[Congressional Record (Bound Edition), Volume 146 (2000), Part 17]
[House]
[Pages 24372-24379]
[From the U.S. Government Publishing Office, www.gpo.gov]



                           HEALTH CARE REFORM

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 1999, the gentleman from New Jersey (Mr. Pallone) is 
recognized for 60 minutes as the designee of the minority leader.
  Mr. PALLONE. Mr. Speaker, this evening I am going to be joined with 
some of my colleagues on the Democratic side of the aisle to discuss 
health care and what we believe should be done in the waning days of 
this Congress. Unfortunately, most of what we are about to discuss is 
part of the unfinished agenda here which I have been somewhat critical 
of the Republican leadership in the House of Representatives for 
because these health care issues have not been resolved; yet they are 
very important to the average American.
  When I talk about health care concerns, I believe that they are the 
Nation's number one priority right now. They concern matters that 
affect the daily lives of our constituents and which I think, if they 
were resolved and if they were attended to by the Republican leadership 
and passed and sent to the President in legislative form, would 
actually make a difference in people's lives. So for that reason I 
regret that on the issues such as prescription drugs for seniors under 
Medicare, HMO reform, and also increasing access to health care for 
those who are uninsured this Congress really has not accomplished much.
  I do not really expect much to be accomplished in the next few days 
that we are here, but I do think it is unfortunate that the Republican 
leadership has so far, and has over the 2 years, refused to address 
these issues in a meaningful way.
  I just wanted to summarize, if I could, and put them also in the 
context of the presidential debate, because I think that health care 
policy has really been one of the defining issues in the context of the 
presidential debate and the presidential campaign.
  Let me mention first the issue of prescription drugs. We know that 
our senior citizens and the disabled, people who currently are eligible 
for Medicare, many of them do not have access to prescription drugs 
because it is not a basic benefit under the Medicare program. What the 
Democrats have been saying is that we would like it to be a basic 
Medicare benefit. We would like it to be included under the rubric of 
the Medicare program because we know that Medicare has been very 
successful in addressing the problems of hospital care, the need for 
hospital care and the need for physicians' care.
  If a person now reaches the age of 65 or is eligible because they are 
disabled, they do get their hospital insurance taken care of under 
Medicare. And if they pay a certain amount a month, about $40 or so per 
month, then they have also their physician's care taken care of. But 
that is not the case with prescription drugs. Some seniors are able to 
get a prescription drug benefit if they are fortunate enough to have an 
HMO in their area that may cover it in some way. But that is not the 
majority.
  Some senior citizens outside of Medicare are able to get coverage 
because they have it as part of an employer retirement plan or maybe 
they are eligible for veterans benefits as part of the Federal 
Government; but generally most seniors do not get either adequate 
prescription drug coverage or, in many cases, no prescription drug 
coverage at all.
  Basically, using the example of Medicare part B for physician's care, 
what the Democrats have been saying and what Vice President Gore has 
been

[[Page 24373]]

saying is that we will establish a new part D, for example, under 
Medicare. And just like with part B for the physician's care, seniors 
would pay so much per month. It would probably start as little as $25 a 
month; but as the benefits increase, it might get to be more. They 
would then get a certain prescription drug benefit that would be 
guaranteed, which would make it possible for them to simply go to their 
local pharmacy, and it would be covered. They would have a choice of a 
pharmacy to go to, and any prescription drug that is recommended by 
their physician or by the pharmacist as medically necessary would be 
covered.
  Very simple concept, really. No magic here. It is simply included 
under the Medicare program. Well, the Republican leadership and the 
Republican presidential candidate, Governor Bush, do not like this. I 
think, frankly, though they may not admit it, that they do not like 
Medicare very much, and they do not like the idea of a public program 
like Medicare including prescription drugs. So what they propose I call 
a voucher. Basically, they say they are going to give a certain amount 
of money in the form of a subsidy or a voucher to seniors who are below 
a certain income, not the majority of seniors, but just those who are 
below a certain income. Those seniors can take this voucher, and they 
can go out in the private marketplace to see if they can find an HMO or 
some other kind of insurance plan that will cover them.
  There are a lot of problems with that. First of all, it is not under 
Medicare, so it is not going to be universal. Most seniors would not be 
able to take advantage of it. In addition to that, with the exception 
of the HMOs, they are probably not able to buy a prescription drug 
policy. Most insurance companies do not sell prescription drug 
policies. So they may be able to get it through an HMO, but we know 
what the problems are with HMOs. We do not know how much the deductible 
is going to be; we do not know how much the copayment is going to be. 
We do not know whether all drugs will be covered. A lot of problems and 
a lot of inability, I would say ultimately, to get a good insurance 
program that covers prescription drugs.
  So I would suggest that this Republican proposal and the one that 
comes from Governor Bush is not realistic. It is not something that is 
going to help most seniors. But even so, basically they have not paid a 
lot of attention to it here in the House of Representatives. They 
talked about it at one time, but that was it. There has not really been 
any movement to get this accomplished. That is unfortunate, because our 
seniors are crying out for an answer on the issue of prescription 
drugs.
  Now, on a second issue, and that is the issue of HMO reform, once 
again the Democrats, and if we listened to the last debate, Vice 
President Gore was very specific that what we need in order to cure the 
abuses in the HMO system is the Patients' Bill of Rights, the Norwood-
Dingell bill that was passed by the House of Representatives, mostly 
with Democratic votes but with some Republican support.
  I will not get into all the details of the Patients' Bill of Rights, 
but basically it changes a lot of things that exist under current law 
in terms of the abuses we face with HMOs. Right now, the decision about 
what kind of medical care a person gets, whether that person gets a 
particular operation, how many days they stay in the hospital, what 
kind of equipment they get, these decisions are made by the insurance 
company, and many times without the patient's input or without the 
doctor's input. That is what leads to abuses.
  HMOs deny care. People do not really have a way to redress their 
grievances because if they have to appeal the decision of the HMO, 
usually it is to the HMO itself, and they, of course, deny it again.

                              {time}  2045

  What the Democrats have been saying with the patients' bill of 
rights, with the support of a minority of Republicans but not with the 
Republican leadership, is that we have been saying that we want to make 
sure that decisions about what kind of care they get, what is medically 
necessary, are made by the physician and the patient, not by the 
insurance company. That is what the patients' bill of rights says.
  And secondly, it says that if the HMO denies them care that they 
think they should have or that they need, then they have a legitimate 
way of redressing their grievance by going into an outside board that 
is independent of the HMO, or, failing that, they have the right to go 
to court and bring suit, which is not possible now for most people who 
are in HMOs.
  Well, if we listen to the third debate, Governor Bush said that he 
was in favor of HMO reform. But then when we look at his record in 
Texas, on one occasion when something like the patients' bill of rights 
came to his desk, he vetoed it. And then on another occasion when it 
came to his desk he basically was told, if you veto it again, we will 
override your veto, we have the votes in the legislature to override; 
and so, he let it become law without his signature, basically 
protesting it but indicating that he could not do anything about it 
because if he did veto it, it was going to be sustained anyway.
  So we do not have much support here. We have a Presidential candidate 
on the Republican side that basically opposed HMO reform as Governor. 
And then we have a Republican leadership that still reluctantly allowed 
the patients' bill of rights to come to the floor of the House and it 
passed, but the Senate is holding it up and the Republican leadership 
continues to oppose it here in the House of Representatives.
  The last major issue, and there are others but I want to get to my 
colleagues, the last major issue with regard to health care reform that 
faces many Americans is that many Americans, something like 44 million 
Americans right now, simply have no health insurance. They are not 
covered through their employer. They are not eligible for Medicaid 
because they are working and their income is a little too high and they 
cannot afford to go out in the private market and buy their own health 
insurance.
  Well, the Democrats have been saying, let us try to solve that 
problem. We solved it to some extent in a significant way with 
children, which was the largest of this 44 million who did not have 
insurance. We passed the CHIP bill, and we gave money to the States so 
they could sign up kids for a health insurance program for the children 
of working parents. And that has been successful in probably signing up 
about half the children around the country that were previously 
uninsured.
  But again, when it came to Governor Bush, he said that, although he 
was getting the money from the Federal Government, he wanted to keep 
the income levels for the kids' care program, for the CHIP program 
fairly low. And he had originally proposed, I think, 150 percent of 
poverty, and it took the Texas legislature basically to insist that the 
eligibility requirements be higher than that. And for a long time, 
essentially, he made it difficult for the CHIP program, for the 
Children's Health Insurance Program, to be implemented in the State of 
Texas in a way that would be helpful to more and more children.
  Now, what the Democrats have been saying and what Vice President Gore 
has been saying is we want to expand the eligibility for this CHIP 
program to even higher incomes, maybe 250 percent of poverty. And at 
the same time, the Vice President and the Democrats have been saying we 
want to address the problem with the adults who are uninsured, so let 
us let the parents of the kids who are in the CHIP program enroll in 
the CHIP program as well so that they are insured. It certainly makes a 
lot of sense. But again, we do not see the Republicans supporting that 
initiative or taking any action here in the House of Representatives to 
address that concern.
  Lastly, the other large group of people that we know are uninsured 
are the near elderly, the people between 55 and 65 that are not 
eligible for Medicare but who often lose their job or take early 
retirement and find themselves or their spouse without health 
insurance.

[[Page 24374]]

  President Clinton and Vice President Gore and the Democrats have been 
advocating that those near elderly be able to buy into Medicare for 
maybe $300 or $400 a month, and again we have seen opposition from the 
Republican leadership and the unwillingness to bring this up in 
committee or on the floor of the House.
  So whether it is the issue of access and covering the uninsured, 
whether it is the issue of HMO reform, or whether it is the issue of 
prescription drugs, over and over again the Democrats have put forward 
proposals supported by the Vice President which have been opposed or 
scuttled, if you will, by the Republicans and again not supported by 
their Presidential candidate, Governor Bush.
  We are only pointing out the facts here tonight. I am joined by a 
number of my colleagues who would like to address this issue.
  First, I would like to yield to the gentlewoman from the Virgin 
Islands (Mrs. Christensen) who also happens to be a physician.
  Mrs. CHRISTENSEN. Mr. Speaker, I thank the gentleman for yielding.
  Mr. Speaker, as my colleague the gentleman from New Jersey (Mr. 
Pallone) said, the big issues that remain before us as we come close to 
the end of the 106th Congress are the same ones that we have not been 
able to get the Republican leadership of this body to adequately 
address through several Congresses, not just this one, education and 
health care.
  Last week I was able to join some of my colleagues to call for 
passage of our education agenda. But tonight I want to join my 
colleague in talking about health care.
  A few weeks ago, I joined Senator Byron Dorgan of North Dakota, along 
with the gentleman from Arkansas (Mr. Berry) and others at a hearing in 
the other body to call on their leadership to bring the patients' bill 
of rights to the floor for a vote and to pass it. To date nothing has 
happened. That is despite the testimony of patients, of a mother who 
lost her daughter because she was denied the test and care that she 
needed, the testimony of health care professionals who said how their 
professional judgment and their values were daily compromised by having 
to work under the current managed care system.
  The system has to be reformed to allow doctors and other providers to 
make decisions in consultation with their patients on what medical 
tests and care is indicated in each instance, to have the system better 
respond to the needs of patients for access to emergency services and 
specialists, and to make those who are making decisions on health care 
to be accountable for those decisions.
  People all over this country are dissatisfied with managed care. They 
want the system revamped. They want a patients' bill of rights. The 
Vice President is poised to make that happen and we, their 
Representatives, need to respond.
  I want to spend the rest of my time on the Medicare give-backs that 
are being proposed as a remedy for the cuts that took place in the 
Balanced Budget Amendment of 1997. It is important that, in this 
measure, the one that is proposed, those who are on the front lines 
providing health care to those in need be treated fairly and be given 
precedence since they are the ones who have suffered the most along 
with the patients who rely on them for service.
  In my district, our only private home care agency was forced to close 
and our public health agency forced to cut back because of the cuts 
that were imposed in BBA 1997. This is a situation that has been 
repeated in towns, cities and rural areas around the country. Our 
hospitals and nursing homes in the Virgin Islands are lucky to still be 
open, although it has been a struggle to continue to provide care. 
Others have had to close their doors.
  I want to say to the Nation's hospitals, do not accept the Trojan 
Horse that is being offered to you. The recommendation as it now stands 
is wrong. Do not let us be picked off one by one and pitted against 
each other. We can all win if we stand together on this issue.
  As a doctor, I know how difficult it is to meet overhead costs and to 
keep providing services when the fees keep getting smaller. Our 
expenses and our operating overhead are not going down. They are going 
up. Our patients need, at the very least, the same level of care, and 
they deserve to have their needs met.
  I resent the fact that the Republican leadership wants to give HMOs 
any part of that give-back. For what? They promise nothing in return. 
They have left Medicare patients, our elderly, stranded because they 
could not make the desired profit. They are holding out their hands for 
more money now, and they are not even being made to increase the 
service to the special population.
  For too long, HMOs have been allowed to take the care out of ``health 
care,'' and we say enough is enough. We need to give the dollars back 
to the providers of health care, to the doctors and nursing homes, 
hospitals and home health care agencies. The people of this country 
deserve the full range of health services, and giving our providers 
fair reimbursements and helping them to stay in business makes that 
possible. We in the Democratic Caucus say give the money to those who 
care, give it to the providers, not to the HMOs.
  I must also mention an issue that is important to my district. That 
is the increases in Medicaid that the administration is seeking and the 
redistribution of the Children's Health Insurance Program funds that 
are not used by the States. In my district and the other territories, 
we have a cap on our Medicaid dollars; and we receive CHIP funds under 
a formula which does not allow us to provide the level or the scope of 
health care that our residents need. With our cap, we are unable to 
provide Medicaid to people even at the poverty level. So we have a 
large gap between those who are covered by Medicaid and the uninsured.
  The Journal of the American Medical Association today reported a 
study on uninsured adults showing that when they are uninsured they are 
just not able to access any care, they go without even preventive 
services. And Sanda Adamson Fryhofer, the President of the American 
College of Physicians American Society of Internal Medicine, which 
funded this study, is quoted as saying, ``Studies such as this one,'' 
the one on the uninsured adults, ``prove that living without 
insurance,'' which many of the people in my district do and have done 
for years, ``is a serious health risk that needs to be treated with the 
same sense of urgency as not wearing seatbelts or drunken driving.''
  In my district, close to one-third of the children are estimated to 
be uninsured. Kids count. The Community Foundation of the Virgin 
Islands recently released a report that showed that 41 percent of our 
children live in poverty, twice the national rate, and that deaths 
among Virgin Islands children under 14 are also nearly twice the 
national rate.
  Health care is a right for all, not a privilege for the few. We have 
to get that straight before we adjourn and leave for this election.
  This means passing a meaningful patients' bill of rights. It means 
adding prescription drug coverage to Medicare. It means making up for 
the damage we have done to hospitals, home health agencies, nursing 
homes, doctors and other providers with the cuts in 1997. And it means 
making CHIP and Medicaid fair and equitable to all Americans.
  In closing, I want to take this opportunity because some of my 
colleagues will be on the floor later to pay tribute to another of our 
colleagues. I want to wish the gentleman from Rhode Island (Mr. 
Weygand) well and thank him for his service to our class in the 
Congress. I want to especially thank him for the interest and help in 
the national park and other issues in my district. And although we hate 
to see him leave this body, it is good to know that they will be able 
to count on his able leadership in the other body. He will make a great 
Senator from Rhode Island. We thank him for his service.
  Mrs. THURMAN. Mr. Speaker, will the gentleman yield?

[[Page 24375]]


  Mr. PALLONE. I yield to the gentlewoman from Florida.
  Mrs. THURMAN. Mr. Speaker, we all respect and know the profession of 
the gentlewoman as being a physician. And she certainly has outlined 
here tonight some issues that I know are something that we are all very 
concerned about. Most of them deal with the choices that our 
constituents and the profession that she also represents feel is so 
important in the health and the welfare of our citizens in the country.
  I want to ask the gentlewoman a question because I think it does go 
to the issue of the Medicare prescription drug benefit.
  I am going to talk a little bit about a report that was just released 
that was done to look at the prescription drug coverage. And the loss 
of prescription drug coverage in Florida has gone from something like 
26 percent to 41 percent within just 2 years for our senior population.
  In the estimation of the gentlewoman, and particularly as we look at 
the buy-back bill that we are talking about on the Medicare, on the 
home health care agencies and hospitals and other things, in her 
professional career, would the gentlewoman agree that because of the 
hardship that people face in buying prescription drugs, and in fact we 
know that they are not taking the medicines as they have been 
prescribed, they are cutting them in half, they are taking them a 
different day, they are giving us the excuses that they want to make 
sure their spouse has them instead of them. What does the gentlewoman 
believe is not number-wise but just the cost to this country in medical 
expenses that we are having to pay for because people are not taking 
the life-saving medicines that they need to be taking on a regular 
basis?

                              {time}  2100

  Mrs. CHRISTENSEN. I cannot give you a specific number as you asked, 
but I know that it is multiplied severalfold because of the inability 
to take the drugs. For example, we know that if someone is able to take 
their hypertensive medication or their diabetic medication and maintain 
their hypertension or diabetes within the normal range, they can expect 
to live a normal life span and avoid the complications which put them 
into the hospital and greatly increase the cost of medical services. If 
we focus on prevention in health care instead of worrying about the 
cutting costs, if we focus on prevention, we will cut the costs of 
health care in this country.
  Mrs. THURMAN. I thank the gentlewoman.
  Mr. PALLONE. I think that that is a very good point. The point is 
that a lot of these preventative measures, particularly including 
prescription drugs, although initially there is a cost to the 
government and we know a rather large cost over the long term it may 
save costs in hospitalization and other kinds of nursing home care and 
institutionalization. It is a very good point.
  Mrs. CHRISTENSEN. Absolutely.
  Mr. PALLONE. Also I wanted to mention, it has to be so difficult as a 
physician with these HMOs when a decision is made that you think is not 
in the best interests of the patient. I imagine you go through that 
many times and this is really sad.
  Mrs. CHRISTENSEN. I was fortunate that I was in a fee for service. 
But if you listen to the doctors who came to the Senate a few weeks 
ago, they talked about the fact that they just in good conscience 
sometimes had to just take the risk of going against the HMO's decision 
because they just could not deny an examination that they felt was 
needed for a patient. The testimony of the mother whose daughter's name 
is the same as mine, Donna Marie, who died because she did not have the 
appropriate test was a testimony to that. We took an oath. To make some 
of the decisions that the HMOs place on us goes against the oath that 
we took as physicians.
  Mr. PALLONE. I want to thank you for joining us this evening and for 
all that you have done as part of our health care task force and 
drawing attention to this issue as well.
  I yield to the gentlewoman from Texas.
  Ms. JACKSON-LEE of Texas. I thank the gentleman very much for 
yielding. I think that this could not be a better discussion, but it is 
a distressing discussion. And I believe that the dialogue between my 
good friend the gentlewoman from Florida (Mrs. Thurman) and the 
gentlewoman from the Virgin Islands (Mrs. Christensen) is an important 
one as it relates to the human factor.
  I would like to yield to a moment to the gentleman from New Jersey 
because I was getting ready to recount and take our historical journey 
back to how long we have actually been discussing the patients' bill of 
rights. I know we are discussing sort of a whole purview; and I have so 
many burning issues as relates to health care. And in Texas, right now, 
I am facing the catastrophe of HMOs closing up shop; and, of course, 
they would argue there is no money. And I would argue my seniors are 
left with distress and inability to be served. So we have to find a 
solution. Part of that solution was the patients' bill of rights.
  As my memory seems to serve me, it looks as if as I came to Congress, 
and I came in the 104th Congress which was in 1995, I remember 
beginning the debate on the patients' bill of rights. I would simply 
like to yield to the gentleman so we all can understand where we are 
with the numbers of Members who signed up on the legislation, I think 
there are 280 plus, why we have not passed it.
  My recollection, the bill was named Norwood-Dingell, that is a 
Republican and a Democrat. I remember physicians from both sides of the 
aisle coming to the floor pleading for that particular version to be 
passed. Might I yield to the gentleman from New Jersey to tell us where 
we are and why we are in this predicament at this point.
  Mr. PALLONE. Basically as I think you remember, when we tried to 
bring up the patients' bill of rights, we were opposed by the 
Republican leadership; and we actually were only able to get it up 
because almost a majority of the House signed a discharge petition, 
including some Republicans. And as it got close to that magic 218 they 
decided we better bring it up, otherwise it is going to be discharged 
to the floor without the leadership's support.
  But even when it passed the House, the Republican leadership made it 
clear that they opposed the bill because when we had the conference 
with the Senate every one of the conferees they appointed on the 
Republican side with one exception voted against the bill. I am one of 
the conferees. When we went to the conference, not surprisingly the 
majority of the Members there between the Senate and the House were 
against the Norwood-Dingell bill.
  My colleague from Arkansas knows that that is a fact because he has 
also been part of the conference. I think the conference met officially 
once and then there were some smaller meetings after that, but the 
Republican leadership in the House and clearly the Republican 
leadership in the Senate made it quite clear that they were not willing 
to support the Norwood-Dingell bill and essentially scuttled the whole 
effort. It is nowhere now. The conference has not met in months. I 
yield to the gentlewoman from Florida.
  Mrs. THURMAN. What you are actually saying to us tonight and 
obviously I have been here, too, but sometimes I think we need to make 
these points very clear, because I think quite frankly that the 
American public is tired of people who have not been trained as 
physicians making decisions, that this House, in a fairly good vote, a 
bipartisan vote, Democrats and Republicans coming together, a 
consensus, believing that the patients' bill of rights that would allow 
the choices, the decision making to return to physicians was passed. 
And if I remember correctly, there were actually instructions on this 
floor even after the conferees had been chosen that we said in again a 
bipartisan fashion that we asked for the conferees to at least be 
Members who had voted with the majority of the membership of this 
House, the people's House. They said to us, put the conferees on that 
believe as we do. And that passed.

[[Page 24376]]


  Mr. PALLONE. That is correct. I would say even further that it is 
quite obvious from the composition of the Senate right now that if the 
bill were brought to the floor of the Senate and we just did not have a 
conference, just took the House bill and sent it over to the Senate and 
brought it up on the floor of the Senate, the votes would be there to 
pass it. So it is the Republican leadership in both Houses that is 
preventing this from happening even when we certainly had a majority 
here and probably even have the majority in the Senate to pass it.
  Mrs. THURMAN. So it is those who control the agenda today, the 
Republican leadership, that is blocking not only the will of the House 
of Representatives but the majority of the people in this country's 
ability to have health care delivered by their doctors and not by 
untrained people.
  Mr. PALLONE. Absolutely. I do not think there is any question that if 
there were a vote once again here or a vote in the Senate that this 
would pass, would go to the President and be signed into law.
  Ms. JACKSON-LEE of Texas. I might add a third component because I 
think the third component is most onerous and slightly evil if I might 
use that terminology and that is, of course, the special interests, 
that has this legislation frozen, literally frozen, and that is 
insurance companies.
  We have given them very nice names, HMOs, which are health 
maintenance organizations, but they are, in fact, insurance companies 
that are frightened beyond their expectations of what will happen if 
you restore to that really sacred relationship the patient and the 
physician assessing their particular status. I would like to just 
explore that, because that is why I believe it is so important that we 
move the Nation's health agenda along, and, that is, because people are 
not being served well by the HMO/insurance dominance.
  I just wish to take you back to a very moving moment on the floor of 
the House by our colleague from Iowa, a physician from the other side 
of the aisle, brought in, I believe what was a quadruple amputee, I 
think all of us saw that and there was certainly a lot of debate about 
that young boy.
  He was one of the most pleasant children that any of us have had a 
chance maybe to encounter, but it was not a pleasant experience. And he 
was here for what I think was a moment of drama that was necessary, and 
I am appreciative of it. Because when we heard the story of this little 
boy that in fact his parents after the tragic accident, I think they 
were camping, I think that what happened is that he got a rusty nail or 
some accident while they were camping and they rushed him to the 
hospital, to the nearest hospital emergency room and were told, your 
HMO does not cover you here.
  The delay which required them to go some 50 miles away caused this 
little boy to have enormous reaction, I do not want to misplace the 
story, it might have been gangrene, but it resulted in him being a 
quadruple amputee, meaning hands and feet.
  I think these are the kinds of stories that are not to be taken 
lightly nor are they only to suggest that we are creating an atmosphere 
of crisis. This is what is happening to Americans day by day, week by 
week and month by month and maybe even hour and minute and second. I 
believe the longer that we frustrate this system by not pushing forward 
the patients' bill of rights, and I thank the gentleman from New Jersey 
for giving the procedural structure as we have now, conference to those 
who do not understand is where you are supposed to come together, 
people of reasonable minds, and say how can we work this out.
  It is well known that your conference was an opportunity for 
obstruction and that really what could happen is come to the floor of 
the House, and we could have this passed. I want to just move quickly 
to that obstruction, the patients' bill of rights, and then this clear 
choice on the prescription drug benefit. All of us have been part of 
that.
  I see the gentleman from Maine (Mr. Allen) and the gentleman from 
Arkansas (Mr. Berry) on the floor. I come from the State of Texas. 
Frankly I can say that we have a record that is not one to be proud of. 
But we certainly appreciate the fact that we have a situation where we 
can explain the difference between the plan that Al Gore has and the 
plan that we have been pushing here in the House as Democrats and what 
the Republicans with George Bush at the helm are trying to push on us.
  Mr. BERRY. Mr. Speaker, knowing that the gentlewoman is from Texas, I 
would be interested to know what her experience with the Governor has 
been in Texas on a patients' bill of rights.
  Ms. JACKSON-LEE of Texas. The gentleman raises a very interesting 
question because I have certainly been confused by the debates that 
have occurred and the explanation that the Governor has given. I think 
it is well known that the Governor did not sign a real patients' bill 
of rights. In fact, the one that is now being emulated here in this 
Congress which has been cited as a Texas bill really was passed without 
his signature. It came to his desk, and we have a procedure in the 
State of Texas where if you do not sign it, it becomes law. So in 
actuality, there are Members in this body, the gentleman from Texas 
(Mr. Turner) for one and other Members who are not in this body who are 
now still State legislators who were the moving forces behind the 
patients bill of rights. But it was never signed by the Governor.
  And so even as we argued in committee, in the Committee on the 
Judiciary, in the Committee on Commerce about the patients' bill of 
rights and we cited the Texas bill, it is a Texas bill but it was never 
signed. One of the reasons that it was not signed, and I cannot read 
the minds of the leadership at that time of our State, the Governor but 
certainly there was some argument about special interests who were 
still opposing it because it did give the right of the aggrieved 
person, the person who lost a loved one, the right to sue.
  I just want to say something about that because you do not hear 
anyone raising their voices about that other than those who are 
continually denying service, because everyone knows patient and 
physician, no one who is dealing with health care and the life or death 
of a loved one is eager to rush to the courtroom. What they are eager 
to do is rush to the recovery room, because they want their loved one, 
they want to be well, they want their child to be well, they are not 
interested in playing out health care in the courtroom. And so it 
really is a minimal issue.
  Mr. PALLONE. If I could ask the gentlewoman to yield a minute, I 
remember when we were discussing this at the time the patients' bill of 
rights passed, that I do not think there were more than a handful of 
cases since the Texas law became law where anybody had gone to court. 
Less than five or so at the time.
  Ms. JACKSON-LEE of Texas. Absolutely. As we have seen, all of the 
testimony talks about the loss of my loved one and the fact that I 
would have wanted to have gotten the care from the physician as opposed 
to a denial of care. That is what we are on the floor to do.
  Let me close my remarks by pointing out again about Texas, and I am 
glad my good colleague and neighbor from Arkansas pointed to 
distinctive differences between what we are debating on the floor of 
the House and what the Democratic caucus and a very large number of 
Members of the other side of the aisle are fighting against with the 
Republican leadership.

                              {time}  2115

  That is, again, pointing not only to the Patients' Bill of Rights, 
but this prescription drug benefit. And I just want to highlight, I 
have interpreted it this way. We now have to kind of say it is 
voluntary, because we hear the other side saying we want to force 
seniors into something. The only thing that we want to force seniors 
into is happiness, because we want seniors to be able to secure 
prescription drugs that they need and they can take the full amount, so 
that they are not choosing rent, they are not choosing food, and they 
are not choosing utilities over

[[Page 24377]]

their full amount that the physician has prescribed.
  What do I have in my offices? Seniors after seniors and letters after 
letters saying ``I cannot take the full complement of the prescription; 
I do not have the money.'' So what our plan, the many who have worked 
on this plan who will speak tonight about their plan and the plan, and 
what Al Gore is proposing is a mandatory guaranteed benefit. Let me say 
the term ``mandatory.'' It is under Medicare. It is mandatory that 
every senior does have a choice, but it is a guaranteed benefit under 
Medicare.
  That makes a world of difference, because what it says is seniors can 
get the same low cost that local hospitals can and will not have to 
suffer the consequences of shooting up blood pressures from not taking 
their full prescription of blood pressure medicine, or their sugar 
going up because of the diabetes, which I hear so often from seniors.
  The last point is on BBA 1997. We all tried to do the right thing. 
But it is interesting, we have been trying to fix it to ensure that we 
take care of our hospitals for a long time. Now, the tragedy is, I wish 
that for once we would have a bipartisan response to a problem that is 
hurting all of us. In rural communities, hospitals are closing. Urban 
communities, hospitals are closing. But yet we have a proposal on the 
table that does not answer the question of providing for the ones who 
are on the front lines, home health care centers, hospitals, and public 
hospitals.
  So I hope that we can turn our attention to putting the right kind of 
legislation on the floor, because my public hospital system is 
watching. And I would hate to have to vote against this legislation 
because all of the money goes to HMOs. That is not keeping my public 
hospitals' doors open. That is not good health care. That is not 
preventive health care. That is not anything, because my hospitals, and 
when I say ``my hospitals,'' I am sure others will talk about their 
hospitals. But the Harris County Hospital District doors will still be 
in trouble if this legislation passes with a large sum of the relief 
going to HMOs.
  Mr. Speaker, I frankly think we can do better by the American people, 
and I think the American people will demand of us that. We have a short 
period of time. I hope that we can put the focus of health care back in 
the hands of the people and not in special interests.
  Mr. PALLONE. Mr. Speaker, I thank the gentlewoman from Texas. She 
points out the fact that this is affecting real people in their lives, 
and that is what is so crucial about this tonight.
  I yield now to the gentleman from Arkansas, who is one of the 
conferees on this ill-fated Patients' Bill of Rights conference, 
unfortunately.
  Mr. BERRY. Mr. Speaker, I thank the gentleman from New Jersey and 
appreciate the leadership he has provided on this matter over the time 
that I have been in the House of Representatives. I appreciate our 
distinguished colleagues, especially the gentlewoman from Florida (Mrs. 
Thurman), for the great job that she has done and the gentlewoman from 
Texas (Ms. Jackson-Lee), and the distinguished gentleman from Maine 
(Mr. Allen). They have been working on these issues all the time we 
have been in the House, and I appreciate them very much.
  The American public is outraged that we have not done anything in the 
106th Congress on health care. Here we are 25 days into October, should 
have already finished the Congress' business and gone home. Yet we are 
here today because the Republican leadership has refused to deal even 
with the basic appropriations matters. We have not passed a 
prescription drug benefit for our seniors. We have not passed a 
Patients' Bill of Rights. We have, as the gentlewoman from Texas just 
referred to, hospitals and nursing homes closing almost daily now 
because of the Balanced Budget Act of 1997 that needs to be repaired.
  Our seniors that do not have medicine cannot wait until the 107th 
Congress. What are we expecting them to do? They cannot wait when they 
do not have medicine and do not have the money to buy it. Our citizens 
that do not have a Patients' Bill of Rights, and they are not getting 
the health care they need from their insurance companies, they cannot 
wait.
  Our nursing homes and hospitals and providers, particularly in rural 
America, cannot wait. It is time that we did something. The Republican 
leadership in this Congress should do something tomorrow to rectify 
this situation.
  Mr. Speaker, I have to say it reminds me of the story of two men in 
the community where I grew up. One of them was named Dude and the other 
one's name was Possum. Now Possum could not see very well and he was 
getting on up in years and needed to go to Little Rock to the doctor 
about a hundred miles away, and Dude decided he would take him. So they 
got in the car and started to Little Rock, and they got to Little Rock 
and it was the first stop light that they encountered after traveling 
100 miles and Dude came up to the stop light and slammed on his brakes. 
He sat there and waited until the light changed and then just floor-
boarded the automobile and roared off to the next stop light. When he 
came to it and it was red, he slammed on his brakes again. After doing 
that three or four times, Possum said, ``Dude, what in the world are 
you doing?'' And he said, ``I don't understand this.'' And Dude said, 
``You know, an ignorant so-and-so irritates me. Can't you see I'm 
fighting the traffic?''
  That is what the Republicans have been doing here for 2 years, is 
fighting the traffic. They are not getting anything done. They are 
slamming on their brakes, and they are stomping the accelerator. They 
are ripping and roaring and tearing around and declaring all of this 
great concern about America's health care, and the fact is they have 
not done anything and do not intend to.
  It has been interesting to listen to Governor Bush talking about 
working in a bipartisan way. We are certainly willing to work with him. 
He better bring some new Republicans with him if he is going to get any 
cooperation. The Democrats are already there ready to pass a 
prescription drug benefit.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, if the gentleman would yield, 
he is eloquently crafting the whole scenario. But I do want to comment 
on the point of the Governor and his constant refrain about working 
with Democrats and Republicans in the State of Texas. The gentleman 
just hit on the point.
  I think it should be made very clear that the last Patients' Bill of 
Rights, which is in fact almost a replica of what we have in the House 
for which we have bipartisan support, which was under legislative 
Democratic leadership in Texas, was a bill he could not bring himself 
to sign. And rather than fight it by a veto again, realizing that he 
could not get a sustained veto, he let it languish and it went into 
law.
  So this refrain of working with Democrats and Republicans on health 
care is somewhat, I might say, hypocritical; and the gentleman from 
Arkansas has hit the nail on the head. I would simply say that a good 
thing he might be able to do in this time frame is to call this 
leadership here and ask them to move forward on the Patients' Bill of 
Rights.
  I yield back to the gentleman.
  Mr. BERRY. Mr. Speaker, I think the gentlewoman from Texas makes a 
very good point. It is time that the Republican leadership in the 
Congress realizes what the American people want and do something about 
it. It is past time. Our seniors cannot afford to wait another day for 
prescription drug coverage, for our hospitals to get the money that 
they need, and for a Patients' Bill of Rights to be passed so that we 
have the ability for our doctors and patients to make the health care 
decisions that they are involved in; so that we can hold the insurance 
companies accountable in the event that they do cause some serious 
damage or injury to our loved ones.
  It is unbelievable to me that one more Congress has already just 
about expired and nothing has happened. I continue to be amazed at this 
rhetoric that the Republicans put out every day: oh, we are for 
Patients' Bill of Rights. We are for prescription drug

[[Page 24378]]

benefits for our senior citizens. We are for that 100 percent. The fact 
is they have been in control of this Congress since 1995 and have done 
absolutely nothing to move these issues forward.
  As the gentleman from New Jersey explained a few minutes ago, we have 
done discharge petitions. We have done everything that we have; every 
tool that we have available to us has been used by the Democrats to try 
to get prescription drug coverage and a Patients' Bill of Rights and to 
change the Balanced Budget Act so that our health care providers, 
particularly in rural America, can stay in business, and yet nothing 
has happened. This is an abomination for this Congress to be this close 
to adjournment and still nothing has happened.
  I yield to the gentleman from Maine.
  Mr. ALLEN. Mr. Speaker, I thank the gentleman from Arkansas for 
yielding me. I would like to follow up what he has been saying, because 
it is not just the Republican leadership here, though they certainly 
have not brought to the floor, they have not helped the process of 
passing a Patients' Bill of Rights or certainly not fought for our 
seniors.
  But there is another group out there. The gentleman knows in the 
Fourth District in Arkansas, Citizens for Better Medicare is running 
television ads all across this country. Citizens for Better Medicare is 
a group, but it is not citizens, and they are not for better Medicare. 
Citizens for Better Medicare is funded by the pharmaceutical industry. 
And it is not the only organization that is funded by the 
pharmaceutical industry.
  What they are doing is trying to go out and make heroes of those who 
have been fighting against a prescription drug benefit for seniors and 
to attack those who have been supporting a Medicare prescription drug 
benefit for seniors. The world is turned on its head and that little 
tag line under the TV ads which says ``Citizens for Better Medicare'' 
means that they are the pharmaceutical industry and they are going to 
do everything they can to stop seniors from getting a discount, stop 
seniors from getting a prescription drug benefit.
  The Republican National Committee is doing the same thing, trying to 
confuse the American people. There is an ad being run by the RNC, and 
it says that the Gore plan would force people into a big government 
HMO. Not true. There is no such animal as a big government HMO. The 
HMOs are the folks, the private sector, they are the folks who are 
allowed by the Balanced Budget Act to come into Medicare and offer 
managed care to Medicare beneficiaries around the country.
  My parents are two of the 1,700 people in Maine who are the last 
people to be covered by managed care under Medicare. And why? Because 
the managed care company could not make enough money in Maine, so they 
have pulled out. I will say one thing about Medicare. Medicare does not 
leave a State just because it is not making money. And the truth is if 
we are going to provide effective, reliable, voluntary prescription 
drug coverage for our seniors, it will only be through Medicare.
  Just contrast George W. Bush's plan. This is a plan which he calls 
``Immediate Helping Hand.'' It is not immediate, and it is not much 
help, because here is how it works. For the first 4 years, there is $48 
billion that will go to 50 different States to run 50 different 
programs to help only those who are low income. What is low income? 
Those who are taking in $14,500 a year or less. A widow earning $15,000 
a year on Medicare, they wait. They wait for 4 years. And after 4 
years, what they get to do under the Bush plan is call up an HMO who is 
operating in their State and hope that maybe, just maybe they will be 
providing a prescription drug plan.
  Now, the chances are slim that they will be, because one thing the 
health insurance industry has made clear is that they will not provide 
stand-alone prescription drug coverage, which is at the heart of the 
Republican effort in the House, the Republican effort in the Senate, 
and the George W. Bush plan. That is how the Republicans say they are 
going to provide for our seniors, through HMOs that are saying 
themselves that they do not want any part of this business.

                              {time}  2130

  It is a scandal.
  Mrs. THURMAN. I would just ask a question, because we talk about in 
these numbers of poverty or somebody under $14,000, that is not after 
expenditures. That is what they get at the beginning of the year, or 
what their allocation would be, would be $14,500. So if you were 
somebody who was 70 years old and if we look at the average of what a 
senior takes in medicine, life-sustaining medicines, then they could 
pay anywhere between $4,000 to $5,000 a year, not on anything else, but 
just on medicines, dropping now their income to $9,000, $9,000 which 
they have to live on, after the medicine which allows them to live.
  Mr. ALLEN. The point is a very good one. I was at an assisted living 
facility just 2 weeks ago and one of the women there said, you know, I 
am spending $700 a month for my prescription medication, and, she said, 
I hope you do something soon. It is very clear, she could not continue 
spending $700 a month very long.
  Yet, under the Bush proposal, it is 4 years, you wait 4 years, if you 
are taking in more than $14,500 a year, and you wait, and then after 4 
years you call up your HMO and hope that maybe they are offering a plan 
that today they say they will not offer under any circumstances.
  There is another issue here that we have not talked about, that I 
find is very important in Maine, and I will bet it is true in Arkansas 
and Florida, and New Jersey as well. When I talk to small businessmen 
and women in Maine, they say to me now, we cannot afford the kind of 
health insurance that we used to buy. And what are they buying, if they 
are buying anything at all? They are buying catastrophic coverage only. 
They are basically getting health insurance, and they will wind up 
paying for the first $5,000 of their health care.
  That is not health insurance as we know it. Under that system, there 
is no incentive, financial incentive, to do preventive care. That is 
basically the individual, small businessman and woman, carrying the 
burden of their own health care, and getting insured only for expenses 
over $5,000.
  I just was noticing that this is an area where Al Gore's plan really 
makes a difference, because he creates a 25 percent tax credit for 
small businesses who are purchasing health insurance for workers, 
number one; number two, he allows those who are 55 to 65 years old to 
buy into Medicare; and, three, he provides access to coverage for all 
children by expanding the children's health insurance program to 250 
percent of poverty and allowing a buy-in to the CHIP program for 
families with incomes above that level.
  So, by focusing on small businesses, by focusing on children and by 
focusing on those people between 55 and 65, you are attempting to get 
to the place where we can expand coverage. It will happen, if it 
happens, because Democrats are willing to stand up and fight the HMO 
industry and fight the prescription drug industry, because these 
industries cannot do it, and in some cases will not do it.
  Mr. PALLONE. I appreciate my colleague's comments. Let me just say, 
we have about 4 or 5 minutes left. I certainly will yield to any of my 
colleagues. The gentleman from Arkansas?
  Mr. BERRY. I thank the gentleman from New Jersey again. One of the 
things that I wonder about is our Republican leadership here, as I have 
said, they have refused to pass a patients' bill of rights and a 
prescription drug benefit for our seniors, and I wonder how they are 
going to face these seniors and say, well, wait 4 more years. How are 
they going to face these seniors that are thrown into terrible 
situations and say, well, we did not do it, but we are going to. We are 
with you. We are going to do it some day. How are they going to face a 
little boy that has lost his limbs?
  Mr. PALLONE. What I find is a lot of times they will try to address 
maybe the individual's problem who comes to

[[Page 24379]]

their office and see what they can do to help, but the bottom line is 
that everyone is suffering from this. Everybody in an HMO has the 
potential, no matter how wealthy they are or what their situation in 
life is, where the insurance company comes along and says to them that 
you cannot have a particular procedure. I do not care what your 
situation is you find yourself in. I noticed people that are the head 
of the company, the CEO of the company, that has had that situation. So 
this is something that affects everybody. This is not just something 
that applies to a few people.
  I think they just pretend like they are doing something about it and 
hope that people forget.
  Mrs. THURMAN. I appreciate the gentleman yielding. We have been doing 
a lot of surveys and different studies across the country, and then in 
particular within our districts, by the governmental operations staff 
to look at the different costs of what it costs in the United States 
for medicine, what it costs in Canada and what it costs in Mexico.
  Just recently we have also looked at another study which has been 
done through the State of Florida, and looked at the prescription drug 
coverage for Florida seniors. I found it very interesting, which just 
tells me this issue is getting more difficult because we are getting 
more seniors who are losing their coverage, and probably a lot because 
of the pullouts of our HMO-managed care, managed-choice program.
  The survey collected during 1999 showed that 41 percent of the 
Medicare beneficiaries surveyed in Florida reported now that they had 
no prescription drug coverage, and in 1998 it was 29 percent of 
surveyed Florida seniors that reported that they did not have. So just 
1 year later, we have already seen an increase to 41 percent. That is 
almost 50 percent of the population of seniors in the State of Florida.
  It would seem to me, and what I am most saddened about is, that we 
leave the 106th Congress after debating, after recognizing the problem, 
still with no prescription drug benefit, no relief in sight, and for 
why not, I do not have the answer, and I do not know what to tell them 
at home. It is because they would not have accepted the bill that was 
passed on this House. They understand that to depend on the very same 
people who have left them out with managed care and insurance 
companies, it is unacceptable.

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