaucrats, and to hold insurance companies 
responsible for the injuries they cause.
  In addition, Mr. Speaker, the Republican leadership blocked the 
addition of offsets to the Norwood-Dingell bill when it was on the 
floor, and pushed through a so-called ``access'' bill loaded with tax 
breaks that were not paid for. The motion appropriately instructs our 
managers to insist on fiscal responsibility and produce managed care 
reform legislation that does not tap into the surplus.
  Mr. STARK. Mr. Speaker, I am pleased that we will finally be going to 
conference for managed care reform. We passed this bill nearly a month 
ago and I don't understand why it has taken so long to get to this 
point.
  My hunch is that the main reason is that by holding this motion to go 
to conference until this late date, the Republican leadership will be 
able to delay any actual convening of the conference until the next 
Congress. Nonetheless, this action is an important step forward in our 
continued effort to protect consumers in managed care plans.
  Last month, the U.S. House of Representatives passed H.R. 2723, The 
Bipartisan Consensus Managed Care Reform Act, by a decisive bipartisan 
margin of 275-151. That same day, the House soundly rejected three 
other more limited approaches to managed care reform.
  The House bill is much stronger than its Senate counterpart. It 
applies to all private health plans unlike the Senate bill which is 
mostly limited to the 40 million Americans in self-insured plans. The 
external appeal provisions in the House bill are much stronger. And, 
most importantly, the House bill also includes health plan liability--a 
provision sorely lacking in the Senate version of the legislation.
  Health plan liability is a vital component of meaningful managed care 
reform. Only the threat of legal consequences will be strong enough to 
ensure the enforcement of these managed care consumer protections. It 
must be included in the final bill approved by Congress or we will have 
failed in our duty to protect consumers in managed care plans.
  To that end, the Conference should report a bill that closely mirrors 
that passed by the House in the form of H.R. 2723, The Bipartisan 
Consensus Managed Care Reform Act.
  It is also important that the final product be paid for. During the 
House consideration of the legislation, the sponsors of H.R. 2723 went 
to the Rules Committee to bring the bill to the House floor fully 
financed. We were forbidden by the Republican leadership from bringing 
our bill to the floor fully paid for--and likewise prevented from 
offering an amendment on the floor that provided such funding. The 
conference must rectify that problem. We have offsets for the costs--
they must be included in the final product.
  The Republican leadership also played games by adding a number of 
costly tax provisions to the package which they billed as new 
``access'' provisions. In fact, there is precious little evidence that 
those provisions would expand insurance coverage. Instead, there is 
definite Congressional Budget Office evidence that those provisions 
would cost the taxpayers some $48 billion over the next ten years. The 
Conference should drop these provisions which do nothing to expand 
coverage and therefore needlessly increase the federal price tag of 
this otherwise very affordable, sensible legislation.
  As a Conferee, you can be sure that this will be my agenda: the final 
product should closely mirror H.R. 2723, it should be fully financed, 
and the costly, ineffective provisions of H.R. 2990 should be dropped. 
I hope that is an agenda we can all pursue.
  Managed care reform should no longer be a partisan issue. The bill 
passed by this House was a consensus package with broad-based 
bipartisan support within the House and the support of more than 300 
organizations representing consumers, doctors, nurses, other health 
care providers, public health advocates. Let's take our consensus bill 
and make it law. I look forward to working with my colleagues to 
achieve this important goal. Let's get to work.


                             General Leave

  Mr. DINGELL. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks on this motion to instruct.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Michigan?
  There was no objection.
  Mr. DINGELL. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. All time for debate has expired.
  Without objection, the previous question is ordered on the motion to 
instruct.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to instruct 
offered by the gentleman from Michigan (Mr. Dingell).
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. SHADEGG. Mr. Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Evidently a quorum is not present.
  The Sergeant at Arms will notify absent Members.
  The vote was taken by electronic device, and there were--yeas 257, 
nays 167, not voting 9, as follows:

                             [Roll No. 558]

                               YEAS--257

     Abercrombie
     Ackerman
     Allen
     Andrews
     Bachus
     Baird
     Baldacci
     Baldwin
     Barcia
     Barr
     Barrett (WI)
     Becerra
     Bentsen
     Berkley
     Berry
     Bilbray
     Bishop
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Bono
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brady (TX)
     Brown (FL)
     Brown (OH)
     Capps
     Capuano
     Cardin
     Carson
     Castle
     Chambliss
     Clay
     Clayton
     Clement
     Clyburn
     Coble
     Condit
     Conyers
     Cook
     Cooksey
     Costello
     Coyne
     Cramer
     Crowley
     Cummings
     Danner
     Davis (FL)
     Davis (IL)
     Davis (VA)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Diaz-Balart
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doyle
     Duncan
     Edwards
     Emerson
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Filner
     Foley
     Forbes
     Ford
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Frost
     Ganske
     Gejdenson
     Gephardt
     Gibbons
     Gilchrest
     Gilman
     Gonzalez
     Gordon
     Graham
     Green (TX)
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hastings (FL)
     Hill (IN)
     Hilliard
     Hinchey
     Hinojosa
     Hoeffel
     Holden
     Holt
     Hooley
     Horn
     Hoyer
     Hunter
     Hyde
     Inslee
     Jackson (IL)
     Jefferson
     Jenkins
     John
     Johnson (CT)
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     King (NY)
     Kleczka
     Klink
     Kucinich
     LaFalce
     Lampson
     Lantos
     Larson
     LaTourette
     Leach
     Lee
     Levin
     Lewis (GA)
     Lipinski
     LoBiondo
     Lofgren
     Lowey
     Lucas (KY)
     Luther
     Maloney (CT)
     Maloney (NY)
     Markey
     Martinez
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McHugh
     McIntyre
     McKinney
     McNulty
     Meehan
     Meek (FL)
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller, George
     Minge
     Mink
     Moakley

[[Page 28200]]


     Mollohan
     Moore
     Moran (VA)
     Morella
     Nadler
     Napolitano
     Neal
     Norwood
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Phelps
     Pickett
     Pomeroy
     Porter
     Price (NC)
     Quinn
     Rahall
     Rangel
     Reyes
     Reynolds
     Rivers
     Rodriguez
     Roemer
     Ros-Lehtinen
     Rothman
     Roukema
     Roybal-Allard
     Sabo
     Sanchez
     Sanders
     Sandlin
     Saxton
     Schakowsky
     Scott
     Serrano
     Shaw
     Shays
     Sherman
     Shows
     Sisisky
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Spratt
     Stabenow
     Stark
     Stenholm
     Strickland
     Stupak
     Tanner
     Tauscher
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Thurman
     Tierney
     Towns
     Traficant
     Turner
     Udall (CO)
     Udall (NM)
     Velazquez
     Vento
     Visclosky
     Walsh
     Waters
     Watt (NC)
     Waxman
     Weiner
     Weldon (FL)
     Weller
     Wexler
     Weygand
     Wise
     Wolf
     Woolsey
     Wu
     Wynn
     Young (AK)
     Young (FL)

                               NAYS--167

     Aderholt
     Archer
     Armey
     Baker
     Ballenger
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bateman
     Biggert
     Bilirakis
     Bliley
     Blunt
     Boehner
     Bonilla
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Cannon
     Chabot
     Chenoweth-Hage
     Coburn
     Collins
     Combest
     Cox
     Crane
     Cubin
     Cunningham
     Deal
     DeLay
     DeMint
     Dickey
     Doolittle
     Dreier
     Dunn
     Ehlers
     Ehrlich
     English
     Everett
     Ewing
     Fletcher
     Fossella
     Fowler
     Gallegly
     Gekas
     Gillmor
     Goode
     Goodlatte
     Goodling
     Goss
     Granger
     Green (WI)
     Greenwood
     Gutknecht
     Hansen
     Hastings (WA)
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (MT)
     Hilleary
     Hobson
     Hoekstra
     Hostettler
     Houghton
     Hutchinson
     Isakson
     Istook
     Johnson, Sam
     Kasich
     Kelly
     Kingston
     Knollenberg
     Kolbe
     Kuykendall
     LaHood
     Largent
     Latham
     Lazio
     Lewis (CA)
     Lewis (KY)
     Linder
     Lucas (OK)
     Manzullo
     McCrery
     McInnis
     McIntosh
     McKeon
     Metcalf
     Mica
     Miller (FL)
     Miller, Gary
     Moran (KS)
     Myrick
     Nethercutt
     Ney
     Northup
     Nussle
     Ose
     Oxley
     Packard
     Paul
     Pease
     Peterson (MN)
     Peterson (PA)
     Petri
     Pickering
     Pitts
     Pombo
     Portman
     Pryce (OH)
     Radanovich
     Ramstad
     Regula
     Riley
     Rogan
     Rogers
     Rohrabacher
     Royce
     Ryan (WI)
     Ryun (KS)
     Salmon
     Sanford
     Schaffer
     Sensenbrenner
     Sessions
     Shadegg
     Sherwood
     Shimkus
     Shuster
     Simpson
     Skeen
     Smith (MI)
     Smith (TX)
     Souder
     Spence
     Stearns
     Stump
     Sununu
     Sweeney
     Talent
     Tancredo
     Tauzin
     Taylor (NC)
     Terry
     Thomas
     Thornberry
     Thune
     Tiahrt
     Toomey
     Upton
     Vitter
     Walden
     Wamp
     Watkins
     Watts (OK)
     Whitfield
     Wicker
     Wilson

                             NOT VOTING--9

     Bereuter
     Berman
     Hulshof
     Jackson-Lee (TX)
     Murtha
     Rush
     Sawyer
     Scarborough
     Weldon (PA)

                              {time}  1236

  Mrs. CUBIN, and Messrs. SKEEN, BURTON of Indiana, BASS, and LEWIS of 
California changed their vote from ``yea'' to ``nay.''
  Messrs. STUPAK, OWENS, JENKINS, and Ms. McKINNEY changed their vote 
from ``nay'' to ``yea.''
  So the motion was agreed to.
  The result of the vote was announced as above recorded.

                          ____________________