[Congressional Record (Bound Edition), Volume 145 (1999), Part 20]
[House]
[Pages 29318-29319]
[From the U.S. Government Publishing Office, www.gpo.gov]



                          MANAGED CARE REFORM

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Iowa (Mr. Ganske) is recognized for 5 minutes.
  Mr. GANSKE. Mr. Speaker, yesterday the newspapers across the country 
trumpeted a headline. Here is one from the Washington Post, similar to 
newspapers all across the country: HMO to Leave Care Decisions Up to 
Doctors. The subheading is United Health Care has 14.5 Million Clients.
  The first three paragraphs read:
  ``United Health Care, one of the Nation's largest managed care 
companies, said yesterday that it will stop overruling doctors' 
decisions about what care patients should receive. The company, which 
covers 14.5 million people nationwide and more than 200,000 people in 
the District of Columbia, Maryland and Virginia, is abandoning a 
cornerstone of the managed care industry's cost containment strategy 
and one of the features most responsible for the outpouring of public 
ill will toward managed care. United says it is taking the final say 
out of the hands of managed care bureaucrats and returning it to the 
treating physician because requiring doctors to get prior authorization 
was costing more money than it saved.''
  Now, think about this. This is the Nation's second largest HMO, in 
the first place admitting, yes, we have been making medical decisions. 
And then in the second place saying, but you know what, we have found 
that that is not cost efficient. So we are going to allow the doctors 
to make the decisions.
  Remember, the HMOs have said during the debate we had here a couple 
of weeks ago, ``Oh, no, we don't make medical decisions, we just make 
determinations of benefits.'' And then they

[[Page 29319]]

said, ``But if you pass the legislation, it is going to cost so much 
more. Premiums will go up.'' And, guess what, one of the two 
cornerstones of the legislation that passed this House was on the 
determination of medical necessity, physicians and patients would make 
the decision.

                              {time}  2215

  Now, the second largest HMO in this country is saying, hey, do you 
know what, we found out that it cost us more money to micromanage those 
decisions, so we are not going to do it anymore. That certainly 
undercuts their arguments about increases in premiums, does it not?
  Mr. Speaker, on October 7, the House of Representatives sent a 
message to the Senate: Get real about protecting patients for all 
citizens from HMO abuses. We passed, remarkably, a bipartisan consensus 
managed care reform bill by the margin of 275 to 151.
  The American public is now demanding real action on this issue. How 
do I know that? A recent survey. The Washington Post did a survey to 
better understand Americans' concerns. More than 2,000 people were 
asked 51 things that might be worrying them. Do Members know what the 
top worry in the public is today, by 66 percent of people who worry 
about it? To a great deal, according to the survey, their worry is that 
insurance companies are making decisions about medical care that 
doctors and patients should be making.
  Do Members know what else the survey showed? The same thing between 
Democrats, the same thing between Republicans, the same thing between 
Independents. Do Members know what else the survey showed? It did not 
matter whether they were supporting Al Gore or Bill Bradley or George 
W. Bush, this was still number one on the public's mind.
  So guess what we did during that debate? We voted on the Senate bill 
in the form of the Boehner amendment. What did the House do? It 
overwhelmingly defeated the Senate bill because it is a sham bill. That 
Senate bill in this House only got 145 votes and 284 votes against it.
  Just a few days ago the House voted again. By a vote of 257 to 167, 
the House instructed conferees to support the House-passed bill, the 
Norwood-Dingell-Ganske bill. Why did the House have to do this? Because 
the Speaker appointed 13 GOP conferees, and only one of them voted for 
the bill that passed the House. When is my Republican leadership going 
to get it?
  A new survey by the Kaiser Family Foundation showed that 85 percent 
of employers support emergency room provisions, and 94 percent of 
employers support the right to an independent review. Even on the right 
to sue, 60 percent of employers support the right to sue a plan, with 
support higher than that for employers of small businesses, and still 
above 50 percent for employers of firms with more than 5,000 workers.
  Mr. Speaker, it is time to get real about managed care reform. Let us 
see if the conference can really come up with something real.

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