[Congressional Record (Bound Edition), Volume 146 (2000), Part 9]
[House]
[Pages 13250-13275]
[From the U.S. Government Publishing Office, www.gpo.gov]



               QUALITY HEALTH-CARE COALITION ACT OF 2000

  The SPEAKER pro tempore. Pursuant to House Resolution 542 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the State of the Union for the consideration of the bill, H.R. 1304.

                              {time}  2259


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the State of the Union, for the consideration of the 
bill (H.R. 1304) to ensure and foster continued patient safety and 
quality of care by making the antitrust laws apply to negotiations 
between groups of health care professionals and health plans and health 
insurance issuers in the same manner as such laws apply to collective 
bargaining by labor organizations under the National Labor Relations 
Act, with Mr. Shimkus in the chair.
  The Clerk read the title of the bill.
  The CHAIRMAN. Pursuant to the rule, the bill is considered as having 
been read the first time.
  Pursuant to the order of the House, the gentleman from Illinois (Mr. 
Hyde) and the gentleman from Michigan (Mr. Conyers) each will control 
10 minutes.
  The Chair recognizes the gentleman from Illinois (Mr. Hyde).

                              {time}  2300

  Mr. HYDE. Mr. Chairman, I yield 5 minutes to the gentleman from 
California (Mr. Campbell) and 5 minutes to the gentleman from Ohio (Mr. 
Boehner), and I ask unanimous consent that they be permitted to control 
that time.
  The CHAIRMAN. Is there objection to the request of the gentleman from 
Illinois?
  There was no objection.
  Mr. CAMPBELL. Mr. Chairman, I yield 2\1/2\ minutes to the gentleman 
from Florida (Mr. Weldon).
  Mr. WELDON of Florida. Mr. Chairman, I thank the gentleman for 
yielding me this time. I rise in support of the bill, and I wanted to 
relate to my colleagues in the Chamber my experience on this issue, the 
very issue we are discussing today.
  Many years before I got elected to the U.S. House, and as most of my 
colleagues know, I am a physician; we had an insurance company come to 
the community offering a product, they called it a PPO, Preferred 
Provider Organization, or network; and it had a fee schedule in it that 
was substantially below what was the prevailing rates in the 
communities. So a whole bunch of the providers, the doctors in the 
community, were concerned about this because this was a big company, it 
insured a lot of people. So we all agreed to gather together in a hotel 
ballroom to discuss this issue, and we invited an attorney to join us 
and asked him to get up first and explain to us the antitrust laws so 
that we would not run afoul of antitrust.
  So we allowed him to speak, and he got up and he said, if you want to 
stay out of trouble, go home. You can't talk about this. If you discuss 
it at all, you can be prosecuted. So we all went home.
  Now, back in those days there was one group that had about 20 
doctors, a few other small groups, and then a lot of solo 
practitioners. Now, in that community there are four large groups, my 
group, which had 20 doctors, has 100 doctors, and there is virtually no 
solo practitioners left. That is really what this bill is about.
  We are talking about the solo pediatrician, the two-man group, the 
family practitioner who operates alone, being able to negotiate with 
these insurance companies.
  There are some people who will argue against this bill and say it is 
going to tip the playing field. The playing field is overwhelmingly in 
the favor of the insurance companies. We have provided them antitrust 
exemptions. They can trade information amongst each other. They can 
trade information about providers, their pricing, but the doctors 
cannot talk amongst themselves at all.
  So what we are really talking about here is evening out the playing 
field, and I think it is the right thing to do. I commend the gentleman 
from California for moving this legislation and the gentleman from 
Michigan.
  Mr. CONYERS. Mr. Chairman, I yield myself 2 minutes.
  In the spirit of us moving as rapidly as we can, is it correct that 
the Chair is now going to roll the votes? Has that been arrived at?
  The CHAIRMAN. When we get into the amendment process, the Chair will 
exercise that discretion.
  Mr. CONYERS. I thank the Chair.
  Mr. Chairman, we are dealing with a trinity of health care bills, the 
Prescription Drug bill, the Patients' Bill of Rights, and this modest 
antitrust exemption for doctors.
  Now, please remember, this is a labor exemption. The antitrust 
legislation was written for capital corrections and guidance. But what 
we are doing here is doing what the doctors need to be able to discuss 
how between HMO administrators and other professionals that they are 
now being restricted in their ability to make decisions for their 
patients.
  We all know about this problem. We now have the opportunity to deal 
with this question, and all I would like my colleagues to keep in mind 
is that the time has come. For several years now we have brought this 
measure forward. We are now debating it.
  Most Americans receive their health insurance coverage through 
managed care plans, but we have seen the massive coalitions and 
consolidations of the managed care market to just a dozen health 
insurance competitors. As a result of this market concentration, we 
need to give some relief to these doctors. They are really feeling the 
pinch. They are depending on us. And, by the way, so are the patients. 
The decisions that the doctors make in the patient-doctor relationship 
are under a severe test at this present point.
  So we respond to this problem by allowing medical professionals to 
jointly negotiate the terms of their contract with health care plans. 
There is a 3-year sunset on the bill. Please support it.
  Mr. BOEHNER. Mr. Chairman, I yield 1 minute to the gentleman from 
Oklahoma (Mr. Coburn).
  Mr. COBURN. Mr. Chairman, every doctor in this country, unless they 
work for an HMO firm as a company doctor judging other doctors, is 
frustrated in this country. What the gentleman from Florida (Mr. 
Weldon) just described to you is a situation that does, in fact, occur. 
One of the things that happens is the doctor is consolidated into a 
group. That group as a group can decide whether or not they will or 
will not take an HMO contract.
  The problem is that in urban areas, we have way too many doctors, and 
the only way an HMO or an insurance company can take advantage of that 
is when there is an excess of physicians. So the real answer to this 
problem is to, in fact, allow the marketplace to work. The problem is 
the former bill of the gentleman from California (Mr. Campbell), which 
we should be voting on, which takes away the exemption from the 
insurance companies rather than giving it to the physicians.
  Mr. CONYERS. Mr. Chairman, I yield 30 seconds to the gentleman from 
Michigan (Mr. Dingell), the Dean of the House of Representatives.
  Mr. DINGELL. Mr. Chairman, I thank my old friend for yielding to me.
  Mr. Chairman, this is a good piece of legislation. It shifts the 
balance back to the point where it is fair to the doctors and to the 
HMOs by whom they are employed. I think it is time that we do this. It 
is simple justice and simple equity, and it will improve a situation 
which has grown increasingly intolerable from the standpoints of 
doctors, of patients, and, very frankly, if

[[Page 13251]]

they were smart enough to know, also the HMOs.
  Mr. Chairman, managed care has dramatically changed health insurance 
in the past 30 years. Once upon a time,it actually managed the care a 
patient received and because that was more efficient, it actually 
saving some money. But, managed care has taken this cost-saving ability 
to new levels and as a result has made the relationship between 
doctors, patients, and insurers more complicated. The balance of power 
has tilted away from the doctor and the patient to the insurer.
  Insurance companies hold supreme power over both payment decisions 
and treatment decisions, potentially compromising the quality of care 
along the way. The Quality Health Care Coalition Act addresses 
providers' concerns with their unequal bargaining position with 
insurers--a problem which hurts the quality of care patients receive. 
For that reason, Congress should act to restore balance to the 
provider-insurer relationship.
  However, passing H.R. 1304 does not relieve us of our responsibility 
to restore the balance to the patient-insurer relationship by enacting 
a meaningful, enforceable Patients' Bill of Rights that covers all 
Americans. The House of Representatives passed such a bill on a 
bipartisan basis last October. The Norwood-Dingell bill provides a 
fair, independent, and expeditious appeals process, and guarantees that 
doctors, not accountants, are making medical decisions. The bill 
ensures that patients have basic rights such as access to specialists, 
access to emergency care, access to ob-gyn care, and access to needed 
drugs. It also ensures that patients can hold their HMO accountable for 
acting irresponsibly, if those actions cause injury or death. More than 
nine months have passed, the conference has failed, and Congress still 
has not delivered a bill to the President.
  The Quality Health Care Coalition Act is one step toward leveling the 
playing field for doctors, but Congress must finish its work for 
patients and get a meaningful, enforceable Patients' Bill of Rights to 
the President. I hope that we will see both bills signed into law this 
year.
  Mr. CONYERS. Mr. Chairman, I yield 30 seconds to the distinguished 
gentleman from Michigan (Mr. Bonior).

                              {time}  2310

  Mr. BONIOR. Mr. Chairman, let me just say that I want to commend the 
gentleman from Michigan (Mr. Conyers) and the gentleman from California 
(Mr. Campbell) on crafting this legislation. Not only is this good for 
doctors and patients, but it reinforces the idea that collective 
bargaining and workers coming together and being able to bargain for 
their work is a valuable, valuable asset in our society today.
  It is not just blue collar workers or technical workers or clerical 
workers. We are finding more and more teachers and scientists and 
people of professional status involved in this kind of collective 
bargaining and organization. I commend them for giving this opportunity 
to the doctors.
  Mr. Chairman, one of history's most enduring lessons is that 
collective bargaining is the only institution that offers Americans the 
voice they need to win fairness in the workplace.
  Most of us understand how that's worked for blue-collar workers and 
clerical and technical employees--but it's just as true for 
professionals.
  That's why, over the years, we've seen teachers, journalists and even 
scientists organize.
  That's why I was proud to join a union when I was an adoption 
caseworker.
  And that's why health care professionals are organizing today.
  They're organizing because they understand what every family in this 
country knows: that American health care today is big business.
  And it's a business where, all too often, the quality of patient care 
has taken a back seat to the demand for profit.
  By passing H.R. 1304, we're giving health professionals an important 
new tool to fight back.
  Through collective bargaining, they'll have the added clout they need 
to talk back to the health plans that dominate American medicine.
  That's not just good for health providers--it's good for the patients 
who depend on them.
  Because when health professionals negotiate they won't only be 
speaking out for themselves, they'll be bargaining for better care.
  The bottom line is that joining a union doesn't undermine 
professionalism--it only bolsters it.
  I'm proud to salute the leadership of my colleagues, Tom Campbell and 
John Conyers, in crafting this measure.
  And I'm proud to join with them in voting for H.R. 1304 today.
  But, like other supporters of this bill I strongly oppose the Cox 
amendment to H.R. 1304.
  The Cox amendment is a shameless attempt to undermine the ability of 
health professionals both to organize and to bargain. It will render 
this legislation virtually useless.
  Vote ``no'' on the Cox amendment, and, once it's defeated, vote 
``yes'' on H.R. 1304.
  Mr. CAMPBELL. Mr. Chairman, I yield 1 minute to the gentleman from 
Georgia (Mr. Barr).
  Mr. BARR of Georgia. Mr. Chairman, I rise in support of H.R. 1304, 
because it is a bill that is simple in concept and based on fundamental 
principles of fair market, and the freedom and right to contract fairly 
as equals on a level playing field.
  This legislation does nothing except remove the current artificial 
barriers that prevent doctors from doing what every other citizen has 
the right to do, and that is to bargain as equals in good faith and on 
a level playing field.
  It is not giving them any special advantage. It is simply saying to 
the doctors of America as they try and practice medicine with the best 
interests of their patients in mind that they can negotiate as equals 
on behalf of their patients. That is all this bill does. It does no 
more and no less. That is why it enjoys the support on both sides of 
the aisle of a majority of Members of this House.
  I urge Members to vote in support of H.R. 1304.
  Mr. BOEHNER. Mr. Chairman, I yield 1 minute to the gentleman from 
Arizona (Mr. Shadegg).
  Mr. SHADEGG. Mr. Chairman, I thank the gentleman for yielding time to 
me.
  Mr. Chairman, it is true that doctors are not on a level playing 
field. I have immense sympathy for their situation. But as well-
intended as this legislation is, we have to look beyond what it says to 
what it will do. What it will do is drive up the cost of health care.
  What we have done in America is we have disempowered patients. The 
reality is patients in America today cannot pick their own doctor 
because they are trapped in a health care plan selected by their 
employer.
  We need to create a marketplace in health care in America today by 
empowering patients. Let us ask ourselves, are doctors not powerful 
enough, are HMOs not powerful enough, or are patients not powerful 
enough? The answer is that it is the patient that has been left out of 
this equation. They are trapped in the health care plan. They cannot 
get to the doctor they want.
  Rather than empowering patients to go hire the doctor they want and 
bring down the cost of health care and get the care they need, what we 
are going to do is we are going to allow doctors to collectively 
bargain.
  The net effect of that will be to increase the cost of health care 
and, mark my words, we will have Hillary care. We will have a single-
payer system within 5 years when this bill becomes law.
  Mr. CONYERS. Mr. Chairman, I am pleased to yield 1\1/2\ minutes to 
the gentleman from New York (Mr. Nadler), a member of the committee.
  Mr. NADLER. Mr. Chairman, today's health care marketplace is 
dominated by six large companies who enjoy monopoly or near monopoly 
power in certain areas of the country. These companies possess 
unchallenged power in their negotiations with health care providers 
because providers are restricted by antitrust laws from bargaining 
collectively for more favorable terms.
  We hear from critics of this legislation that the bill is just about 
helping doctors get rich, but I say it is about helping patients get 
quality care. When a doctor is told they may only provide the cheapest 
treatment available, it is the patient who suffers. When a doctor is 
told he may not even discuss alternative treatments not covered by the 
insurance plan, it is the patient who suffers. When a doctor is told he 
must see a dozen patients in an hour in order to make the reimbursement 
rates viable, it is the patient who inevitably suffers.
  This bill is not about lining the pocketbooks of doctors, it is about 
allowing

[[Page 13252]]

doctors to stand up to the insurance companies and say, we will not 
accept conditions that harm our patients or put them in jeopardy.
  Opponents argue that this bill would significantly raise costs in the 
health care industry because doctors will be able to extract exorbitant 
reimbursement rates from insurance companies if they were able to 
negotiate collectively. But to suggest that doctors will have these 
monolithic, multibillion dollar companies at their mercy defies logic 
and credulity.
  What this bill would do, all this bill would do, is to place doctors 
on a somewhat less tilted, a somewhat more level playing field on which 
to negotiate decent rates and decent conditions for their patients.
  This may be the most important bill we could pass this year. I urge 
its adoption.
  Mr. Chairman, I rise in strong support of H.R. 1304, the Quality 
Health Care Coalition Act of 1999. This is a very important piece of 
legislation that will immensely improve the quality of patient care in 
this Nation.
  Mr. Chairman, the health care landscape is increasingly being 
controlled by just a few large insurance companies. Today's health care 
marketplace is dominated by six large companies, who enjoy monopolies 
or near monopolies in certain areas of the country. These companies 
possess unchallenged power in their negotiations with health care 
providers because providers are restricted by antitrust laws from 
bargaining collectively for more favorable terms. It has gotten to the 
point where insurance companies are effectively dictating the terms of 
an agreement to the providers.
  We hear from critics of this legislation that this bill is just about 
helping doctors get rich, but I say that it's about helping patients 
get quality care. When a doctor is told he may only provide the 
cheapest treatment available, it's the patient who suffers. When a 
doctor is told he may not even discuss alternative treatments not 
covered by the insurance plan, it's the patient who suffers. And when a 
doctor is told that he must see a dozen patients an hour in order to 
receive viable reimbursement rates, it's the patient who inevitably 
suffers.
  This bill is not about lining the pocketbooks of doctors. It's about 
allowing doctors to stand up to insurance companies and say, ``We will 
not accept conditions that harm our patients or put them in jeopardy.'' 
We must once again place medical decisions in the hands of doctors 
rather than an HMO bureaucrat who is not involved in our care.
  Opponents argue that this bill would significantly raise costs in the 
health care industry because doctors would be able to extract 
exorbitant reimbursement rates from insurance companies if they were 
able to negotiate collectively. But to suggest that doctors will have 
these monolithic, multibillion dollar companies at their mercy defies 
credulity. What this bill would do is place doctors on a somewhat more 
level playing field on which to negotiate. We do not tip the scales in 
their favor.
  Let me also mention another criticism of this bill raised by 
nonphysician providers such as nurse midwives and nurse practitioners. 
When the Judiciary Committee held hearings on this bill, these groups, 
among others, expressed in important concern over H.R. 1304, namely 
that doctors would be able to use the collective bargaining power 
granted under the bill to effectively exclude them from the field or 
severely limit their ability to practice. That is certainly not the 
intent of the bill.
  The purpose of this bill is to ensure that no member of the health 
care profession has the terms of his or her practice dictated to them. 
This includes all of the licensed nonphysician providers who have 
worked alongside doctors to provide quality care to patients. We do not 
want to provide a tool for one class of health care professionals to 
squeeze out another.
  That is why I worked with Representatives Frank and Jackson-Lee to 
amend the bill in the Judiciary Committee to specifically bar doctors, 
or any other provider, from entering into an agreement or conspiracy 
which would exclude, limit the participation or reimbursement of, or 
otherwise limit the scope of services to be provided by any other 
health care professional or group of professionals.
  Under this language, no member of the health care field can have the 
terms of their practice dictated to them by insurance companies, 
doctors, or anyone else. All terms will be worked out by negotiation, 
exactly as this bill intends. I am confident that this language fully 
protects all nurses and other nonphysician providers from attempts by 
doctors to limit their ability to practice.
  Mr. Chairman, this is responsible legislation that will release 
doctors from the grip of insurance companies and help them negotiate 
terms that best serve their patients. I believe this bill will help 
restore confidence in the doctor-patient relationship and ensure that 
it is only doctors and other licensed professionals who practice 
medicine. I urge my colleagues to support H.R. 1304 so that all 
providers will be free to practice in the best interests of their 
patients.
  Mr. CONYERS. Mr. Chairman, I am pleased to yield 1 minute to the 
gentlewoman from Texas (Ms. Jackson-Lee), a distinguished member of the 
Committee on the Judiciary.
  Ms. JACKSON-LEE of Texas. Mr. Chairman, I thank the gentleman for 
yielding time to me.
  Since 1974, there have been 275 mergers and acquisitions of health 
plans. That is why I support the work of the gentleman from Michigan 
(Mr. Conyers) and the gentleman from California (Mr. Campbell). With 
this wave of consolidation, seven giant health care insurers have come 
to dominate the marketplace, and 80 percent of all Americans get their 
coverage through managed care.
  The enormous size of these companies allows insurers to not only 
control the costs of but also the quality and access to health care. 
The health care system has become David and Goliath. We have to give 
David something to fight with.
  In my State of Texas, although we already passed legislation that 
allows health care professionals to jointly negotiate, this is limited 
only to physicians in Texas. So national or regional health plans still 
have a stronger negotiating power, whereas a Federal law would help 
address this imbalance.
  Any amendments on this bill, unfortunately, are driven by the 
insurance companies to destroy the bill, so I hope my colleagues will 
vote down these poison pill amendments. This legislation would enable 
medical professionals to serve their patients in the way their best 
medical judgment indicates. To do that, they will occasionally have to 
present a united front to the giant HMOs.
  Mr. Chairman, this is a key vote for medicine. Therefore, I urge my 
colleagues to support this legislation by the Committee on the 
Judiciary.
  Mr. CAMPBELL. Mr. Chairman, may I inquire how much time is left on 
each side? I have only one more speaker in the general debate, myself, 
and I intend to close.
  The CHAIRMAN. The gentleman from Ohio (Mr. Boehner) has 3 minutes 
remaining, the gentleman from California (Mr. Campbell) has 1\1/2\ 
minutes remaining, the gentleman from Michigan (Mr. Conyers) has 4\1/2\ 
minutes remaining.
  Closing comments will be in this order: The gentleman from Ohio will 
start first, the gentleman from Michigan will go second, and the 
gentleman from California has the right to close.
  The Chair recognizes the gentleman from Michigan (Mr. Conyers).
  Mr. CONYERS. Mr. Chairman, I am pleased to yield 1 minute to the 
gentlewoman from New York (Mrs. Maloney).
  Mrs. MALONEY of New York. Mr. Chairman, I thank the gentleman for 
yielding time to me, and I rise in strong support of the Campbell-
Conyers Quality Health Care Coalition Act, and congratulate both of 
them on their really thoughtful and creative legislation.
  Mr. Chairman, what this bill is really about is who do we want in 
charge of our health care decisions, an HMO accountant bean counter, or 
our doctor who knows our health needs?
  This bill will level the playing field between enormous health care 
plans and physicians and patients, allowing physicians to come together 
to negotiate with health care plans over contract provisions. Patients' 
interests should be at the bargaining table, and this bill allows it.
  Many doctors in my district tell me that insurers are imposing 
greatly unfair contract terms on them. They say they have no choice but 
to sign the contracts unless they want to risk losing many of their 
patients.
  The choice is very clear. The patients want it, the doctors want it. 
The only opposition is the HMO accountants. I urge a yes vote.
  Mr. BOEHNER. Mr. Chairman, I yield 1 minute to the gentleman from 
Oklahoma (Mr. Largent).

[[Page 13253]]


  Mr. LARGENT. Mr. Chairman, I thank the gentleman for yielding time to 
me.
  I rise in opposition to this bill. I have been sitting listening to 
this debate. It is most unusual. I hear my friends, the Democrats, my 
friend, the gentleman from Michigan, talk about those poor doctors 
feeling the pinch. We need to help those poor doctors. Yet, when 
Republicans bring tax cuts to the floor, they holler no, no, those are 
tax cuts for the wealthy. We cannot give them a break on their taxes.
  What the Democrats want to do to help those poor doctors is to let 
them form a union. That is how we level the playing field, let them 
form a union.
  I have finally figured out and was able to put together the pieces of 
the puzzle, because when those proverbial union thugs go out to break 
knees, they will have the doctors there to fix them. It all makes 
perfect sense.

                              {time}  2320

  Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentleman from 
Pennsylvania (Mr. Hoeffel).
  Mr. HOEFFEL. Mr. Chairman, I thank the gentleman from Michigan (Mr. 
Conyers) for yielding me this time. I rise in strong support of the 
Campbell-Conyers bill, a bill that would allow collective bargaining, 
not unions I would say to the previous speaker, but collective 
bargaining, so that doctors can deal with the one-sided, unfair 
arbitrary contracts that are forced upon them by the big managed care 
companies. Contracts that impose gag rules so that doctors cannot 
discuss all of their treatment options with their patients. Contracts 
that discourage referrals to specialists. Contracts that block 
appropriate tests and delay care to patients. Contracts that give 
financial rewards for denying care.
  Mr. Chairman, in southeastern Pennsylvania where one managed care 
company controls 62 percent of the marketplace, they not only have 
offered orthopedic surgeons, as one example, a 40 percent cut in 
compensation, but they have also required that all doctors sign 
confidentiality agreements before negotiations begin as a precondition 
of negotiations one-on-one with the doctors. These agreements are 
unfair. They deny rights that doctors ought to have.
  Mr. Chairman, I support the bill.
  Mr. BOEHNER. Mr. Chairman, I yield myself the balance of my time.
  Mr. Chairman, I think we all know that we are going through major 
changes in the delivery of health care in America. Those issues have 
been fought out on this floor over the 10 years that I have been a 
Member and all of the changes are disconcerting to all involved.
  First, the patients, doctors, hospitals, employers who pay the costs, 
insurance companies, everyone is in turmoil trying to find the right 
balance making sure the patients get what they need and trying to hold 
costs under control.
  Every year that I have been here, we have debated Medicare and the 
tremendous increases in the costs of Medicare. We have been through all 
types of changes trying to what? Give the patients what they need while 
controlling the costs.
  And so as we look at the situation in managed care today, we have a 
number of those groups in the middle with their lobbyists coming to 
Washington wanting us to level the playing field. Now, leveling the 
playing field is like beauty. It is in the eye of the beholder. Of 
course, they all want it level as long as it is slightly tilted toward 
them.
  Mr. Chairman, this bill is no exception, except one small little 
exception. This is a big tilt, A big tilt to one group at the expense 
of all others that are locked into this system.
  Why would we provide an antitrust exemption to one group in the 
medical profession with no oversight, no regulatory body overseeing 
their actions? Every time we have provided an antitrust exemption in 
the law, there has been some Federal regulatory body that has the 
responsibility to provide oversight. The National Labor Relations Act 
allows for collective bargaining. That is why we have the National 
Labor Relations Board to oversee these activities between labor and 
management.
  To allow any group of Americans to go out and to form a cartel to 
prey on America's consumers is not good for our country. We know what 
happened with the OPEC cartel; we have higher prices at the gas pump 
today. What we are doing here is we are creating another cartel. It is 
a bad bill.
  Mr. CONYERS. Mr. Chairman, I yield 1 minute and 15 seconds to the 
gentleman from New Jersey (Mr. Andrews).
  Mr. NADLER. Mr. Chairman, will the gentleman yield?
  Mr. ANDREWS. I yield to the gentleman from New York.
  Mr. NADLER. Mr. Chairman, I must correct the statement made a moment 
ago. This bill does not grant any privilege to one group. I presume the 
gentleman meant doctors. The bill refers to ``all health care 
professionals,'' doctors, nurses, physical therapists, everybody in the 
field. It is not a cartel of one group. It is simply a mistaken fact 
and a misquote of the bill.
  Mr. ANDREWS. Mr. Chairman, reclaiming my time, I thank the gentleman 
from New York, my friend.
  In our economy, actors are regulated either by litigation, regulation 
or competition. None of those three things applies to the oligarchs of 
the managed care industry.
  This Congress, I am confident, is going to take a step to impose the 
quality control of litigation through the Patients' Bill of Rights. 
This bill is a very important step in imposing some competition in the 
health care market for the first time in a long time.
  This really is about leveling the playing field. It is about reining 
in the conduct of the oligarchs of managed care. For that reason, I 
strongly support the legislation and commend the gentleman from 
California (Mr. Campbell) and the gentleman from Michigan (Mr. 
Conyers), my friend, for offering it.
  The CHAIRMAN. The gentleman from Michigan (Mr. Conyers) has 1 minute 
and 15 seconds remaining. The gentleman from California (Mr. Campbell) 
has 1\1/2\ minutes remaining. The gentleman from California has the 
right to close.
  Mr. CONYERS. Mr. Chairman, I yield myself the balance of my time.
  Mr. Chairman, this Quality Health Care Coalition Act is an important 
antitrust exemption for doctors. I want to begin my closing remarks in 
general debate by merely commending the gentleman from California (Mr. 
Campbell) for all the work that he has done on this measure and for 
allowing me to work with him.
  Mr. Chairman, we would not be here today if we were not concerned 
about the doctor-patient relationship which is in crisis. We are giving 
an exemption that the labor movement already has. This is not ground-
breaking legislation. It sunsets in 3 years. The original costs were 
based on a 10-year basis; and of course, it is only going to run for 3 
years.
  The managed care market has consolidated. Some of my colleagues may 
know that some doctors are in very dire circumstances. Private 
practices are in decline.
  Mr. Chairman, I urge my colleagues to support the antitrust exemption 
for doctors.
  Mr. CAMPBELL. Mr. Chairman, I yield 1 minute to the gentleman from 
Virginia (Mr. Davis).
  Mr. DAVIS of Virginia. Mr. Chairman, I also compliment the gentleman 
from California (Mr. Campbell) for bringing this forward. The American 
health care system has many players, but doctors and health care 
providers are essential. They are the essential players. They are on 
the frontline making life and death decisions every day, and they are 
being picked apart.
  Fees are cut unilaterally. Their medical advice that they are giving 
to patients is being countermanded by nondoctors, and they have no say 
in this situation the way it has come today. We have come to this that 
if we do not make these changes today, we are jeopardizing the best 
health care system in the world. People who want to enter and stay in 
the medical profession are looking outward at other options because, 
frankly, not only is the remuneration not there, and the respect is

[[Page 13254]]

not there, but they are not able to carry out their advice to patients 
because they are being countermanded.
  Mr. Chairman, that is what makes this legislation essential. I 
commend the gentleman from California (Mr. Campbell) for bringing this 
to the floor tonight. I hope we will give it a resounding ``yes'' for 
American health care, for doctors, the providers, and the patients.
  Mr. CAMPBELL. Mr. Chairman, I yield myself the balance of my time.
  Mr. Chairman, the key point I want to stress in closing is that this 
does not create a union of doctors. The words ``collective bargaining'' 
only occur in the statute with reference to an antitrust exemption 
already in law for unions. We do not use the words ``collective 
bargaining'' at all with regard to health care professionals.
  We explicitly say ``there shall be no right to strike,'' in case 
somebody thought there might be. No right to cease work that does not 
already exist. The bill has a 3-year sunset, and it explicitly provides 
the right for individuals not to be choosing an exclusive bargaining 
agent; and hence there is no need for the regulatory oversight such as 
the NLRB provides.
  Ms. DeLAURO. Mr. Chairman, today I cast my vote in support of the 
Quality Health Care Coalition Act, because I believe that physicians 
and other health care professionals should be on an equal playing 
ground when they negotiate contracts with health plans. The Quality 
Health Care Coalition Act would provide limited relief from the 
antitrust laws by allowing self-employed physicians to negotiate 
collectively with large managed care organizations regarding contract 
terms that protect patient confidentiality, increase patient choice and 
improve quality of care. It would restore balance in the market by 
increasing physicians' power to negotiate for their patients with large 
managed care organizations. It would not force health plans to accept 
terms and conditions sought by health care professionals, it would 
simply allow physicians to band together as a bargaining unit for 
purposes of negotiation.
  Unfortunately, this bill has been plagued by ``poison pill'' 
amendments, designed to divide and conquer the long-time supporters of 
this legislation. Representative Tom Coburn, authored a poison pill 
amendment that attempts to limit access to legal abortions. Mr. 
Coburn's amendment would restrict health care professionals from 
discussing health insurance coverage for abortions. Many fear that this 
restriction could prevent physicians not only from negotiating coverage 
for legal abortions, but also prevent them from discussing methods and 
procedures for providing referrals elsewhere. I joined my pro-choice 
colleagues in voting against this amendment. However, this amendment 
passed.
  As was the intention of this poison pill, this left me and my pro-
choice colleagues with a Hobson's choice--an affirmative vote for 
physicians and patients tied to a restriction on choice or a negative 
vote against physicians and patients to prevent an anti-choice measure 
from going forward.
  I voted for final passage of this legislation with the hope that the 
Coburn amendment will be struck when this bill reaches conference with 
the Senate. If this legislation proceeds through conference and reaches 
the President's desk with the anti-choice Coburn amendment intact, I 
urge the President to veto the bill.
  Mr. POMEROY. Mr. Chairman, H.R. 13204, which provides a broad 
exemption from federal anti-trust laws for health care professionals, 
is intended to restore parity between providers and third-party payers. 
I believe that this is a good intention, and I agree that in some 
markets, third-party payers have taken a hold so strong as to be able 
to dictate health care fees and standards.
  As a former state insurance commissioner, however, I know that the 
answer is not to completely tilt the scales in the opposite direction. 
No other organization or segment of our economy, except for Major 
League Baseball, enjoys such a broad, federal anti-trust exemption. 
Even the Business of Insurance is regulated under the McCarran Ferguson 
Act.
  Unfortunately, some proponents of this legislation have 
misinterpreted that McCarran Ferguson Act. They have stated that this 
act gives the insurance industry an exemption from anti-trust laws, and 
that H.R. 1304 simply levels the playing field for health care 
providers. Mr. Chairman, I want to emphasize something for my 
colleagues: the McCarran Ferguson Act creates a partial exemption for 
the business of insurance that is regulated by state law. Activities 
that do not relate to the business of insurance--such as a health 
plan's negotiations with health care providers--are still subject to 
federal antitrust laws.
  As a representative of rural America, I am also concerned about the 
effect this legislation will have on quality of care. H.R. 1304 would 
allow unrestrained, unregulated price fixing by all of the health care 
providers in a given market. Such price-fixing schemes would give 
physicians a monopoly within their market, permitting physicians to 
raise their own salaries, through higher reimbursement rates, at the 
expense of consumers, employers and taxpayers.
  Again, let me say that I know this is not the intent of the 
legislation or the plan of my respected colleagues and the professional 
organizations who support H.R. 1304. We probably do not need antitrust 
consumer protections for the leading, most ethical participants in the 
health care market. Unfortunately, in an industry as vast as health 
care, there will inevitably be those of other, less reputable 
intentions.
  For those well-intentioned physicians, legitimate antitrust 
mechanisms already exist under which physicians and other health care 
providers who have formed legitimate legal entities can collaborate and 
negotiate with health plans. Physicians do not need exemptions from the 
antitrust laws to collectively discuss quality of care issues among 
themselves or with these plans.
  Mr. Chairman, I would be inclined to support a more moderate measure. 
I understand that my colleagues on the Judiciary Committee adopted an 
amendment that would allow H.R. 1304 to sunset in three years. In my 
opinion, however, three years is enough time to increase both private 
and public health care costs and decrease quality of care. In fact, the 
CBO has estimated that a three-year exemption will raise insurance 
premiums by 1.5% by 2003 and cost the government $1.7 billion over 5 
years.
  Instead I suggest that if we really want to level the playing field, 
we regulate these medical providers in their bargaining groups, 
subjecting them to oversight as we have with other organizations, from 
trading companies to newspaper operations.
  Mr. Chairman, while well-intended, this is flawed policy. I urge my 
colleagues to think seriously about the effects this legislation may 
have on consumers, providers and payers alike. Please vote no.
  Ms. JACKSON-LEE of Texas. Mr. Chairman, I rise in support of H.R. 
1304, The Quality Health Care Coalition Act of 1999. As we consider 
this bill, let us remember what a truly bipartisan piece of legislation 
it has been thus far. In fact, H.R. 1304 passed the Judiciary Committee 
by a vote of 26-2. With that in mind, I wish to applaud Congressman 
Campbell and Congressman Conyers for their genuinely bipartisan efforts 
respecting this bill.
  H.R. 1304 would modify the anti-trust laws and would apply only to 
conduct in conjunction with good faith negotiations. The modifications 
would allow health care professionals to collectively settle the terms 
of their contracts with health care plans. I support this legislation 
because I believe that health care providers should be allowed to 
bargain collectively with health plans and insurance providers.
  In my state of Texas, although we already passed legislation that 
allow health care professionals to jointly negotiate, this is limited 
only to physicians in Texas. So, national or regional health plans 
still have a stronger negotiating power whereas a federal law would 
help address this imbalance.
  Since 1994, there have been 275 mergers and acquisitions of health 
plans. With this recent wave of consolidations, seven giant health care 
insurers have come to dominate the marketplace and 80% of all Americans 
get their coverage through managed care.
  The enormous size of these companies allows insurers to not only 
control the cost of, but also the quality and access to health care. 
These powerful health plans intimidate and threaten physicians with 
antitrust violations in order to bar them from talking to one another 
and to insurers about patient care. As a result, the decisions of 
health care professionals have been compromised.
  With the increased level of market concentration, HMOs have been 
practically setting the terms of contracts with health care providers, 
including forcing patients to accept the least expensive care and 
preventing patients from being fully informed of all available 
treatment options. Insurers should not make decisions such as these.
  We rely upon health care professionals to advocate for our care. No 
one is comfortable with the idea of a physician who withholds treatment 
information! In cases where doctors are prohibited from discussing all 
available treatment options, it could be a matter of life or death. 
Health care professionals need decision-making power to determine what 
is best for their patients.

[[Page 13255]]

  H.R. 1304 would provide guarantees that patients are protected from 
bureaucratic abuses. There is no way to predict what kind of healthcare 
quality issues will arise in the future. H.R. 1304 would enable 
healthcare providers to address managed care abuses and other patient 
care issues as they arise through contract negotiations.
  For doctors who provide specialty services, this bill will assist 
them in negotiating contracts with the health care plan to make their 
services more readily accessible. African-American physicians 
especially need this bill because they face special barriers that 
impede their full participation in managed care networks.
  African-American doctors are more likely to serve minority 
communities that are disproportionately low-income and severely ill. 
Because of these patients' special needs, African-American doctors 
often face the constant threat of being excluded from health plans 
because their patients are exceedingly sick and too costly to treat.
  In my district in Houston, Texas, where 70% of the people in the 5th 
Ward are infected with HIV/AIDS, these patients are often poverty 
stricken and need special care that most managed care networks will not 
provide. Physicians are often forced to pay out of pocket for the cost 
of prescription drugs for their patients if the cost is excessive. 
Thus, caring for any patient with AIDS is a money-losing endeavor.
  In California, a 1999 Price Waterhouse Cooper's study indicated that 
physicians there are filing for bankruptcy at an alarming rate because 
they cannot afford to provide quality care when they receive less than 
50% of the cost it takes to care for a patient! These health care 
providers should not be punished for living up to their pledge to 
faithfully care for the people of America to the best of their ability.
  Despite what critics may say, this bill does not allow doctors to fix 
the prices of their services. Price-fixing is illegal and will remain 
illegal under H.R. 1304. Health care professionals support this 
legislation because they want the ability to negotiate with HMOs in 
order to do their jobs and provide quality care for their patients. 
Although doctors will be able to join together to negotiate the terms 
of their contracts, they will not be able to determine the actual 
prices for services.
  This bill simply places doctors on the same level of market power as 
the health care plans. In fact, the oversight currently exercised by 
the Department of Justice and the Federal Trade Commission would remain 
intact so that H.R. 1304 would not decrease their authority to 
prosecute health care professionals for illegal activities such as 
exclusive dealing or price-fixing.
  Critics claim that allowing health care professionals the right to 
collectively bargain would permit professionals like nurse 
practitioners and chiropractors to be discriminated against. I continue 
to be approached by organizations like the Academy of Nurse 
Practitioners, The Texas Chiropractic Association and the American 
Chiropractic Association who are sincerely concerned about the negative 
effect this legislation will have on their ability to continually serve 
their patients.
  As a result of their concerns I introduced an amendment, along with 
Representative Nadler that clarifies our objective to not sanction 
discriminatory practices between physicians and health insurers.
  This amendment, which is included in H.R. 1304 includes several 
important safeguards. The bill would prohibit any group of health care 
professionals from negotiating contract language which limits any other 
group of professionals from doing work that they are licensed to do 
under applicable scope of practice acts and regulations. In addition, 
Medicaid managed care plans, Medicare+Care plans and plans covering 
federal employees are excluded from the legislation. Finally, the bill 
sunsets after three years, unless re-approved by Congress.
  If the insurance industry is allowed a special exemption under the 
antitrust laws, physicians who act on behalf of their patients should 
also be able to ensure that the contracts they enter are not 
detrimental to patient care.
  Currently, the bargaining power of managed care organizations dwarfs 
the bargaining power of individual physicians and other professionals. 
As a result, insurers are able to impose contracts on a take-it-or-
leave-it basis, no matter how egregious the contract terms. Physicians 
often have no choice but to sign the contracts offered. Otherwise, they 
run the risk of losing a large share of their patients and being force 
out of business. These one-sided contracts often violate professional 
and ethical standards and prevent practitioners from providing adequate 
care.
  Of course, the health insurers claim the bill would drive up costs. 
But note what they are really saying is if they take a hit in their own 
profits, they will seek to make up for the loss by charging patients 
more for the same services. With this in mind, we know that any 
resulting increases in medical cost will not be due to the passage of 
H.R. 1304, but will be the direct result of greed.
  Because this bill has already been through an intense amendment 
process in the Judiciary committee where four amendments were adopted 
by a vote of 26-2, I ask my colleagues not to allow additional 
amendments to this important legislation. There has been a bipartisan 
effort to work with professional health care organizations and we 
should respect the work that has been done to develop this bill.
  Any amendments at this point would be purely insurance driven 
attempts to destroy the bill. As reported by the judiciary, the bill 
would ensure that Congress could address any potential concerns that 
may arise before the legislation is re-authorized. Adding unnecessary 
and burdensome requirements would harm patients and effectively gut the 
bill.
  This legislation would enable medical professionals to serve their 
patients in the way their best medical judgement indicates. And to do 
that, they will occasionally have to present a united front to a group 
of HMOs. Mr. Speaker, this is a key vote for medicine and therefore, I 
urge my colleagues to support this legislation as presented by the 
Judiciary.
  Mr. GOODLING. Mr. Chairman, I rise in opposition to H.R. 1304. I have 
many concerns regarding this bill, but I wish first to focus on one: is 
cost. The bill before the House costs $6.1 billion in mandatory federal 
funds, yet does not include a single penny to pay for it. Ordinarily, 
legislation like this would be subject to several Budget Act points of 
order for this failure, but the rule waived all those points of order. 
For what does this bill spend federal money? It increases doctors' 
incomes!
  Since the bill doesn't spell out how to pay for this $6.1 billion 
benefit to doctors, the money will have to come out of the existing 
federal budget. My colleagues know that the federal budget includes the 
National School Lunch Act, a program that provides a healthy nutritious 
meal to millions of school age children across this country. If I had 
$6 billion to spend, I think I would use some of that money for school 
lunches, rather than for forming doctor cartels.
  My colleagues know that the federal budget includes the Individuals 
with Disabilities Education Act, a program ensuring that children with 
disabilities will received an education. This is a program that is 
woefully underfunded, where we have never met our 40 percent of funding 
commitment. If I had $6 billion to spend, I think I would use some of 
that money for educating children with disabilities instead of for 
hiking the net worth of doctors.
  The federal budget also includes student aid programs in the Higher 
Education Act--programs that help students across this country attend 
college. If I had $6 billion to spend, I think I would use some of that 
money for student aid instead of for increasing doctors' incomes. The 
federal budget includes healthcare; it includes Social Security; it 
includes aid for farmers, including crop insurance; it includes our 
national defense; it includes programs for literacy. If I had $6 
billion to spend, I think I would use some of that money for these 
worthy purposes, rather than for lining the pockets of doctors.
  As a matter of fact, I can't think of a single current program, 
issues, or concern that should receive a lower priority than this bill.
  On the issue jurisdiction, Mr. Chairman, I want the record to reflect 
that I have been making the point--repeatedly--for the past year that 
H.R. 1304 is a labor bill that should have been referred to the 
Workforce Committee.
  I am going to include in the record a memorandum prepared by the 
American Law Division of the Congressional Research Service, discussing 
case law and House precedent in support of the Workforce Committee's 
jurisdiction over H.R. 1304.
  I know that sometimes issues do not lend themselves to easy sound 
bites. Sometimes they require a bit of patience to understand. I want 
members to understand that this bill is a labor bill--and a very bad 
labor bill at that.
  If this bill becomes law, health care costs will skyrocket, and 
Congress will have granted a group of professionals the rights of 
collective bargaining without any corresponding responsibilities.
  H.R. 1304 allows doctors and other health care professionals to band 
together and collectively bargain. This is done by exempting them from 
the antitrust laws. The Supreme Court has held that the ``nonstatutory 
labor exemption'' which this bill extends to doctors is a concept 
arising in labor law, and is applicable only in the context of labor 
law. Simply put, H.R. 1304 is about collective bargaining, and it is a 
labor bill. It is a flawed labor bill because it grants rights similar 
to those contained in the National Labor Relations Act, but

[[Page 13256]]

fails to provide any mechanism to make sure those rights are effective, 
or fair.
  Mr. Chairman, on all counts this six billion dollar special interest 
gift is misguided, irresponsible, and unnecessary. I urge my colleagues 
to vote against this legislation.
  The aforementioned memorandum follows:
                                   Congressional Research Service,


                                          Library of Congress,

                                    Washington, DC, July 12, 1999.


                               memorandum

     To: Honorable Bill Goodling, Chairman House Committee on 
       Education and the Workforce
     From: Morton Rosenberg, Specialist in American Public Law, 
       American Law Division
     Subject: Jurisdictional Basis for Referral of H.R. 1304, the 
       Quality Health-Care Coalition Act of 1999 to the Committee 
       on Education and the Workforce

       On March 25, 1999, Representative Campbell, for himself and 
     27 co-sponsors, introduced H.R. 1304, the Quality Health-Care 
     Coalition Act of 1999, which was referred to the House 
     Judiciary Committee. The purpose of the bill is stated in its 
     preamble to be ``[t]o ensure and foster continued patient 
     safety and quality of care by making the antitrust laws apply 
     to negotiations between groups of health care professionals 
     and health plans and health insurance issuers in the same 
     manner as such laws apply to collective bargaining by labor 
     organizations under the National Labor Relation Act.'' The 
     bill makes a congressional finding that ``[p]ermitting health 
     care professionals to negotiate collectively with health care 
     plans will create a more equal balance of negotiating power, 
     will promote competition, and will enhance the quality of 
     patient care.'' Section 2(4). The purpose of the bill is to 
     be accomplished by treating health care professionals who are 
     engaged in bargaining with health care plans and health 
     insurance issuers as if they were employees in collective 
     bargaining units under the National Labor Relation Act (NLRA) 
     and by entitling all parties to such negotiations ``to the 
     same treatment under the antitrust laws as the treatment to 
     which bargaining units which are recognized under the 
     National Labor Relation Act are entitled in connection with 
     such collective bargaining.'' Section 3(a). Health care 
     professionals are denied any right to strike ``not otherwise 
     permitted by law.'' The proposed legislation is silent with 
     respect to mechanisms for resolving disputes that may occur 
     during the collective bargaining process or as to the 
     establishment and enforcement of a legal ``duty to bargain.''
       You inquire whether your Committee has a substantial claim 
     to jurisdiction over H.R. 1304. From our review, it would 
     seem that the broad authority delegated to the Committee 
     under House Rule X(g)(6) over labor matters generally, its 
     long history of legislative action and oversight with respect 
     to subject matter that is the same or closely analogous to 
     that of H.R. 1304, and the essentially labor-related nature 
     and orientation of the bill's core operational provision, 
     which imparts antitrust immunity to bargaining decisions over 
     wages, hours and conditions of employment, establish a 
     substantial basis for arguing for sequential referral of the 
     bill to your committee.
       The courts have provided significant guidance in 
     determining the appropriate jurisdiction and authority of 
     legislative committees. A congressional committee is a 
     creation of its parent House and only has the power to 
     inquire into matters within the scope of the authority that 
     has been delegated to it by that body. Therefore, the 
     enabling rule or resolution which gives the committee life or 
     particular direction is the charter which defines the grant 
     and the limitations of the committee's power. United States 
     v. Rumely, 345 U.S. 41, 44 (1953); Watkins v. United States, 
     354 U.S. 178, 201 (1957); Gojak v. United States, 384 U.S. 
     702, 708 (1966). In construing the scope of a committee's 
     authorizing rule or resolution, the Supreme Court has adopted 
     a mode of analysis not unlike that ordinarily followed in 
     determining the meaning of a statute: it looks first to the 
     words of the resolution itself, and then, if necessary, to 
     the usual sources of legislative history. As explained by the 
     Court in Barenblatt v. United States, 360 U.S. 109, 117 
     (1959), ``Just as legislation is often given meaning by the 
     gloss of legislative reports, administrative interpretation, 
     and long usage, so the proper meaning of an authorization to 
     a congressional committee is not to be derived alone from its 
     abstract terms unrelated to the definite content furnished 
     them by the course of congressional actions.''
       Thus, the starting point for analysis is the House's 
     delegation of jurisdictional authority under Rule X. Under 
     Rule X (g) (6) and (7) the Committee on Education and the 
     Workforce is currently vested with jurisdiction over matters 
     relating to ``education and labor generally'' and ``mediation 
     and arbitration of labor disputes,'' and has been so vested 
     with the same authority for at least 30 years. In addition, 
     Rule X(2)(b)(1) directs each standing committee to:
       ``Review and study on a continuing basis, the application, 
     administration, execution, and effectiveness of those laws, 
     or parts of laws, the subject matter of which is within the 
     jurisdiction of that committee and the organization and 
     operation of the Federal agencies or entities having 
     responsibilities in or for the administration and execution 
     thereof, in order to determine whether such laws and the 
     programs thereunder are being implemented and carried out in 
     accordance with the intent of the Congress and whether such 
     programs should be continued, curtailed or eliminated. In 
     addition, each such committee shall review and study any 
     conditions or circumstances which may indicate the necessity 
     or desirability of enacting new or additional legislation 
     within the jurisdiction of that committee (whether or not any 
     bill or resolution has been introduced with respect thereto), 
     and shall on a continuing basis undertake future research and 
     forecasting on matters within the jurisdiction of the 
     committee.''
       In turn, this oversight obligation of standing committees 
     is buttressed by the express grant under Rule XI (1)(B)(1) to 
     each committee of authority ``at any time to conduct such 
     investigations and studies as it may consider necessary and 
     appropriate in the exercise of its responsibilities under 
     Rule X.'' Thus, on its face, your Committee has been vested 
     with broad legislative and oversight jurisdiction over laws, 
     proposals and activities that implicate labor relations 
     generally and collective bargaining particularly, and in the 
     past the Committee and its immediate predecessor, the 
     Committee on Education and Labor, has dealt with subject 
     matter and issues directly analogous to those found in H.R. 
     1304.
       In the 92d Congress, the Special Subcommittee on Labor of 
     the Committee on Education and Labor held hearings on H.R. 
     11357, a bill to repeal the NLRA's exemption for coverage of 
     employees of private non-profit hospitals which was added by 
     the Taft-Hartley Amendments of 1947. A critical issue was 
     whether affording NLRA coverage for health care institutions 
     would result in increased strikes which could endanger 
     patient care. The Committee's hearings revealed that, in 
     fact, recognition strikes and labor unrest had increased at 
     the exempt hospitals in contrast with the situation at 
     covered proprietary hospitals. The bill, which was 
     unanimously reported by the full Committee and passed the 
     House on August 7, 1972, contained a number of special 
     provisions designed to facilitate bargaining settlements 
     (i.e., a 90 day notice requirement of termination or 
     expiration of a contract, a 60 day notice of termination or 
     expiration to the Federal Mediation and Conciliation Service 
     (FMCS), and a requirement that a health care institution and 
     a labor organization had to participate in mediation if so 
     directed by the FMCS), and that a health care institution had 
     to be given a 10 day notice by a labor organization before 
     any picketing or strike could take place. No action was taken 
     by the Senate on that bill. An identical bill was re-
     introduced in the 93d Congress, H.R. 1236, and hearings were 
     held by the Special Subcommittee in Labor on April 12 and 19, 
     1973. A new modified bill, H.R. 13678, was subsequently 
     introduced, reported by the full Committee, passed the House 
     on July 11, 1974, and was signed by the President on July 26, 
     1974. The new law contained the Committee proposed bargaining 
     facilitation and picketing and strike notification 
     provisions.
       The Committee's interest in the bargaining rights of health 
     care professionals in non-proprietary hospitals continued 
     after the 1974 health care amendments. In the 94th Congress 
     the Committee held a hearing to consider a National Labor 
     Relations Board (Board) decision denying coverage of the NLRA 
     to hospital interns, residents and follows (housestaff) on 
     the grounds that they were students and not employees. In the 
     95th and 96th Congress's the Committee held hearings on 
     legislation to amend the NLRA to expand the definition of 
     professional employees covered under collective bargaining 
     provisions to include hospital interns, residents and 
     housestaff. In the 98th Congress Committee held oversight 
     hearings on two NLRB decisions in 1982 and 1984 involving St. 
     Francis Hospital that adhered to earlier Board decisions with 
     respect to NLRA coverage of housestaff employees.
       In the 97th Congress the Committee held hearings to 
     consider Health Care Financing Administration (HCFA) 
     guidelines permitting medical reimbursement to hospitals and 
     nursing houses for the costs of influencing employee 
     organizing activities conducted under the NLRA.
       In the 103d Congress the Committee held hearings on H.R. 
     226, The Live Performing Artist Labor Relations Act, a bill 
     that would have amended the NLRA to define the employer-
     employee relationship between musicians and purchasers of 
     musical services, permitted employers to enter into pre-hire 
     agreements with unions representing live performing artists, 
     and allowed for the establishment of employee collective 
     bargaining rights in the performing arts industry.
       In the 101st, 102d, and 103d Congresses the Committee held 
     hearings on proposed legislation to extend coverage of the 
     NLRA and the Fair Labor Standards Act to seamen working on 
     foreign flag, U.S.-owned cargo vessels regularly engaged in 
     U.S. foreign trade or on foreign flag passenger ships 
     operating primarily from U.S. ports. The bills were intended 
     to address alleged problems

[[Page 13257]]

     with union organization, wages, and working conditions aboard 
     foreign flag cruise ships whose contact with the U.S. is 
     central to their business, and aboard U.S.-owned vessels 
     registered with so-called flag of convenience countries 
     allegedly for the purpose of exempting the vessels from U.S. 
     labor laws.
       Finally, reference may be made to evidence of your 
     Committee's historic interest in the so-called nonstatutory 
     labor exemption to the antitrust laws which is incorporated 
     as the key operational provision of H.R. 1304. See Section 
     3(a). The nonstatutory labor exemption is a creation of the 
     Supreme Court founded on its recognition that the antitrust 
     laws could not be applied with full force to the parties to a 
     collective bargaining relationship if the compulsory 
     collective bargaining policies of the labor laws were to be 
     successfully realized. To ``accommodate . . . the 
     congressional policy favoring collective bargaining under the 
     [NLRA] and the congressional policy favoring free competition 
     business markets,'' the Court recognized an implicit 
     exemption to the antitrust laws applicable to certain conduct 
     by unions and employers alike. Connel Construction Co. v. 
     Plumbers and Steamfitters, Local Union No. 100, 421 U.S. 616, 
     622 (1975); See also, Local No. 189, Amalgamated Meat Cutters 
     v. Jewel Tea Co., 381 U.S. 676 (1965); United Mine Workers v. 
     Pennington, 381 U.S. 657 (1965). The Supreme Court has 
     explained that the nonstatutory exemption is a labor law 
     concept and is part of the broad, independent body of law 
     that encourages and protects the collective organizational 
     and bargaining processes:
       ``Federal policy as . . . developed not only a broad labor 
     exemption from the antitrust laws, but also a separate body 
     of labor law specifically designed to protect and encourage 
     the organizational and representational activities of labor 
     unions. Set against his background, a union, in its capacity 
     as bargaining representative, will frequently not be part of 
     the class the Sherman Act was designed to project, especially 
     in disputes with whom it bargains.''

     Association Gen. Contractors of California, Inc. v. 
     California State Council of Carpenters, 459 U.S. 519, 339-40 
     (1983).
       The rationale of the nonstatutory exemption as enunciated 
     by the High Court mandates that concerted conduct by 
     management or by labor organizations in a collective 
     bargaining relationship is exempt from antitrust attack as 
     long as it principally affects the employees' terms and 
     conditions of employment. Labor market restraints reached 
     through the collective bargaining process are immune from 
     antitrust scrutiny when three conditions are met: (1) the 
     restraints primarily affect only the parties to the 
     collective bargaining agreement; (2) the restraints concern 
     mandatory subjects of bargaining; and (3) agreement on the 
     restraints was the product of bona fide arms-length 
     bargaining or the restraints were implemented during on 
     ongoing collective bargaining relationship.
       The most recent Supreme Court articulation of these 
     precepts and understandings was in Brown et al. v. Pro 
     Football, Inc., 518 U.S. 231 (1996). That case involved an 
     antitrust suit by professional football players against team 
     owners of the National Football League charging that the 
     unilateral imposition of a salary cap on ``developmental 
     squad'' players after a collective bargaining contract had 
     expired and after an impasse in bargaining had been reached, 
     was a violation of the antitrust laws. The Court held that 
     employers may lawfully form multiemployer bargaining groups 
     and agree amongst themselves to impose controls on a labor 
     market as long as those actions ``grew out of'' and were 
     ``directly related to'' a multiemployer bargaining process, 
     did not offend the federal labor laws that sanction and 
     regulate that process, affected terms of employment subject 
     to compulsory bargaining, and directly concerned only parties 
     to the collective bargaining relationship. Brown, 518 at U.S. 
     at 250. Neither the expiration of a collective bargaining 
     agreement nor the reaching of an impasse serves to terminate 
     the bargaining relationship. Thus lawful unilateral actions 
     taken by the multiemployer group were held immune from 
     antitrust scrutiny. In the course of its opinion, the Court 
     reviewed the development of the implicit labor exemption, 
     noting that it finds its support in both the history of and 
     logic of the federal labor laws:
       ``The immunity before us rests upon what this Court has 
     called the `nonstatutory' labor exemption from the antitrust 
     laws. . . . The Court has implied this exemption from federal 
     labor statutes, which set forth a national labor policy 
     favoring free and private collective bargaining, see 29 
     U.S.C. Sec. 151; Teamsters v. Oliver, 358 U.S. 283, 295 
     (1959); which require good-faith bargaining over wages, 
     hours, and working conditions, see 29 U.S.C. 
     Sec. Sec. 158(a)(5), 158(d); NLRB v. Wooster Div. of Borg-
     Warner Corp., 356 U.S. 342, 348-349 (1958); and which 
     delegate related rulemaking and interpretive authority to the 
     National Labor Relations Board (Board), see 29 U.S.C. 
     Sec. 153; San Diego Building Trades Council v. Garmon, 359 
     U.S. 236, 242-245 (1959).
       ``This implicit exemption reflects both history and logic. 
     As a matter of history, Congress intended the labor statutes 
     (from which the Court has implied the exemption) in part to 
     adopt the views of dissenting Justices in Duplex Printing 
     Press Co. v. Deering, 254 U.S. 443 (1921), which Justices had 
     urged the Court to interpret broadly a different explicit 
     `statutory' labor exemption that Congress earlier (in 1914) 
     had written directly into the antitrust laws. Id., at 483-488 
     (Brandeis, J., joined by Holmes and Clarke, JJ., dissenting) 
     (interpreting Sec. 20 of the Clayton Act, 38 Stat. 738, 29 
     U.S.C. Sec. 52); see also United States v. Hucheson, 312 U.S. 
     219, 230-236 (1941) (discussing congressional reaction to 
     Duplex). In the 1930's, when it subsequently enacted the 
     labor statutes Congress, as in 1914, hoped to prevent 
     judicial use of antitrust law to resolve labor disputes--a 
     kind of dispute normally inappropriate for antitrust law 
     resolution. See Jewel Tea, supra, at 700-709 (opinion of 
     Goldberg, J.); Marine Cooks v. Panama S. S. Co., 362 U.S. 
     365, 370, n. 7(1960); A. Cox, Law and the National Labor 
     Policy 3-8 (1960); cf. Duplex, supra, at 485 (Brandeis, J., 
     dissenting) (explicit `statutory' labor exemption reflected 
     view that `Congress, not the judges, was the body which 
     should declare what public, policy in regard to the 
     industrial struggle demands'). The implicit (`nonstatutory') 
     exemption interprets the labor statutes in accordance with 
     this intent namely, as limiting an antitrust court's 
     authority to determine, in the area of industrial conflict, 
     what is or is not a `reasonable' practice. It thereby 
     substitutes legislative and administrative labor-related 
     determinations for judicial antitrust-related determinations 
     as to the appropriate legal limits of industrial conflict. 
     See Jewel Tea, supra, at 709-710.
       ``As a matter of logic, it would be difficult, if not 
     impossible, to require groups of employers and employees to 
     bargain together, but at the same time to forbid them to make 
     among themselves or with each other any of the competition-
     restricting agreements potentially necessary to make the 
     process work or its results mutually acceptable. Thus, the 
     implicit exemption recognizes that, to give effect to federal 
     labor laws and policies and to allow meaningful collective 
     bargaining to take place, some restraints on competition 
     imposed through the bargaining process must be shielded from 
     antitrust sanctions. See Connell, supra, at 622 (federal 
     labor law's `goals' could `never' be achieved if ordinary 
     anti-competitive effects of collective bargaining were held 
     to violate the antitrust laws); Jewel Tea, supra, at 711 
     (national labor law scheme would be `virtually destroyed' by 
     the routine imposition of antitrust penalties upon parties 
     engaged in collective bargaining); Pennington, supra, at 665 
     (implicit exemption necessary to harmonize Sherman Act with 
     `national policy . . . of promoting `the peaceful settlement 
     of industrial disputes by subjecting labor-management 
     controversies to the mediatory influence of negotiation) 
     (quoting Fibreboard Paper Products Corp. v. NLRB, 379 U.S. 
     203, 211 (1964).''

     518 U.S. at 235-37 (emphasis in original).
       Your committee's most recent opportunity to address the 
     implications of the nonstatutory exemption was in the context 
     of the 1994 Major League Baseball labor-management dispute 
     which resulted in the cancellation of part of that years 
     regular season as well as the World Series. The Committee's 
     Subcommittee on Labor-Management Relations had before it for 
     consideration H.R. 5095, the Major League Play Ball Act of 
     1995, which would have required mandatory binding arbitration 
     of the baseball strike if the strike was not resolved by the 
     players and owners by February 1, 1995; and H.R. 4994, which 
     would have partially created antitrust law exemption for 
     major league baseball. The crucial issue before the 
     Subcommittee was whether baseball's unique antitrust 
     exemption was the cause of the sport's seemingly endemic 
     labor unrest, and whether repeal of the exemption would be 
     proper resolution. Uncontradicted testimony elicited at the 
     hearing made it clear that even if baseball's judicial 
     exemption were eliminated, the nonstatutory labor exemption 
     would remain.


                        analysis and conclusion

       The Committee on Education and the Workforce (and its 
     predecessor) has been vested by the House with plenary 
     legislative and oversight jurisdiction over matters relating 
     to ``labor generally'' as well as the ``mediation and 
     arbitration of labor disputes,'' and over the years has 
     engaged in legislative and oversight actions encompassing the 
     fullest range of activities directly or indirectly within the 
     broad purview of that assigned subject matter. H.R. 1304 
     attempts to deal with emerging difficulties of the key actors 
     in the health care industry.-- health care professionals, 
     health plans, and health insurance issuers--to reconcile 
     their divergent interests and concerns with respect to HMO's. 
     Court decisions have raised antitrust issues with respect to 
     certain resolutions. Also, a recent unit determination 
     decision by a regional office of the NLRB found that a group 
     of doctors seeking to be certified by the Board as the 
     exclusive bargaining representative at an HMO were 
     independent contractors and therefore not employees eligible 
     to be covered by the NLRA.
       H.R. 1304 proposes to overcome these legal difficulties by 
     legally deeming health care professionals who wish to bargain 
     with HMO's or insurance companies as employees in collective 
     bargaining units under the

[[Page 13258]]

     NLRA, and then cloaking the products of negotiations with the 
     equivalent of the nonstatutory labor exemption to the 
     antitrust laws. Perhaps because on the face of the bill it 
     appears to be primarily concerned with traditional antitrust 
     law issues--Section 3 (d)(1) defines the term ``antitrust 
     laws'' as referencing provisions in the Clayton Act and the 
     Federal Trade Commission Act--it was referred to the 
     Judiciary Committee. But in fact the principal thrust of the 
     bill is to import a judicial construct--the implied labor 
     antitrust exemption--that is well understood as applicable 
     exclusively in the context of labor law. As indicated in the 
     discussion of the Supreme Court decisions in this area, the 
     implied exemption emanates from the national labor laws alone 
     and when applicable displaces the antitrust laws. Also key in 
     H.R. 1304 is the notion that health care professionals should 
     bargain collectively with HMO's and insurers, again a concept 
     rooted firmly in labor relations. Thus the two essential 
     concepts of the proposal are labor relations--related. They 
     may be also be seen as ``incomplete.'' For example, though 
     collective bargaining appears contemplated, there is no 
     definition or requirement of a ``duty to bargain,'' no 
     mechanism to resolve disputes that might arise during the 
     bargaining process, not any enforcement mechanism to ensure 
     good faith bargaining, which presumably is the ultimate goal 
     of the execise.
       This is not say that any such provisions are necessary. But 
     given the strong labor orientation of the bill, the 
     Committee's labor expertise and perspective could be brought 
     to bear on the issues. As has been catalogued above, the 
     Committee in the past has dealt with legislative proposals 
     and engaged in oversight of activities comparable to the 
     subject matter and concerns raised by H.R. 1304. The 1974 
     private non-proprietary health care institutions amendments 
     to the NLRA and 1994 hearings on legislation dealing with the 
     antitrust implications of the baseball strike are among the 
     prominent and analogous examples which evidence the 
     Committee's past concerns in this area.
  Mr. TIAHRT. Mr. Chairman, I arise today in opposition to H.R. 1304, 
the Quality Health Care Coalition Act. This may surprise some as I 
became a cosponsor of this bill last summer. I strongly believe that we 
need to improve the quality of and access to our nation's health care 
system and support measures to do so. I originally felt that exempting 
negotiations between groups of health care professionals and health 
from antitrust laws would be an important step towards fostering 
continued patient safety and quality of care. Upon further reflection, 
however, I have changed my opinion. Despite its name, I believe that 
this bill has nothing to do with health care quality and will only 
impede efforts to improve access and quality.
  This legislation will be a major burden to employers and employees--
the exact people we should be trying to help. A CBO study shows that 
the increased costs to health insurance companies as a result of 
physician collective bargaining will surely be passed on to employers 
who provide health care coverage to their employees. This will either 
result in less employers providing coverage or less overall wages and 
benefits for employees. Neither of these is an acceptable outcome. The 
costs will not go towards patient care but towards sustaining doctor 
unionization and salary hikes. This bill also allows for physician 
boycotts of health plans, an outcome that could have a devastating 
effect on insurance plans in rural areas that already struggle to 
survive. I do not see how these effects will improve the quality of our 
health care.
  Additionally, I am disturbed by CBO's finding that if enacted H.R. 
1304 will costs the taxpayers $3.6 billion dollars in lost revenue over 
the next ten years. We all know where these lost revenues will be made 
up--through Social Security and Medicare. We have made a pledge to 
protect the Social Security surplus and shore up Medicare, a pledge we 
must honor. We cannot support the so-called doctor cartels at the 
expense of our senior citizens.
  I have carefully considered this bill over the last two months. Since 
April, as this bill approached the floor, I have not received any 
support for H.R. 1304 from physicians in my district. Without their 
urging and upon realizing the devastating effect H.R. 1304 could have 
on our health care system, I decided to vote against the Quality Health 
Care Coalition Act.
  I consider my vote today a vote for increased access to health care 
and to move affordable health care for everyone. We all owe a debt of 
gratitude to the lengths physicians must go to be ready to serve our 
health care needs. I honor their dedication and am proud that the very 
highest quality health care in the world is within our borders. While I 
want and encourage our best and brightest to become doctors, I do not 
think this bill will be helpful in the long run. Therefore, I urge my 
colleagues, even those who at first blush might have been favorably 
disposed to this, to vote against H.R. 1304.
  Mr. CROWLEY. Mr. Chairman, today, most American families receive 
their health coverage from managed care providers. In recent years, 
physician and patients have lost control over this market due to the 
rapid consolidation of managed care organizations.
  I am a proud co-sponsor of the Quality Health-Care Coalition Act, 
which would allow health care professionals to collectively bargain the 
terms of patient car with Health Care Organizations. Currently, 
physicians are forced to accept contracts, which often contain 
provisions that threaten the quality of patient care. In addition, many 
health plans impose gag rules on physicians that force them to accept 
arbitrary reimbursement rates with no thought to the quality of care 
being provided to the patient. These days, dominant health plans are 
not just managing costs, they are also determining the level, type, 
frequency and hoops patients most jump through in order to receive 
their health care.
  Being married to a nurse has helped me recognize the issues many 
health care professionals encounter each day. H.R. 1304 would help 
physicians and other health care professionals fight for better patient 
care by beginning to level the playing field between enormous, 
controlling managed care plans and individual physicians and other 
health care professionals. H.R. 1304 would provide physicians enough 
leverage to effectively negotiate the terms of patient care with 
Managed Care Organizations. In essence, this bill would restore a 
physician's ability to provide quality care to patients without any 
interference from an HMO. Additionally, H.R. 1304 would promote the 
fairness and balance the health care marketplace needs and lacks today.
  Those who oppose this legislation argue that patients would not be 
protected under this bill. However, that is a false satement. H.R. 1304 
guarantees the protection of patients by requiring the U.S. General 
Accounting Office to study the impact of this bill over a three-year 
trial period before Congress would be allowed to reauthorize the bill.
  The Quality Health Care Coalition Act is an important piece of 
legislation that would ensure the provisions of optimal health care to 
all patients in New York City and the rest of the country. I urge you 
to support this bill because all patients and their health care 
providers should have the right to make informed decision about their 
health care needs--without being subjected to the rules of an HMO.
  Mr. PALLONE. Mr. Chairman, I rise in support of the Quality Health 
Care Coalition Act. It is a good piece of legislation and I urge all of 
my colleagues to join me in supporting it.
  As you know, Mr. Chairman, current anti-trust law prohibits health 
care professionals, including doctors, dentists, pharmacists, and 
nurses from banding together to negotiate with managed care 
organizations. Although this prohibition alone has stacked the deck 
against health care professionals seeking to protect both themselves 
and their patients from managed care abuse, consolidations in the 
health insurance industry have exacerbated this imbalance even further 
over the last several years.
  To complement the enhanced negotiating power they have accrued 
through mergers and acquisitions, managed care organizations also use 
exclusionary contracting practices to bully health care professionals 
into accepting terms they surely would not accept if they were able to 
negotiate on a level playing field. These trends have enabled insurers 
to employ a ``take it or leave it'' approach when negotiating with 
health care professionals. As a result, the doctor-patient relationship 
has been compromised and the quality of care for all patients has 
suffered.
  I have heard many first hand accounts of these abusive practices from 
the New Jersey Medical Society, the New Jersey Pharmacists Association, 
and countless other physicians with whom I have met over the last 
several years. We must put an end to them.
  The Quality Health Care Coalition Act would correct this problem by 
giving health professionals the tools they need to band together when 
negotiating with managed care organizations. This enhanced negotiating 
power will level the playing field and allow health professionals to 
stand up for what's right and make medical judgments based on patients' 
medical needs rather than the managed care industry's financial 
motivations.
  Vote ``yes'' on final passage.
  Mr. PAUL. Mr. Chairman, I am pleased to take this opportunity to lend 
my support to H.R. 1304, the Quality Health Care Coalition Act, which 
takes a first step towards restoring a true free-market in health care 
by restoring the rights of freedom of contract and association to 
health care professionals. Over the past few years, we have had much 
debate in Congress about the difficulties medical professionals and 
patients are having with Health Maintenance Organizations (HMOs). HMOs 
are devices used by insurance industries to

[[Page 13259]]

ration health care. While it is politically popular for members of 
Congress to bash the HMOs and the insurance industry, the growth of the 
HMOs are rooted in past government interventions in the health care 
market though the tax code, the Employment Retirement Security Act 
(ERSIA), and the federal anti-trust laws. These interventions took 
control of the health care dollar away from individual patients and 
providers, thus making it inevitable that something like the HMOs would 
emerge as a means to control costs.
  Many of my well-meaning colleagues would deal with the problems 
created by the HMOs by expanding the federal government's control over 
the health care market. These interventions will inevitably drive up 
the cost of health care and further erode the ability of patents and 
providers to determine the best health treatments free of government 
and third-party interference. In contrast, the Quality Health Care 
Coalition Act addresses the problems associated with HMOs by restoring 
medical professionals' freedom to form voluntary organizations for the 
purpose of negotiating contracts with an HMO or an insurance company.
  As an OB-GYN with over 30 years in practice, I am well aware of how 
young physicians coming out of medical school feel compelled to sign 
contracts with HMOs that may contain clauses that compromise their 
professional integrity. For example, many physicians are contractually 
forbidden from discussing all available treatment options with their 
patients because the HMO gatekeeper has deemed certain treatment 
options too expensive. In my own practice, I have tried hard not to 
sign contracts with any health insurance company that infringed on my 
ability to practice medicine in the best interests of my patients and I 
have always counseled my professional colleagues to do the same. 
Unfortunately, because of the dominance of the HMO in today's health 
care market, many health care professionals cannot sustain a medical 
practice unless they agree to conform their practice to the dictates of 
some HMO.
  One way health care professionals could counter the power of the HMOs 
would be to form a voluntary association for the purpose of negotiating 
with an HMO or an insurance company. However, health care professionals 
who attempt to form such a group run the risk of persecution under 
federal anti-trust laws. This not only reduces the ability of health 
care professionals to negotiate with HMOs on a level playing field, it, 
like existing antitrust laws, are an unconstitutional violation of 
medical professionals' freedom of contract and association.
  Under the United States Constitution, the federal government has no 
authority to interfere with the private contracts of American citizens. 
Furthermore, the prohibitions on contracting contained in the Sherman 
antitrust laws are based on a flawed economic theory: that federal 
regulators can improve upon market outcomes by restricting the rights 
of certain market participants deemed too powerful by the government. 
In fact, anti-trust laws harm consumers by preventing the operation of 
the free-market, causing prices to rise, quality to suffer, and, as is 
certainly the case with the relationship between the HMOs and medical 
professionals, favoring certain industries over others. In fact, Mr. 
Speaker, I would hope that my colleagues would see the folly of 
antitrust laws and support my Market Process Restoration Act (H.R. 
1789), which repeals all federal antitrust laws.
  By restoring the freedom of medical professionals to voluntarily come 
together to negotiate as a group with HMOs and insurance companies, 
this bill removes a government-imposed barrier to a true free market in 
health care. I am quite pleased that this bill does not infringe on the 
rights of health care professionals by forcing them to join a 
bargaining organization against their will. Contrary to the claims of 
some of its opponents, H.R. 1304 in no way extends the scourge of 
federally-mandated compulsory unionism to the health care professions. 
While Congress should protect the right of all Americans to join 
organizations for the purpose of bargaining collectively, Congress also 
has a moral responsibility to ensure that no worker is forced by law to 
join or financially support such an organization.
  Mr. Chairman, it is my hope that Congress will follow up on its 
action today by empowering patients to control their health care by 
providing all Americans with access to Medical Saving Accounts (MSAs) 
and large tax credits for their health care expenses. Putting 
individuals back in charge of their own health care decisions will 
enable patients to work with providers to ensure they receive the best 
possible health care at the lowest possible price. If providers and 
patients have the ability to form the contractual arrangements that 
they found most beneficial to them, the HMO monster would wither on the 
vine without the imposition of new federal regulations on the insurance 
industry.
  In conclusion, Mr. Chairman, I urge my colleagues to support the 
Quality Health Care Coalition Act and restore the freedom of contract 
and association to American's health care professionals. Antitrust laws 
are no more legitimate or constitutional in the health care market than 
they are on the software market. Therefore, I hope my colleagues will 
not just pass this bill but will also support my Market Process 
Restoration Act and exempt all Americans from antitrust laws. I also 
urge my colleagues to join me in working to promote a true free-market 
in health care by putting patients back in charge of the health care 
dollar through means such as Medical Savings Accounts (MSAs) and 
individual health care tax credits.
  The CHAIRMAN. All time for general debate has expired.
  Pursuant to the rule, the committee amendment in the nature of a 
substitute printed in the bill shall be considered as the original bill 
for the purpose of amendment under the 5-minute rule and shall be 
considered read.
  The text of the committee amendment in the nature of a substitute is 
as follows:

                               H.R. 1304

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Quality Health-Care 
     Coalition Act of 2000''.

     SEC. 2. APPLICATION OF THE ANTITRUST LAWS TO HEALTH CARE 
                   PROFESSIONALS NEGOTIATING WITH HEALTH PLANS.

       (a) In General.--Any health care professionals who are 
     engaged in negotiations with a health plan regarding the 
     terms of any contract under which the professionals provide 
     health care items or services for which benefits are provided 
     under such plan shall, in connection with such negotiations, 
     be entitled to the same treatment under the antitrust laws as 
     the treatment to which bargaining units which are recognized 
     under the National Labor Relations Act are entitled in 
     connection with such collective bargaining. Such a 
     professional shall, only in connection with such 
     negotiations, be treated as an employee engaged in concerted 
     activities and shall not be regarded as having the status of 
     an employer, independent contractor, managerial employee, or 
     supervisor.
       (b) Protection for Good Faith Actions.--Actions taken in 
     good faith reliance on subsection (a) shall not be the 
     subject under the antitrust laws of criminal sanctions nor of 
     any civil damages, fees, or penalties beyond actual damages 
     incurred.
       (c) Limitation.--
       (1) No new right for collective cessation of service.--The 
     exemption provided in subsection (a) shall not confer any new 
     right to participate in any collective cessation of service 
     to patients not already permitted by existing law.
       (2) No change in national labor relations act.-- This 
     section applies only to health care professionals excluded 
     from the National Labor Relations Act. Nothing in this 
     section shall be construed as changing or amending any 
     provision of the National Labor Relations Act, or as 
     affecting the status of any group of persons under that Act.
       (d) 3-Year Sunset.--The exemption provided in subsection 
     (a) shall only apply to conduct occurring during the 3-year 
     period beginning on the date of the enactment of this Act and 
     shall continue to apply for 1 year after the end of such 
     period to contracts entered into before the end of such 
     period.
       (e) Limitation on Exemption.--Nothing in this section shall 
     exempt from the application of the antitrust laws any 
     agreement or otherwise unlawful conspiracy that excludes, 
     limits the participation or reimbursement of, or otherwise 
     limits the scope of services to be provided by any health 
     care professional or group of health care professionals with 
     respect to the performance of services that are within their 
     scope of practice as defined or permitted by relevant law or 
     regulation.
       (f) No Effect on Title VI of Civil Rights Act of 1964.--
     Nothing in this section shall be construed to affect the 
     application of title VI of the Civil Rights Act of 1964.
       (g) No Application to Federal Programs.--Nothing in this 
     section shall apply to negotiations between health care 
     professionals and health plans pertaining to benefits 
     provided under any of the following:
       (1) The medicare program under title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.).
       (2) The medicaid program under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.).
       (3) The SCHIP program under title XXI of the Social 
     Security Act (42 U.S.C. 1397aa et seq.).
       (4) Chapter 55 of title 10, United States Code (relating to 
     medical and dental care for members of the uniformed 
     services).
       (5) Chapter 17 of title 38, United States Code (relating to 
     Veterans' medical care).
       (6) Chapter 89 of title 5, United States Code (relating to 
     the Federal employees' health benefits program).
       (7) The Indian Health Care Improvement Act (25 U.S.C. 1601 
     et seq.).
       (h) General Accounting Office Study and Report.--The 
     Comptroller General of the

[[Page 13260]]

     United States shall conduct a study on the impact of 
     enactment of this section during the 6-month period beginning 
     with the third year of the 3-year period described in 
     subsection (d). Not later than the end of such 6-month period 
     the Comptroller General shall submit to Congress a report on 
     such study and shall include in the report such 
     recommendations on the extension of this section (and changes 
     that should be made in making such extension) as the 
     Comptroller General deems appropriate.
       (i) Definitions.--For purposes of this section:
       (1) Antitrust laws.--The term ``antitrust laws''--
       (A) has the meaning given it in subsection (a) of the first 
     section of the Clayton Act (15 U.S.C. 12(a)), except that 
     such term includes section 5 of the Federal Trade Commission 
     Act (15 U.S.C. 45) to the extent such section 5 applies to 
     unfair methods of competition, and
       (B) includes any State law similar to the laws referred to 
     in subparagraph (A).
       (2) Health plan and related terms.--
       (A) In general.--The term ``health plan'' means a group 
     health plan or a health insurance issuer that is offering 
     health insurance coverage.
       (B) Health insurance coverage; health insurance issuer.--
     The terms ``health insurance coverage'' and ``health 
     insurance issuer'' have the meanings given such terms under 
     paragraphs (1) and (2), respectively, of section 733(b) of 
     the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1191b(b)).
       (C) Group health plan.--The term ``group health plan'' has 
     the meaning given that term in section 733(a)(1) of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1191b(a)(1)).
       (3) Health care professional.--The term ``health care 
     professional'' means an individual who provides health care 
     items or services, treatment, assistance with activities of 
     daily living, or medications to patients and who, to the 
     extent required by State or Federal law, possesses 
     specialized training that confers expertise in the provision 
     of such items or services, treatment, assistance, or 
     medications.

  The CHAIRMAN. No amendment to that amendment is in order except those 
printed in House Report 106-709. Each amendment may be offered only in 
the order printed in the report, by a Member designated in the report, 
shall be considered read, shall be debatable for the time specified in 
the order of the House, equally divided and controlled by the proponent 
and an opponent, shall not be subject to amendment, and shall not be 
subject to a demand for division of the question.
  The Chairman of the Committee of the Whole may postpone a request for 
a recorded vote on any amendment and may reduce to a minimum of 5 
minutes the time for voting on any postponed question that immediately 
follows another vote, provided that the time for voting on the first 
question shall be a minimum of 15 minutes.

                              {time}  2330

  The CHAIRMAN. It is now in order to consider amendment No. 1 printed 
in the House Report 106-709.


                Amendment No. 1 Offered by Mr. Ballenger

  Mr. BALLENGER. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 1 offered by Mr. Ballenger:
       Page 3, line 9, strike ``Any'' and insert ``Except as 
     provided in paragraph (3) of subsection (c), any''.
       Page 4, after line 20 insert the following:
       (3) Application.--The exemption provided in subsection (a) 
     shall not apply to the following:
       (A) Any negotiations with a health plan regarding or 
     relating to fees, payments, or reimbursement, including the 
     methodology of such fees, payments, or reimbursement between 
     health care professionals and health plans.
       (B) Any negotiations with a health plan to permit health 
     care professionals to balance bill patients.
       (C) Any health care professional who has not submitted to 
     and received approval from the Secretary of Health and Human 
     Services for a plan that specifies policies and procedures to 
     identify and reduce the incidence of medical errors.
       (D) Any health care professional who has not disclosed to 
     patients and prospective patients information regarding the 
     professional's participation in such negotiations.
       (E) Any acts by health care professionals to engage in 
     boycotts.

  The CHAIRMAN. Pursuant to the order of the House of today, the 
gentleman from North Carolina (Mr. Ballenger) and a Member opposed each 
will control 5 minutes.
  The Chair recognizes the gentleman from North Carolina (Mr. 
Ballenger).
  Mr. BALLENGER. Mr. Chairman, I yield myself 1\1/2\ minutes.
  Mr. Chairman, I still do not understand why this bill is not under 
the Fair Labor Standards Act. We all know that there has been a great 
expansion of HMOs. Large insurance companies seem to care more about 
the bottom line than the patients that they are supposed to serve.
  These issues should be addressed. However, allowing doctors to 
unionize without a governing body or any enforcement mechanism is not 
the way to solve this problem.
  This bill would create many opportunities for patients to be harmed 
by boycotts and other union tactics but would do nothing for patients. 
This means that, as presently written, there is absolutely nothing in 
this bill for patients.
  Simply put, my amendment would guarantee that doctors are using their 
exempt status for quality care for their patients, not negotiating 
higher fees, which would lead to higher fees and raise health care 
costs, which would increase the present uninsured group in this country 
from 40 million to 50 million people in a very short period of time
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I rise in opposition to the amendment.
  Mr. Chairman, the amendment of the gentleman simply very effectively 
prevents negotiations over the quality of healthcare, which is what we 
are all about here tonight.
  Among other things, it would prohibit negotiations between doctors 
and health plans regarding fees, payments, or reimbursement.
  Why? It is not always possible to separate costs from quality. And 
so, by forcing physicians to refrain from negotiating fees, payments, 
and reimbursements, this amendment cleverly forces physicians to 
provide less quality health care and, thus, potentially harms patients. 
The result is more health plan profits and more unfair tactics.
  Mr. Chairman, I hope the amendment will be rejected.
  Mr. Chairman, I reserve the balance of my time.
  Mr. BALLENGER. Mr. Chairman, I yield such time as he may consume to 
the gentleman from California (Mr. Thomas).
  Mr. THOMAS. Mr. Chairman, I tell my friend the gentleman from 
Michigan (Mr. Conyers) this amendment is not very clever at all. It is 
very straightforward.
  The gentleman from New York was very concerned about the precise 
language used over here, and maybe he did not hear himself talk, 
because he used the term ``collective bargaining.'' He said doctors 
need collective bargaining.
  Now, if this was about moving doctors under the National Labor 
Relations Act, where they would get collective bargaining, where there 
are rights associated with responsibilities, we would not have this 
problem.
  That is not the case. What we have got are giving people the rights 
without the responsibilities.
  Federal Trade Commission Chairman Robert Pitofsky has said, ``In 
every case we have brought, it is really related to doctors' income and 
not to patients' welfare.''
  I think my colleagues can call this amendment ``trust but verify.'' 
If, in fact, the doctors are really needing this suspension of 
antitrust to help patients, then this amendment is exactly what it will 
do. Trust but verify.
  One: Do not negotiate regarding fees. Do not tell us that is about 
patients and care. It is about money.
  Two: Do not cost shift. Do not cut a deal in which the patient has to 
bear the extra cost in balanced billing.
  Three: Hey, we got a 100,000 deaths every year. How about getting 
some medical error structure in place before they turn them loose in 
terms of the ``collective bargaining.''
  Let us have some truth in packaging.
  And finally, this amendment says that any acts by health care 
professionals engaging in boycotts is not allowed.
  We have all read The New York Times story about a doctor bragging 
about withholding medicines because the company that made the medicines

[[Page 13261]]

was not supporting the legislation. That is about patients' care?
  Very simple. Let us help doctors help patients, but we should not let 
doctors help doctors without this amendment to trust but verify. That 
is what this is all about.
  We have heard slips of the tongue over here about collective 
bargaining, doctors should have the right to bargain collectively. It 
is under the guise of patients' rights.
  If they want doctors to bargain collectively, put them under the 
National Labor Relations Act. That gives them rights and it gives them 
responsibilities. This legislation does not do that.
  If they believe that they get a right and they have a responsibility 
to go with it, then the Ballenger amendment is the trust but verify. 
Let them have the right, but make sure they do not abuse it, not for 
fees, not for patient-balanced billing, not for boycotting.
  If my colleagues want it for patients, everyone should vote for the 
Ballenger amendment.
  Mr. CONYERS. Mr. Chairman, I yield myself 1 minute.
  It is so instructive that the previous speaker is from California and 
is talking about preventing negotiations over the quality of health 
care.
  In California, pediatricians receive as little as $10 per month for 
each patient, while the average monthly cost to care for a child in the 
State is $24.
  Now, how can a physician provide quality care for a child when he or 
she cannot afford to keep their practice open and then we would add 
this debilitating amendment?
  Mr. Chairman, I yield 2 minutes to the gentleman from California (Mr. 
Campbell).
  Mr. CAMPBELL. Mr. Chairman, I thank the gentleman for yielding me the 
time.
  Mr. Chairman, let us be very clear. This is not a unionization bill. 
My friend and colleague the gentleman from California (Mr. Thomas) 
misperceives the bill.
  First of all, the bill itself has explicitly in it section 2(e), a 
prohibition on boycott.
  Secondly, the question about putting them under the NLRA and an NLRB 
is appropriate only if we were creating exclusive bargaining units. 
That is to say that the doctors would have no one else to represent 
them.
  We are not doing that. We are simply removing the effect of a Supreme 
Court opinion, which, 84 years after the passage of the Sherman Act, in 
my judgment, erroneously applied antitrust to what is a profession. And 
so, we do not need the National Labor Relations Act because we are not 
creating exclusive bargaining units.
  Furthermore, the National Labor Relations Board does not investigate 
the content of contracts. It never does. It exists merely to create the 
fair election process to determine the sole exclusive bargaining agent. 
Since we do not have an exclusive bargaining agent, there is no need 
for the labor model.
  My friend the gentleman from California (Mr. Thomas) misapprehends 
the purpose and effect and indeed the very words of the statute that we 
are proposing tonight.
  As to the fundamental amendment by my friend the gentleman from North 
Carolina (Mr. Ballenger) I simply put this, and it is as simple as can 
be said I think: If they want better quality of medicine, it might be 
that they have to pay for it.
  Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentleman from 
Iowa (Mr. Ganske).
  Mr. GANSKE. Mr. Chairman, I thank the gentleman for yielding me the 
time.
  Mr. Chairman, I think it is very important for my Republican 
colleagues to understand that the Campbell-Conyers bill is not a bill 
that will make physicians join unions. It is just the opposite.
  Under current law, the only way that they can negotiate a contract is 
if they are salaried and then they can join a union.
  Under the Campbell-Conyers bill, individual practitioners can get 
together, negotiate on behalf of their patients without being salaried, 
without being in a union.

                              {time}  2340

  This is a fundamental point to this bill that my Republican 
colleagues need to understand. If they are worried about physicians, 
ultimately all of them becoming members of a union, then vote against 
this bill because that is ultimately what will happen if we do not 
establish some level of competition.
  The CHAIRMAN. The gentleman from Michigan (Mr. Conyers) has the right 
to close.
  Mr. CAMPBELL. Mr. Chairman, could the Chair inform me, unless I am 
mistaken, I have not used any of my time. The gentleman from Michigan 
(Mr. Conyers) yielded to me.
  The CHAIRMAN. The time is controlled by the gentleman from Michigan 
(Mr. Conyers).
  Mr. CAMPBELL. Mr. Chairman, I apologize. I misunderstood. Then I 
would ask my colleague, the gentleman from Michigan (Mr. Conyers), to 
yield me 30 seconds.
  The CHAIRMAN. The gentleman from Michigan (Mr. Conyers) has the right 
to close and the gentleman from Michigan (Mr. Conyers) has 30 seconds 
remaining. The gentleman from North Carolina (Mr. Ballenger) has 1 
minute remaining.
  Mr. BALLENGER. Mr. Chairman, I yield 1 minute to the gentleman from 
California (Mr. Thomas).
  Mr. THOMAS. Mr. Chairman, let us listen to what people say who have 
to enforce the law. Federal Trade Commission Chairman Robert Pitofsky 
again says, the stated goal of this bill is to promote quality of 
patient care. The labor exemption, however, was not created to solve 
issues regarding the ultimate quality of products or services consumers 
receive. Collective bargaining rights are designed to raise the incomes 
and improve working conditions of union members. We do not rely on the 
United Auto Workers to bargain for safer cars. Joe Klein, assistant 
Attorney General of the Justice Department's Antitrust Division, says 
this about 1304: The AMA could pull every single doctor together or its 
local doctors and go to each and every HMO or managed care program and 
say we will not work for you unless you pay us X. That is 
unprecedented, irrational economic power.
  That is all the doctors are asking for.
  Mr. BALLENGER. Mr. Chairman, I yield back the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield myself the remainder of my time.
  Mr. Chairman, this amendment effectively prevents negotiations over 
the quality of health care. It would prohibit negotiations regarding 
fees, payments or reimbursements, and therefore undercuts the whole 
bill. We do not want a bill or an amendment that forces physicians to 
provide, quote, ``the least costly,'' unquote, care, or a bill that 
denies payments to health professionals for care already provided.
  Mr. Chairman, I am strongly opposed to this amendment, which would 
require pre-approval from the FTC or the Department of Justice to 
health care groups which comprise 20 percent or more of a given 
specialty area for a particular market area before they can engage in 
collective negotiations. This amendment would gut the bill and decimate 
the beneficial aspects of the legislation.
  We have never required a labor union to obtain antitrust pre-approval 
to have the right to collectively bargain, and there is no reason to 
require it in the context of health care negotiations. As a matter of 
fact, such a requirement would be in many respects even more onerous 
than current law for health care professionals. Unlike Hart-Scott-
Rodino, the bill has no time frames or deadlines, so the approval 
process could go on indefinitely. Delays would be compounded by the 
provisions allowing for public comment on each application. The 
amendment could also necessitate large filing fees, which would in 
essence serve as a tax on health care.
  The limitation raises several very serious concerns.
  First, there is no guidance as to the meaning of what a particular 
specialty or subspecialty is or how the market is to be determined. Is 
gynecology different than fertility? Are these the same field or two 
separate fields? And how would the bill apply if two separate subgroups 
of health care providers sought to form a collective bargaining group? 
Would you add up the numbers for each specialty or would this create a 
whole new field?

[[Page 13262]]

  Second, under the amendment, it is up to the group of health care 
providers to determine if the 20 percent threshold applies. How is the 
group supposed to have any idea what the relevant market is or what 
their market share is? Only the government is in a position to make 
these types of complex market share determinations. By placing the 
burden on the group of health care providers, this amendment will force 
every collective bargaining unit to file with the government, 
subjecting them all to long and expensive delays.
  Third, even if these issues could be worked out--and that could take 
years of litigation--the bill's percentage limitation cannot be 
justified. Why is 20 percent the threshold? Supreme Court legal 
precedent says that a company or group of companies does not have 
market power unless they have 70 percent or more of the market. 
Determining market power is very much facts and circumstances based, 
which is why the antitrust laws have intentionally avoided arbitrary 
cutoffs. This bill creates an artificially low threshold, and threatens 
to undercut more than a century of settled antitrust law.
  I would remind the proponents of this amendment that the bill 
provides for a three year sunset with a report by the GAO. In my 
opinion this negates the need for any further oversight amendment 
because it would be foolish for health care professionals to engage in 
anti-consumer conduct given that it could cause them to lose their 
rights under this legislation.
  I urge the Members to oppose this dangerous amendment.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from North Carolina (Mr. Ballenger).
  The question was taken; and the Chairman announced that the noes 
appeared to have it.
  Mr. THOMAS. Mr. Chairman, I demand a recorded vote, and pending that, 
I make the point of order that a quorum is not present.
  The CHAIRMAN. Pursuant to House Resolution 542, further proceedings 
on the amendment offered by the gentleman from North Carolina (Mr. 
Ballenger) will be postponed.
  It is now in order to consider amendment No. 2 printed in House 
Report 106-709.


                 Amendment No. 2 Offered by Mr. Stearns

  Mr. STEARNS. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 2 offered by Mr. Stearns:
       Page 3, line 17, insert before the period the following: 
     ``, but only if such health care professionals have received 
     prior approval for such negotiations from the Federal Trade 
     Commission or the Assistant Attorney General pursuant to 
     subsection (i).''.
       Page 6, after line 21, insert the following new subsection 
     (and redesignate the succeeding subsection accordingly):
       (i) Prior Approval.--
       (1) In general.--Health care professionals who seek to 
     engage in negotiations with a health plan as provided in 
     subsection (a) must obtain approval from the Commission or 
     the Assistant Attorney General prior to commencing such 
     negotiations. The Commission or the Assistant Attorney 
     General shall grant such approval if the Commission or 
     Assistant Attorney General has determined that recognition 
     under subsection (a) of the group of health care 
     professionals for the purpose of engaging in collective 
     negotiations with the health plan will promote competition 
     and enhance the quality of patient care. The approval that is 
     granted under this subsection may be limited in time or scope 
     to ensure that these criteria are met. The Commission and the 
     Assistant Attorney General shall make a determination 
     regarding a request for approval under this paragraph within 
     30 days after the date it is received, if the request 
     contains the information specified in regulations issued 
     under paragraph (2). Failure by the Commission or Assistant 
     Attorney General to make such determination within such 30-
     day period will be deemed to be an approval of the request by 
     the Commission or the Assistant Attorney General.
       (2) Regulations.--The Commission, in consultation with the 
     Assistant Attorney General, shall publish regulations 
     implementing this subsection within six months of the 
     effective date of this Act. Such regulations shall include 
     the following:
       (A) A description of the information that must be submitted 
     by health care professionals who seek to obtain approval to 
     engage in collective negotiations.
       (B) Provisions for the opportunity for the public to submit 
     comments to the Commission or the Assistant Attorney General 
     for consideration in reviewing any request for approval by 
     health care professionals to engage in collective 
     negotiations under this section.
       (C) Provision for a filing fee in an amount reasonable and 
     necessary to cover the costs of the Commission and the 
     Assistant Attorney General to implement this subsection. On 
     an annual basis, this fee shall be updated to reflect any 
     increases or decreases determined to be necessary to cover 
     such costs.
       (3) Coordination.--The Commission and the Assistant 
     Attorney General shall coordinate so that an application is 
     reviewed under this subsection by either the Commission or 
     the Assistant Attorney General, but not both.
       (4) Exemption for small groups.--
       (A) In general.--Notwithstanding any other provision of 
     this subsection (other than subparagraph (B)), no prior 
     approval is required under this subsection in the case of a 
     group of health care professionals who are acting 
     collectively with respect to a negotiation if such group 
     constitutes less than 20 percent of the health care 
     professionals in a specialty (or subspecialty) in the market 
     area involved, as determined under regulations of the 
     Commission.
       (B) Oversight.--The Commission shall establish a process 
     under which, if it receives a bona fide request that alleges 
     that the negotiations of a group described in subparagraph 
     (A) has not promoted competition or has not enhanced the 
     quality of patient care, the Commission will review the 
     request and may take such action as the Commission determines 
     to be appropriate. Such action may include ordering that the 
     results of the negotiations be vitiated and that the 
     exemption under subparagraph (A) not apply to such group for 
     such period as the Commission may specify.
       Page 8, after line 8, insert the following:
       (4) Commission.--The term ``Commission'' means the Federal 
     Trade Commission.
       (5) Assistant attorney general.--The term ``Assistant 
     Attorney General'' means the Assistant Attorney General in 
     charge of the Antitrust Division of the Department of 
     Justice.

  Mr. CAMPBELL. Mr. Chairman, just a point of procedure, if I might. 
How may I go about claiming the time in opposition?
  The CHAIRMAN. The gentleman from California (Mr. Campbell) may claim 
the time.
  Mr. CAMPBELL. With the consent of my colleague, the gentleman from 
Michigan (Mr. Conyers), I claim the time in opposition.
  Mr. CONYERS. Mr. Chairman, I am pleased to give the control of the 
time to the gentleman from California (Mr. Campbell).
  Mr. CAMPBELL. I appreciate that, Mr. Chairman. How much time is that, 
Mr. Chairman?
  The CHAIRMAN. The time in opposition will be 5 minutes.
  Pursuant to the order of the House of today, the gentleman from 
Florida (Mr. Stearns) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Florida (Mr. Stearns).
  Mr. THOMAS. Mr. Chairman, is there a motion available to object to 
the use of the chart on the floor?
  The CHAIRMAN. The Chair recognizes the gentleman from Florida (Mr. 
Stearns).
  Mr. STEARNS. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I thank my colleague, the gentleman from California 
(Mr. Thomas), for allowing me to have the charts here on the House 
floor.
  Mr. Chairman, my amendment is pretty simple. It is basically asking 
for oversight on the Conyers-Campbell, Campbell-Conyers amendment. When 
we look across the landscape at different groups that have been 
exempted, labor unions, of course, as mentioned earlier, go to the 
National Labor Relations Board. If one developed a cooperative, a 
farming cooperative, they would have to go to the Secretary of 
Agriculture to certify that they did not have any monopoly practices 
and that they were not restraining trade.
  If one were an export association or a trading company or even a 
fishing association, even a fishing association, they would have to go 
to the Secretary of the Interior or to the Federal Trade Commission.
  If one is an insurance company and they tried to meet different 
people, insurance companies tried to meet, they would also have to be 
governed by antitrust laws.
  Newspapers, national defense contractors, throughout all of America, 
everybody has some oversight, but not in the Campbell-Conyers bill.
  Now, in Texas, Governor George Bush passed a bill which had similar 
language to the Campbell-Conyers bill,

[[Page 13263]]

but it had oversight. In fact, when one looked at it, and many other 
States are adopting this language, provided for the doctors to be able 
to get together and to negotiate with HMOs; but it had oversight.
  One had to go to the State attorney general to certify that their 
plan and what they were doing were not antitrust, was not developing a 
monopoly.
  So basically my amendment, which is very simple, adds a few words. It 
says that when they go to the HMOs and when they develop their 
collective strategy, that it will be certified by the Federal Trade 
Commission or the Justice Department. So it is very simple. It brings 
in that trust but verify.
  So I ask my colleagues to say if they support the Campbell amendment, 
the Conyers amendment, why not have a little bit of trust but verify by 
having this group of doctors, much like everybody else in America, have 
some oversight; and they would have to go to the Federal Trade 
Commission or to the Justice Department to get certified for what they 
are doing?
  Mr. Chairman, I reserve the balance of my time.
  Mr. CAMPBELL. Mr. Chairman, I yield 3 minutes to the gentleman from 
Georgia (Mr. Norwood).
  Mr. NORWOOD. Mr. Chairman, I thank the gentleman from California (Mr. 
Campbell) for yielding me this time.
  Mr. Chairman, I rise to strongly oppose the Stearns amendment. I am 
not going to spend much time talking about it. It simply guts the bill. 
Do not vote for it.
  I do want to go back and refer to the Ballenger amendment for just a 
moment which basically says that, okay, we will let the docs actually 
get together and have a discussion about this great big insurance 
company that comes to town, is going to take over all their practices; 
and we will actually let them get in a room and talk about it without 
prosecuting them, except they cannot talk about fees.
  Now, I assure everyone that is part of the discussion. After having 
practiced dentistry for 25 years and fooled around a few years 
experimenting with this managed care environment, I can say absolutely 
that it is not possible to negotiate with HMOs without bringing up fees 
and payments.
  Some HMOs have contracts that require doctors to spend no more than 
12 minutes with a patient. Other HMOs pay doctors bonuses to provide 
the cheapest possible care, even when another treatment is more 
appropriate. The list goes on, such as bonuses for using HMO facilities 
and suppliers even when they are inferior.
  Mr. Chairman, those who support this amendment, and I am talking 
about the Ballenger amendment, are technically correct when they say 
that doctors could negotiate over spending more time with patients, 
providing appropriate treatments with patients, or which facility to 
use without specifically bringing up cost issues. But if that is all 
the doctor can question in this negotiation, we will see every HMO in 
this country switch to one of their other options, which is straight 
capitation.
  I have actually tried to practice dentistry under these conditions, 
in which one is assigned a flat fee per person. Some years ago I think 
it was $3.00, not $10.00 as the gentleman from Michigan (Mr. Conyers) 
said, but $3.00. The plan does not put any standards in the contract, 
but the fee received is based on the same 12-minute per patient, 
cheapest care possible and the use of HMO facilities only.
  If one does not do all of these things, they just simply go broke.
  Now, the playing field out there is tilted. The gentleman from Ohio 
(Mr. Boehner) mentioned it. It is tilted. It is tilted way out of line. 
We have turned health care in this country over to the insurance 
industries. We have said, you run it, we cannot. The Federal Government 
will be solid about it. The States have all of their laws preempted, 
and by the way let us give the insurance companies an exemption from 
antitrust.

                              {time}  2350

  That is what we have going on out there. Health care is not better 
off for it. Now, we need to, if we cannot get a patient's protections 
bill, at least level the playing field, so these men and women who care 
for your bodies every day can come together in a room and actually 
discuss their life.
  Mr. STEARNS. Mr. Chairman, how much time is remaining?
  The CHAIRMAN. The gentleman from Florida (Mr. Stearns) has 2 minutes 
and 45 seconds remaining.
  Mr. STEARNS. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, the gentleman from Georgia (Mr. Norwood) just finished 
a very eloquent, emotional speech. The point is that a lot of the 
States are already enacting these protections for the physicians, and 
we do not need the Federal Government to go ahead and do it. For 
example, Texas passed, as I mentioned earlier, an antitrust bill that 
exempted physicians but had oversight with the Attorney General there 
in the State.
  Why not let the States throughout this country do what we are trying 
to do and let them be first? Negotiations in the States will proceed on 
an orderly manner, and in those States where it is not required, it 
will not go forward.
  Mr. Chairman, I have these charts that I want to show here briefly. 
The myth, the bill would grant doctors the same type of labor 
protections afforded other workers. Other workers can obtain a labor 
exemption only, only if they are employees, not independent 
contractors. Two, physicians who are employees are already entitled to 
the exemption under existing law, and, third, under H.R. 1304, 
physicians' collective bargaining would not be subject to the NLRA or 
any other NLRB oversight.
  I ask my colleagues, do we want to have them have that carte blanche 
ability? Myth, doctors cannot organize without the exemption. Antitrust 
laws permit physicians to perform large group practices and IPAs now. 
In many areas, these groups have considerable leverage over plans, 
particularly when they are organized around specialities. Three, 
doctors already can discuss qualities and other contractual terms with 
each other and with health care plans.
  My colleagues, let us have some oversight. They did it in the State 
of Texas. This bill would supersede Texas and all other States that are 
moving forward. So I ask you to vote for the Stearns amendment and let 
us have trust, but verify.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CAMPBELL. Mr. Chairman, I have no further speakers, except to 
close.
  Mr. STEARNS. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, let me tell my colleagues on tonight's vote, whether 
you are a Democrat or a Republican, we know how controversial this is. 
We know that a lot of the people that went on the Campbell bill decided 
they wanted to get off but they could not get off, and they are hoping 
tonight that somehow this amendment would not be brought to the floor 
or possibly there would be some way that they would have to vote for 
it.
  My colleagues if we want a fair compromise to this bill and still 
retain our loyalty to it, then vote for the Stearns bill, because it 
allows you to have oversight of these doctors, without it, everything 
we heard from the other speakers could occur.
  It does not hurt to have some verification through the antitrust 
measures that are in this amendment, much like even the Fishery 
Association has, so I urge passage of the Stearns bill.
  Mr. CAMPBELL. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, of 228 cosponsors, three have asked to come off the 
bill. We have 225. I do not know where my good friend, the gentleman 
from Florida (Mr. Stearns), believes that people have been asking to 
get off the bill. Let me say eight have joined since our bill was 
postponed a month ago, eight new sponsors have joined.
  The capitation rate can be so low in some instances that quality of 
health care suffers, that is just a fact. When

[[Page 13264]]

people say that they would try to limit negotiations only to matters 
unrelated to fees, they miss the fact.
  If your capitation rate requires you as a general practitioner to see 
10 patients per hour, then they are not providing quality care. The 
gentleman from Florida (Mr. Stearns) suggests that we get the Federal 
Trade Commission to oversee.
  Let me tell my colleagues what the Stearns amendment does. It gives 
the FTC the power. The gentleman did not discuss it but at page 4 in 
his amendment, and it is in my handout so those colleagues that come on 
the floor will see it, the FTC is given the authority and, I quote, to 
determine whether the terms are appropriate and then take such action 
as they think as appropriate, including the results of the negotiations 
be vitiated. I am not kidding. The FTC has plenary authority under the 
Stearns amendment to vitiate the bill, and all of its amendments. 
Furthermore, the FTC does not want this authority.
  In testimony before the Committee on the Judiciary, the chairman of 
the FTC said they did not have the manpower, personpower to handle 
this. Furthermore, the Stearns amendment says that there is an 
exemption if you are 20 percent or less of a market. How is the FTC to 
determine if we have 20 percent or less of a market?
  Mr. Chairman, I used to be in charge of the Bureau of Competition at 
the FTC, and we were doing mergers in 45 days with compulsory process. 
How do we determine whether anybody has 20 percent of a market within 
30 days? That is why the chairman of the FTC testified that it could 
not be done, not without a huge increase in his budget.
  Lastly that the doctors have existing authority; only if they 
integrate, that is just the point. Some doctors do not choose to be 
business people. They never choose to become in an IPA or an IPO, they 
chose to be professional doctors, we should let them be professional 
doctors.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Florida (Mr. Stearns).
  The question was taken; and the Chairman announced that the noes 
appeared to have it.
  Mr. STEARNS. Mr. Chairman, I demand a recorded vote, and pending 
that, I make the point of order that a quorum is not present.
  The CHAIRMAN. Pursuant to House Resolution 542, further proceedings 
on the amendment offered by the gentleman from Florida (Mr. Stearns) 
will be postponed.
  The point of no quorum is considered withdrawn.
  It is now in order to consider Amendment No. 3 printed in House 
Report 106-709.


                   Amendment No. 3 Offered by Mr. Cox

  Mr. COX. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 3 offered by Mr. Cox:
       Page 4, after line 20, insert the following new paragraph:
       (3) Physicians' right to choose whether to join a labor 
     organization.--Nothing in this Act shall impair the right of 
     any health care professional to refrain from self-organizing, 
     from forming, joining or assisting a labor organization 
     (including an organization of other health care 
     professionals), from bargaining collectively, or from 
     engaging in concerted activities, and no agreement with a 
     health care plan may require membership by a health care 
     professional (who under existing law prior to the enactment 
     of this Act would not have been treated as an employee) in a 
     labor organization, including any organization of other 
     health care professionals, as a condition of employment.

  The CHAIRMAN. Pursuant to the order of the House of today, the 
gentleman from California (Mr. Cox) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentleman from California (Mr. Cox).
  Mr. COX. Mr. Chairman, I yield myself such time as I may consume.
  The physicians who support this bill do so for one reason, they wish 
to negotiate with HMOs and other managed care organizations in order to 
improve the quality of the patient care. They do not seek this 
legislation in order to force other doctors into a labor union if those 
doctors do not wish to join one. America's physicians deserve the 
fundamental right to choose whether to join a union or not, whether to 
belong to a union and whether to pay dues to it.
  This amendment states clearly that even as they are gaining the right 
to collectively bargain, America's doctors will also be protected in 
their right to join a labor organization or to choose not to.
  It is necessary, because this bill states that doctors will 
henceforth be treated as, this is the language of the bill, quote, 
bargaining units, which are recognized under the National Labor 
Relations Act in connection with such collective bargaining, but the 
National Labor Relations Act says that workers can be compelled to join 
a union as a condition of employment.
  This would happen if, for example, some doctors under this bill 
collectively bargain with an HMO and negotiated a contract that 
required membership in a union as a condition of working for that HMO.
  Without this amendment, a physician could be shut out from 
participating in a health care plan were such a collective bargain 
agreement negotiated with an HMO. That physician could be shut out of 
the health care plan simply because he or she chose not to join a 
union, simply because, for example, a physician exercised her right to 
choose not to become a member of a union.
  Unfortunately, forced unionization is a very real and very unfair 
fact of life under the National Labor Relations Act. This amendment 
makes clear the original intent of the bill's author, to allow 
physicians to collectively bargain and leave them free to choose 
whether or not to join a union.
  If this bill is enacted, doctors will collectively bargain with HMOs. 
Doctors and HMOs will undoubtedly enter into collective bargain 
agreements. Under the National Labor Relations Act, those collective 
bargaining agreements could legally require that in order for a doctor 
to work at the HMO he or she must join a union.

                              {time}  2400

  This amendment will protect doctors from such compulsory unionism 
that is nowhere forced on them today.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I rise in opposition, and I yield myself 1 
minute.
  Mr. Chairman, this may be one of the most incredible amendments of 
the evening, because we are now talking about mandating a Federal 
right-to-work law with respect to health care professionals. I say to 
my colleagues, we have never considered that before in any particular 
field, and the practical impact of the amendment would be to harm the 
ability of health care professionals to collectively bargain and 
protect patients' rights.
  This is an amendment that would seek to turn pro-labor Members 
against H.R. 1306.
  Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Michigan 
(Mr. Bonior), our distinguished whip.
  Mr. BONIOR. Mr. Chairman, most of us live in communities where we pay 
taxes for the cost of operating schools, for paving the streets, for 
picking up the garbage, and we each pay our share, so do our neighbors. 
Everyone does their part, everyone reaps benefits. But imagine for a 
moment if it were different. Imagine if our neighbors could each decide 
to opt out of paying their fair share. They would still get the 
benefits, they just would not pay for them. Well, I think it would be 
pretty obvious it would not take long for that system to fall apart 
because we could not afford a system like that.
  That is exactly the kind of system that the Cox amendment would force 
on to the health professionals. It says you can organize, you can 
bargain, but you have to provide the same services for the freeloaders, 
those who do not want to pay, as you do to provide for those who pay 
their fair share.
  Mr. Chairman, no one here would ever argue that individuals have a

[[Page 13265]]

right not to pay their taxes if they do not want to, yet this amendment 
tells health care professionals they would have the right not to pay 
their fair share of the cost of collective bargaining.
  So I say to my colleagues, this amendment may not stop professionals 
from organizing, but make no mistake about it, this amendment will 
prevent them from succeeding. It is, as the gentleman from Michigan 
(Mr. Conyers) has stated, an amendment that would kill the bill from 
the perspective of many people in this Chamber, and I hope Members will 
vote no on it.
  Mr. CONYERS. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from New Jersey (Mr. Andrews).
  Mr. ANDREWS. Mr. Chairman, I rise in opposition to the Cox amendment.
  Those who are sympathetic and in support of the underlying purpose of 
this bill will surely see their intention defeated if this amendment is 
adopted. Because no rational-thinking physician would proceed to try to 
organize and bargain collectively if this amendment became law, because 
those leaders in the collective bargaining process would bear all the 
risk, and there is considerable risk of going up against the managed 
care companies, considerable risk of being ostracized, considerable 
risk of being leveraged in the marketplace, considerable risk of 
suffering professional and economic harm. Those who would be the first 
to step forward would bear all the risk, and then those who sat and 
waited to see how it turned out would yield all the benefit if they so 
chose.
  No one, Mr. Chairman, would embark on that kind of risky venture if 
he or she was not assured that those who would benefit from the hard-
won bargain would have to pay to support the process of winning the 
hard-won bargain.
  So this is an amendment that if it became law would act as a 
significant disincentive for anyone ever stepping forward and taking 
advantage of the rights that are contemplated in the underlying bill.
  If one is sympathetic to the principles of the underlying bill, one 
should oppose this amendment.
  Mr. COX. Mr. Chairman, I yield 1 minute to the distinguished 
gentleman from Virginia (Mr. Goodlatte).
  Mr. GOODLATTE. Mr. Chairman, I thank the gentleman for yielding me 
this time, and I rise in strong support of this amendment and to debunk 
some of the allegations made on the other side.
  We have 21 States that have right-to-work laws now, and in all of 
those States we have unions that are organized. To deny the right to 
members of a health care organization to choose for themselves whether 
or not to engage in collective bargaining is a fundamental principle 
that every American should have. In fact, we should not just be voting 
on this issue on this particular group of people; we should be bringing 
the legislation that I have introduced and has been cosponsored by more 
than 140 members for a national right-to-work law to be voted on here 
in the Congress.
  Mr. Chairman, I strongly support this provision being added to this 
bill, to give people the right to choose for themselves whether or not 
they want to participate in something. They should not be made 
involuntarily to participate in collective bargaining if they choose 
not to do so. So this is something that has worked well for a great 
many people in a great many places, and to require somebody to do this 
against their will is tyranny. We should support this amendment.
  Mr. COX. Mr. Chairman, I yield 1 minute to the gentleman from 
California (Mr. Rohrabacher), my distinguished colleague.
  Mr. ROHRABACHER. Mr. Chairman, I rise in strong support of H.R. 1304, 
and I want to note that I was an original cosponsor of H.R. 1304. Many 
of us who feel strongly about this also strongly support the Cox 
amendment.
  Mr. Chairman, this bill, the base bill, is about voluntary 
association, the right of people to gather to work together and to form 
unions if they want to, yes, but to have voluntary associations, if 
they want to do so. It is also about the right to choose. The Supreme 
Court recently had two decisions based on freedom of association, the 
Boy Scout decision and the political parties decision.
  The Cox amendment will ensure that this bill's lofty goals are 
actually achieved. The lofty goals of making sure that doctors are 
working for the benefit of the public and that the medical profession 
is not taken over by labor union bosses or anybody else, or managers of 
HMOs, but instead, the freedom of association will ensure that doctors 
can gather together and that they will remain true to the ideals that 
brought them together in the first place. Support the Cox amendment.
  Mr. CONYERS. Mr. Chairman, I yield 15 seconds to the gentlewoman from 
Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Chairman, I rise in opposition to this 
amendment. I wish the discussion was accurate. There is no coercion in 
this bill whatsoever. There is no requirement to unionize, to organize; 
there is perfect freedom in this legislation. I oppose this amendment, 
because there is no need for clarification.
  Mr. Chairman, I stand in opposition to the amendment offered by 
Congressman Cox to ``clarify that a health care plan may not force a 
physician to join a union as a condition of employment.''
  H.R. 1304 would exempt health care professional from antitrust laws 
when they negotiate with health plans over fees and other terms of any 
contract under which they provide health care items of service. 
Professionals who form coalitions for that purpose would receive the 
same treatment under antitrust laws that labor organizations receive 
for collective bargaining activities under the National Labor Relations 
Act.
  To this point, H.R. 1304 has truly been a piece of legislation formed 
through the combined efforts of my colleagues who sit on the Judiciary 
Committee, both on the left and the right. Now, our combined efforts 
seem to be traveling down that destructive road called 
``partisanship.'' Let us be careful not to be divided at this point.
  As it stands, H.R. 1304 makes clear its objectives. There is no 
ambiguity in this legislation. Hence, there is no need for 
clarification! This amendment is proffered to ``reaffirm the right of 
any health care professional to refrain from self-organizing, from 
forming, joining, or assisting a labor organization, from bargaining 
collectively, or from engaging in concerted activity.''
  There is no language in H.R. 1304 that would minutely suggest that 
collective bargaining, organization, or unionization is, or may be 
required. Independent practitioners who wish to remain private in 
practice and in negotiations with health care plans may do so. This 
legislation would only give independent practitioners protection should 
they ``choose'' to engage in collective bargaining.
  For care givers who provide speciality services, this bill will 
assist them in negotiating contracts with the health care plans to make 
their services more readily accessible. This legislation is clear in 
that it provides a benefit to health care providers and does not impose 
any requirements.
  H.R. 1304 has already been through an intense amendment process in 
the Judiciary Committee and adopted by a vote of 26-2, I urge my 
colleagues not to allow additional amendments to legislation that is 
already crystal clear.
  There has been a bipartisan effort to work with professional health 
care organizations and we should respect the work that has been done to 
develop this bill.
  Any amendments at this point would be hidden attempts to destroy a 
very simple and important piece of legislation. As reported by the 
judiciary, the bill would ensure that Congress could address any 
potential concerns that may arise before the legislation is re-
authorized. Adding unneeded language would only harm patients by 
delaying passage and ultimately destroying the bill.
  Mr. Chairman, this legislation is clear and I press upon my 
colleagues the need to oppose all amendments at this point and to 
support the passage H.R. 1304 so the American people may begin to 
receive the best health care possible.
  Mr. CONYERS. Mr. Chairman, I yield myself the remaining time.
  The Cox amendment is nothing less than a last-minute attack on the 
rights of health care professionals and patients in particular. Now, 
notice, this is a nongermane amendment that had the rule prescribed 
that all points of order had not been waived would not even be in 
order. It is a last-grasp effort on the part of the opponents of the

[[Page 13266]]

bill to change the subject matter of the bill and turn pro-labor 
Members against the measure.
  The practical impact of the amendment would be devastating to the 
ability of health care professionals to collectively bargain and 
protect patients' rights. Let us not pass tonight inadvertently the 
first Federal right-to-work law in our country's history.

         American Federation of Labor and Congress of Industrial 
           Organizations,
                                    Washington, DC, June 29, 2000.
     Hon. John Conyers, Jr.,
     House of Representatives, Washington, DC.
       Dear Congressman Conyers: The AFL-CIO opposes the Cox 
     amendment to H.R. 1304, Quality Health Care Coalition Act. 
     This amendment is clearly an attempt at passing a federal 
     ``right to work'' law for doctors and health professionals.
       We strenuously oppose this amendment and urge Members to 
     vote against it.
           Sincerely,
                                                     Peggy Taylor,
                              Director, Department of Legislation.

  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from California (Mr. Cox).
  The question was taken; and the Chairman announced that the ayes 
appeared to have it.
  Mr. CONYERS. Mr. Chairman, I demand a recorded vote.
  The CHAIRMAN. Pursuant to House Resolution 542, further proceedings 
on the amendment offered by the gentleman from California (Mr. Cox) 
will be postponed.
  It is now in order to consider Amendment No. 4 printed in House 
report 106-709.


                  Amendment No. 4 Offered by Mr. Terry

  Mr. TERRY. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 4 offered by Mr. Terry:
       Page 4, after line 20, insert the following:
       (3) No negotiation over fees.--The exemption provided in 
     subsection (a) shall not apply to negotiations over fees.

                              {time}  0010

  The CHAIRMAN. Pursuant to the order of the House of today, the 
gentleman from Nebraska (Mr. Terry) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentleman from Nebraska (Mr. Terry).
  Mr. TERRY. Mr. Chairman, I yield myself 2 minutes.
  Mr. Chairman, this amendment is really rather simple. This Terry-
Coburn amendment states rather simply that this broad antitrust 
exemption should be provided, not for fees, but only for the protection 
of patients.
  The AMA in our discussions has assured me that this bill that they 
support and want is not about money. In fact, they sent around a flier 
today to all of us saying it is about the patient, not dollars. So, in 
theory, they should support this type of an amendment that still 
protects their rights to negotiate the quality of patients' care, but 
not to collaborate on fees and increase the cost.
  I have met with several of the doctors back in my home district. They 
have shared with me that they want the ability to communicate and 
balance the table, to talk to the insurance companies about the quality 
of care, that they are concerned about being gagged in what they can 
and cannot talk to their patients about, or gatekeeper provisions, or 
medical necessity definitions. These are the types of things they would 
like to sit down and negotiate.
  I think we should allow them that type of opportunity, because that 
does go to the heart of the quality of patient care. So why are they 
against this amendment? Maybe it is about the money. Providing quality 
care should never take a back seat to cost or treatment. This amendment 
will assure that this bill remains focused on what we all want, and 
that is quality of care, and is not simply increasing the cost of that 
care.
  I urge my colleagues to vote for this simple solution that splits the 
difference.
  Mr. CAMPBELL. Mr. Chairman, I rise in opposition.
  The CHAIRMAN. The gentleman from California (Mr. Campbell) is 
recognized for 5 minutes.
  Mr. CAMPBELL. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Iowa (Mr. Ganske).
  Mr. GANSKE. Mr. Chairman, I urge my colleagues on both sides of the 
aisle to reject this amendment. Here is why: The Terry amendment would 
prevent negotiations over quality of care. It addresses costs.
  Let me give an example of how costs can affect quality of care. As a 
reconstructive surgeon, if somebody has their hand cut off, I can take 
that patient to the operating room and under microsurgical repair sew 
back all the tendons, the blood vessels, put the nerves back together. 
That is probably a 10-hour operation, an 8- to 10-hour operation.
  That HMO that I may be contracted with can determine that the payment 
to the surgeon for that procedure would be $200, or maybe $150. By 
their pricing, they can effectively, despite their promises to their 
patients, prevent those patients from getting the services paid for, 
covered by their plans, by simply making it impossible for that patient 
to get that type of care that they need. They can price a product, a 
health care product, so low that we effectively are not providing the 
service.
  Yes, if that patient comes in, under medical ethics I would take the 
patient to the operating room and fix their hand, but I would be 
essentially doing it for free.
  Mr. CAMPBELL. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Florida (Mr. Weldon).
  Mr. WELDON of Florida. Mr. Chairman, I rise in opposition to the 
amendment offered by the gentleman from Nebraska. I have the utmost 
respect for him, but happen to disagree with him on this issue.
  I think the gentleman from Iowa (Mr. Ganske) was fairly eloquent on 
this issue. He presupposes that there is no correlation between 
reimbursement and quality. When I talk to a lot of the physicians in my 
community about their experiences on this issue, many of them share 
with me the same thing, that the lower and lower the reimbursement 
schemes that the insurance companies are essentially ramming down their 
throats, the way they cope is they see more and more patients in a 
given amount of time.
  There has been some very good research out of Canada to show that 
physicians spend very little time seeing patients because the 
reimbursement is so bad that patients have to go to a doctor two, 
three, or four times before they finally get properly diagnosed, and 
the essential problem is the doctors are not spending any time with the 
patients.
  While this bill passed with the gentleman's exception would be better 
than no bill, I think the gentleman's amendment does serious injury to 
the fundamental issue.
  There are 220 cosponsors of the underlying bill. I would encourage 
all of them to vote no on the Terry amendment.
  Mr. TERRY. Mr. Chairman, I yield 3 minutes to the gentleman from 
Oklahoma (Mr. Coburn).
  Mr. COBURN. Mr. Chairman, this is an ironic twist that I am against 
my doctor friends in the House. I do so not without risk to myself. I 
was castigated at the AMA when they had the House of Delegates because 
I opposed the bill.
  I voted for the Patients' Bill of Rights. I have worked hard to try 
to see that we get a bill for patients. I understand the motivation, 
severely, behind this bill. I think the motivation is pure.
  But I do think that our obligation, and as the gentleman from Iowa 
(Mr. Ganske) said, if a patient came to him, he would do it whether he 
got paid or not. How is it we have a health care system where we have 
to make a consideration about whether we get paid or not, whether or 
not there is a question about adequate remuneration?
  The fact is that this is about money, unfortunately. To say it is 
about patient care is really not true, because everything I have heard 
from the doctors that I have talked about has been about money. Money 
is associated with patient care.

[[Page 13267]]

  The question has been raised about low monthly payments for patients 
in an HMO, but the only way an HMO can force a doctor to accept $10 a 
month for pediatric care is if there are way too many doctors in that 
market. So although the goals and the desires of my friends from the 
AMA are good, what they want to do is continue to perpetrate the 
maldistribution of physicians in this country.
  The other thing to think about is if this bill becomes law and 
Members live in a rural district, half of their doctors will no longer 
be in the rural district because we will have set up a system where 
they can come to the urban areas, where many of them would rather be, 
and get the same treatment because we can negotiate the fees higher. So 
we are going to disrupt further the distribution of physicians in the 
country.
  I am with my brothers and sisters in the medicine field. I believe 
this is the wrong way to solve our problem. The right way to solve our 
problem is the Patients' Bill of Rights. If this amendment is accepted 
and my amendment is accepted, I will be voting for this bill.
  Mr. CAMPBELL. Mr. Chairman, I yield the balance of our time to the 
gentleman from Georgia (Mr. Norwood).
  Mr. NORWOOD. Mr. Chairman, I thank the gentleman for yielding time to 
me.
  I want to say to my dear friend, and I mean that, the gentleman from 
Oklahoma (Mr. Coburn), I simply do not agree with him. I think we ought 
to vote this amendment down.
  Is this about money? Of course it is about money. People who are 
going broke are concerned about that. I have been involved in managed 
care a few years. I can tell the Members right now it is a lot easier 
to stay home and go fishing than go broke, because their choice is to 
go broke or give bad care. That is the choices they give us.
  I have always wanted to tell this story. I hate to tell it when 
nobody is awake. It is a story basically about what this is all about. 
It has occurred since I have been in Congress.
  In 1996, Concordia Dental Insurance Company won the bid from the 
United States government to care for all the dependent personnel for 
our military across the country, a $1 billion contract. There is a 
little town in eastern North Carolina called Jacksonville, North 
Carolina. One hundred thousand people live there. Thirty thousand are 
civilians, 70,000 belong to the Marines.

                              {time}  0020

  Now, there are only 30 dentists there, and Concordia comes to town 
and says, Guys, we are going to take two-thirds of your practice. We 
are go to cut everything that you are paid in half, your fees are cut 
in half. You do not have to take this contract. The gentleman from 
Oklahoma (Mr. Coburn) says they could just walk away. How can they walk 
away? They are taking two-thirds of their practice.
  They are simply saying, We want you to treat these people with 
quality care as long as you can. You may be out of business in a year, 
you may even last 2 years. These people said, No. We are not going to 
do this. These 30 dentists said, No, we cannot do this. We will go 
broke. We cannot feed our families or take care of our children's 
education.
  What do my colleagues think happened to these people? The next thing 
they get is the big arm of the Federal Government from the Federal 
Trade Commission slamming down on their door saying, We know you are in 
collusion. You have got to be, because none of you will come to work 
for this insurance company and go broke. Something has got to be wrong. 
You are talking to each other. Sure you are. We are going to prosecute 
you.
  Do my colleagues know what happened? A classmate from Harvard who was 
a lawyer from Concordia just happened to know a classmate of his at the 
Federal Trade Commission and he calls him up and he says, John, I 
cannot get these people to work for nothing. You need to help me do 
something about that. So our great Federal Trade Commission puts all of 
these 30 people under the threat of jail because they will not work for 
nothing.
  Mr. Chairman, I urge my colleagues, do not pass this amendment.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Nebraska (Mr. Terry).
  The question was taken; and the Chairman announced that the noes 
appeared to have it.
  Mr. TERRY. Mr. Chairman, I demand a recorded vote.
  The CHAIRMAN. Pursuant to House Resolution 542, further proceedings 
on the amendment offered by the gentleman from Nebraska (Mr. Terry) 
will be postponed.
  It is now in order to consider amendment No. 5 printed in House 
Report 106-709.


                 Amendment No. 5 Offered by Mr. Coburn

  Mr. COBURN. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 5 offered by Mr. Coburn:
       Page 6, after line 10, insert the following new subsection 
     (and redesignate the succeeding subsections accordingly):
       (h) Exemption of Abortion and Abortion Services.--Nothing 
     in this section shall apply to negotiations specifically 
     relating to requiring a health plan to cover abortion or 
     abortion services.

  The CHAIRMAN. Pursuant to the order of the House of today, the 
gentleman from Oklahoma (Mr. Coburn) and a Member opposed each will 
control 7\1/2\ minutes.
  The Chair recognizes the gentleman from Oklahoma (Mr. Coburn).
  Mr. COBURN. Mr. Chairman, I yield 2 minutes to the gentleman from New 
Jersey (Mr. Smith).
  Mr. SMITH of New Jersey. Mr. Chairman, first of all let me begin by 
saying that the gentlewoman from Texas (Ms. Jackson-Lee), my friend and 
colleague, misstated--was in error--when she suggested that any 
amendment to H.R. 1304, constituted a poison pill crafted by the 
insurance industry to destroy the bill.
  As a strong and longstanding cosponsor of the Campbell bill, and as 
one speaking in favor of the pro-life Coburn amendment, nothing could 
be further from the truth. Our only intent in proposing this amendment 
is to protect innocent babies and their mothers from the violence of 
abortion. Abortion isn't health care--it is the dismembering and 
poisoning of fragile children.
  Mr. Chairman, let us make no mistake about it, pro-abortion groups 
have long had as their goal complete assimilation of abortion into the 
Nation's health care system. It is clear that absent Coburn abortion 
providers could certainly use the exemption created by H.R. 1304 to 
pressure private group health plans to cover abortion. It is 
appropriate then, and I think it is a vital duty of this Congress, to 
adopt the Coburn abortion-neutral amendment if we are going to grant 
physicians the significant leverage in negotiations over benefits and 
other important issues permitted under the legislation. But we 
certainly should not, however unwittingly or inadvertently, permit more 
abortions as a consequence of this measure.
  The Coburn amendment, which would simply maintain the status quo, 
would only exclude negotiations over abortions. That is all it would 
do. In other words, current antitrust law would remain in place if 
organizations and health care providers tried to leverage expansive 
abortion coverage from insurers.
  Opposition to the Coburn amendment could only come from those who 
want abortion advocates to use this special antitrust exemption granted 
by H.R. 1304 to expand coverage of abortion. That is why the National 
Right to Life is in favor of Coburn. That is why NARAL and other pro-
abortion organizations are against it. It could not be clearer.
  Mr. Chairman, I strongly urge a positive vote in favor of the Coburn 
amendment.
  Mr. CONYERS. Mr. Chairman, I rise in opposition to the amendment.
  The CHAIRMAN. The gentleman is recognized for 7\1/2\ minutes.
  Mr. CONYERS. Mr. Chairman, I yield myself 45 seconds.
  Mr. Chairman, this is another example of the kind of gamesmanship 
that we have been subjected to. The bill

[[Page 13268]]

says nothing about abortion. This anti-choice gag rule is a poison pill 
designed only to kill another bill to provide quality health care to 
all Americans.
  How many Members have told me on the floor tonight if this amendment 
passes, they will vote against the bill? It is very simple. It is very 
obvious. To talk about leaving a rape victim without medical guidance.
  Mr. Chairman, I reserve the balance of my time.
  Mr. COBURN. Mr. Chairman, I yield 30 seconds to the gentleman from 
Arizona (Mr. Shadegg).
  Mr. SHADEGG. Mr. Chairman, the gentleman from Michigan (Mr. Conyers), 
my colleague on the other side, said point blank that the bill says 
nothing about abortion. He is simply wrong. The language of the bill 
clearly provides that physicians cannot negotiate in order to preclude 
people from providing abortion, but in fact they can negotiate to force 
them.
  The language of the bill is right here. I invite the gentleman to 
read it. It simply says if a doctor is licensed to perform an abortion, 
negotiations may not be held to preclude him from performing abortions, 
in plain language of the bill. I invite the gentleman to read it.
  Mr. CONYERS. Mr. Chairman, I yield 2 minutes to the distinguished 
gentlewoman from New York (Mrs. Lowey).
  Mrs. LOWEY. Mr. Chairman, I have been a cosponsor of this bill for 
nearly a year. But the amendment before us strips physicians of their 
right to speak about their medical, religious, and moral beliefs; and 
it says doctors can collectively bargain on any subject except those 
related to abortion and abortion services.
  Every single time the anti-choice majority in this House can 
interfere with a women's right to access family planning or choose a 
legal abortion, they do. It is never enough. This bill contains no 
mention of any specific health service. It offers no directive about 
specific benefits or services that must be covered. But here we are 
debating women's reproductive health care once again.
  We need not fear that it will be covered because this amendment would 
ensure it cannot even be discussed. I hope that Americans who are 
watching this debate will think carefully about the kind of Congress 
they want to elect in November. We can have a Congress that encourages 
responsible decision-making and access to quality reproductive health 
care. We can have a Congress that works to prevent the need for 
abortion by increasing access to effective family planning methods. Or 
we can continue to have a Congress like this where nearly every day it 
seems there is another amendment, another bill to make the right to 
choose obsolete.
  This is what it is all about. We are gagging our doctors. We are not 
giving them the right to negotiate.
  Mr. Chairman, I urge my colleagues to fight for quality health care 
for their constituents and oppose this amendment.
  Mr. COBURN. Mr. Chairman, I yield myself 2 minutes.
  Mr. Chairman, let me quote from the bill:

       Nothing in this section shall exempt from the application 
     of the antitrust laws any agreement or otherwise unlawful 
     conspiracy that excludes, limits, the participation or 
     reimbursement or other otherwise limits the scope of services 
     to be provided by any health care professional, or group of 
     health care professionals, with respect to the performance of 
     services that are within their scope of practice as defined 
     by permitted relevant law or regulation.
  Well, let me tell my colleagues what that very slickly says. What 
that says is that health care providers have the right to retain 
services, but no right to exemption from antitrust laws to reduce 
services. So if a group, if a Catholic hospital buys a hospital that is 
presently performing abortions and under their conscience do not 
additionally want to offer that service, then in fact they will not be 
able to do that.

                              {time}  0030

  So that is not the intention of this author, and I understand that. 
That was never his intention. But that is the result and the effect is 
that those hospitals in this country who consciously object to the 
taking of unborn life can in fact be forced to perform that.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I am pleased to yield 45 seconds to the 
distinguished gentlewoman from Maryland (Mrs. Morella).
  Mrs. MORELLA. Mr. Chairman, actually, I am sure that what I will say 
has already been said, but it needs to be repeated.
  Actually, first of all, I am very pleased that this bill is coming to 
the floor. It is a good bill. It is supported by 220 Members of 
Congress and a myriad of associations and organizations. With the ever 
increasing consolidation within managed care, it is essential.
  Actually, the bill does not mandate any benefit of service, nor does 
it force insurance companies to provide abortion coverage. So I am 
dismayed that the very distinguished gentleman from Oklahoma (Mr. 
Coburn) has offered this amendment because it drags the abortion issue 
into this discussion.
  But what is happening with this amendment is we are dragging the 
abortion issue into this discussion when our debate should pivot on 
whether or not giving doctors the right to collectively bargain will 
have a beneficial or adverse consequence on the health care industry.
  This should not be a discussion on the specific conscience of a 
doctor or a health care, but the Coburn amendment would do just that. 
And so, I urge defeat of the amendment.
  Mr. COBURN. Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 45 seconds to the gentleman from 
Pennsylvania (Mr. Greenwood).
  Mr. GREENWOOD. Mr. Chairman, I thank the gentleman for yielding me 
the time.
  Mr. Chairman, those of my colleagues who are supporters of this 
measure really have to vote against the Coburn amendment, and they have 
to do it for a reason of substance and a reason of process.
  The substantive reason is that if they argue that this is all about 
freeing doctors, freeing doctors to use their individual liberty to go 
and negotiate with their plans, then they cannot have it both ways, 
they cannot say except in this one instance and be consistent.
  Secondly, if they are for the bill, they cannot vote for the Coburn 
amendment. Because if we look at the people who voted for the rule to 
allow this to happen at all, nearly half of them are pro-choice Members 
and they will kill the bill with the Coburn amendment.
  So to be consistent and support the right of doctors to individually 
and collectively argue for good care for their patients and to be 
consistent and say they want the bill to pass, they must vote against 
the Coburn amendment unless they are going to go home to their doctors 
and let them know they tried to have it both ways.
  Mr. COBURN. Mr. Chairman, I yield myself 1 minute just to answer the 
gentleman from Pennsylvania (Mr. Greenwood).
  Mr. Chairman, what the bill says is that they can negotiate for 
abortion rights but they cannot negotiate for life. That is the 
ultimate result of this language. And in fact, it puts in jeopardy 
every Catholic hospital in this country.
  What it also does, to say that this is not happening is the 
California Medical Association has already tried to introduce this law. 
It is through the State of California to mandate that every health care 
provider and every health care organization offer abortion services.
  Mr. Chairman, I reserve the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield 1 minute to the gentleman from New 
York (Mr. Nadler).
  Mr. NADLER. Mr. Chairman, I was going to use my minute to talk about 
how this is a total red herring and this debate should not be about 
abortion because the bill does not talk about abortions.
  Then the amendment that I wrote and negotiated over a period of 6 
months with doctors and nurses is cited by the gentleman on the other 
side as an abortion amendment. It has nothing to do with abortion.
  The purpose of section (e) is to say that a group of doctors cannot 
negotiate with the HMO an agreement that

[[Page 13269]]

says they may not pay nurses more than x dollars an hour. It is to 
prevent one group of professionals, doctors generally, from saying that 
nurses may not do certain things that the law says they may do.
  That fear was expressed by the nurses, the physical therapists, the 
chiropractors; and we carefully negotiated language in this section 
with the doctors, the nurses, the chiropractors and the physical 
therapists to prevent the bill from being used by one group of health 
care practitioners to exclude or limit the reimbursement of another 
group of health care practitioners.
  It has nothing whatsoever to do with abortion, period. It is just 
completely irrelevant to it. This bill says nothing about abortion pro 
or con.
  Mr. COBURN. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, if, in fact, the gentleman is correct, then there is 
nothing wrong with my amendment. If, in fact, he is incorrect, and I 
believe he is, that the unintended consequence is exactly as I 
described, we will, in fact, have the situation as I described.
  Mr. CONYERS. Mr. Chairman, I am pleased to yield 1 minute to the 
gentlewoman from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Chairman, I respect the differences 
that my friends have who are against abortion. I do again reaffirm that 
the Supreme Court has said the right to choose is the law of the land.
  The Coburn amendment makes this bill more difficult and untenable 
than it is or may be. By preventing any negotiations between health 
care plans and doctors about abortion, the Coburn amendment could leave 
an incest victim stranded on an island of despair. Even her own 
psychiatrist could be prevented by an HMO to referring her to an 
obstetrician to exercise her constitutional protected right to choose.
  It could also leave a rape victim without any medical guidance, or an 
emergency room doctor could be forbidden from ensuring that a health 
plan allows a referral to an appropriate reproductive health clinic.
  By preventing any negotiations between health care plans and doctors 
about any abortion-related service, this extreme anti-choice amendment 
could prevent a physician from ensuring that an HMO provides ultrasound 
to mothers. It is not in this bill.
  We should not vote for this amendment. We should allow the right to 
choose to stand on its own.
  Mr. Chairman, I rise in opposition to this amendment offered by 
Representative Coburn to exclude ``negotiations specifically relating 
to requiring a health plan to cover abortion or abortion services.''
  H.R. 1304, the Quality Health Care Coalition Act is about controlling 
health costs and quality and access to health care, not about limiting 
health care services because of a mention of abortion. It does so by 
amending the antitrust laws to allow health care professionals to 
jointly negotiate the terms of their contracts with health care plans.
  This bill is not about abortion rights. That debate has already been 
decided in the Supreme Court in 1973 in the landmark ruling of Roe v. 
Wade. Furthermore, just yesterday, once again the Supreme Court upheld 
a woman's right to choose whether or not an abortion is right for her, 
without the State enacting undue restrictions. By ruling the Nebraska 
``partial-birth'' ban unconstitutional, the Court reiterated that Roe 
v. Wade is still the law of the land and cannot be undermined with 
ambiguous anti-abortion language.
  Under the Coburn amendment, providers could not negotiate against any 
oppressive restrictions that appear in their contracts concerning 
abortion services. Such restrictions could include a ban on referring 
clients for abortions elsewhere, or from discussing abortion as a 
medically appropriate and legal option with patients.
  The amendment runs counter to the spirit of the underlying 
legislation--the goal of which is to empower health-care providers in 
their negotiations with large health plans. This amendment is merely 
another attempt to stigmatize abortion by separating it from other 
medical care.
  Contrary to what the amendment sponsors will argue, H.R. 1304 would 
not force insurance companies to provide abortion coverage. In fact, 
specific benefits are not usually outlined in contracts between health 
plans and providers. Rather, they are contained in contracts between 
health plans and patients or groups of patients or employers on their 
behalf.
  H.R. 1304 would not alter this practice. The Coburn amendment, 
however, would silence physicians and other providers. Those who have a 
medical and ethical responsibility to promote the well being of their 
patients would be unable to advocate with health plans on their 
patients' behalf for comprehensive reproductive health care.
  Physicians would be precluded from negotiating on their patient's 
behalf with hospitals to provide abortions in cases of medical 
emergency, or even mentioning that an abortion does not meet an 
adequate standard of care. Although today's Coburn amendment is limited 
to abortion or abortion services, it is very likely that those who seek 
to gag doctors from discussing abortion with their patients would soon 
target other reproductive health services, such as tubal ligations, 
sterilization, or contraception!
  H.R. 1304 gives health care professionals the power to jointly 
negotiate contract terms to promote quality health care for their 
patients. H.R. 1304 would provide guarantees that patients are 
protected from bureaucratic abuses and help pave the way for such 
assurances.
  Mr. Chairman, this amendment is strongly opposed by the American 
College of Obstetricians and Gynecologists and the American Medical 
Women's Association because this is an inappropriate amendment designed 
to kill support for this bill.
  Personalized attention is what most Americans desire from their 
doctors, social workers and other care providers. H.R. 1304 encourages 
doctors to focus on the care they give to their patients. It allows us 
to return to an era when physicians were able to act on behalf of their 
patients and not for the benefit of the bottom line for an insurance 
company.
  I ask my colleagues not to support such outlandish tactics and to 
rise above this so that we might approve this most significant piece of 
legislation.
  Mr. COBURN. Mr. Chairman, I yield myself the balance of the time.
  Mr. Chairman, my point is said by this chart, is that, in fact, the 
rule of the land is that they do not provide good health care unless 
they are willing to terminate an unborn child. That is NARAL's 
position. That is where we are headed with the language as it is 
written in this bill.
  This bill has great intention. The authors never intended this quirk 
of availability to be there. That was not the intention of the 
gentleman from California (Mr. Campbell). But it is there. And unless 
it is fixed, what will happen is NARAL's position that they are not 
providing health care unless they are terminating unborn children in 
every health plan, every Catholic hospital in this country that are on 
health insurance or extended facility will be at the mercy of NARAL.
  Seventy-five percent of the people in this country, the latest poll, 
believes it is murder to kill an unborn child. Twenty-five percent of 
the people in this country are wrong. They are wrong.
  There is a God in heaven, and we will pay a price for what we are 
doing to unborn children.
  Do not let this bill go out of this House without this amendment. My 
colleagues will doom not only those organizations that are there for 
life, but they will doom some of the best health care organizations in 
the country.
  Mr. Chairman, I yield back the balance of my time.
  Mr. CONYERS. Mr. Chairman, I yield the balance of the time to the 
gentlewoman from New York (Mrs. Maloney).
  Mrs. MALONEY of New York. Mr. Chairman, I yield to the gentleman from 
Michigan (Mr. Conyers).
  Mr. CONYERS. Mr. Chairman, the word ``abortion'' does not appear. I 
wrote this with the gentleman from California (Mr. Campbell). We can 
assure our colleagues that in no place does the word ``abortion'' 
appear.
  I just want to emphasize that.

                              {time}  0040

  Mrs. MALONEY of New York. Mr. Chairman, I thank the gentleman for his 
leadership.
  Mr. Chairman, I rise against the amendment of the gentleman from 
Oklahoma (Mr. Coburn). No HMO has ever required a doctor to perform an 
abortion. They have never required a doctor to perform an abortion. 
This amendment is totally unnecessary. Come on, we all know what this 
is about.

[[Page 13270]]

  The Campbell-Conyers amendment, the underlying bill, is not about 
abortion. The Coburn amendment is irrelevant, deceptive, and 
transparent. Its goal has nothing to do with abortion. Its goal is to 
try to undermine a very thoughtful and important bill. I urge a no vote 
on the Coburn amendment and a yes vote for Campbell-Conyers.
  Mr. Chairman, I yield to the gentlewoman from New York (Mrs. Lowey), 
my good friend.
  Mrs. LOWEY. Mr. Chairman, I would like to clarify the statement from 
my good friend, the gentleman from Oklahoma (Mr. Coburn), who said that 
unless someone is willing to terminate an unborn child they cannot 
practice medicine. Look at what the Greenwood amendment says, that the 
Committee on Rules and the gentleman would not accept. It clearly says 
and provides for a religious exception.
  The CHAIRMAN. The question is on the amendment offered by the 
gentleman from Oklahoma (Mr. Coburn).
  The question was taken; and the Chairman announced that the noes 
appeared to have it.
  Mr. COBURN. Mr. Chairman, I demand a recorded vote, and pending that, 
I make the point of order that a quorum is not present.
  The CHAIRMAN. Pursuant to House Resolution 542, further proceedings 
on the amendment offered by the gentleman from Oklahoma (Mr. Coburn) 
will be postponed.
  The point of no quorum is considered withdrawn.
  It is now in order to consider amendment No. 6 printed in House 
Report 106-709.


            Amendment No. 6 Offered by Mr. Davis of Illinois

  Mr. DAVIS of Illinois. Mr. Chairman, I offer an amendment.
  The CHAIRMAN. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Amendment No. 6 offered by Mr. Davis of Illinois:
       Add at the end the following new subsection:
       (j) Sense of Congress.--It is the sense of Congress that 
     decisions regarding medical care and treatment should be made 
     by the physician or health care professional in consultation 
     with the patient.

  The CHAIRMAN. Pursuant to the order of the House today, the gentleman 
from Illinois (Mr. Davis) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Illinois (Mr. Davis).


                         Parliamentary Inquiry

  Mr. CAMPBELL. Mr. Chairman, I have a parliamentary inquiry.
  The CHAIRMAN. The gentleman from California (Mr. Campbell) may 
inquire.
  Mr. CAMPBELL. In the absence of anyone opposed, may I claim the time 
for additional speakers on our side?
  The CHAIRMAN. The gentleman from California (Mr. Campbell) may claim 
the time in opposition, by unanimous consent.
  Mr. CAMPBELL. Mr. Chairman, I ask unanimous consent to claim the time 
in opposition to the amendment, that I like and support.
  The CHAIRMAN. Is there objection to the unanimous consent request of 
the gentleman from California?
  Mr. DICKS. Mr. Chairman, I object.
  The CHAIRMAN. Objection is heard.
  The gentleman from Illinois (Mr. Davis) is recognized for 5 minutes.
  Mr. DAVIS of Illinois. Mr. Chairman, I yield myself such time as I 
may consume.
  Mr. Chairman, first of all, I want to commend and congratulate the 
gentleman from California (Mr. Campbell) and the gentleman from 
Michigan (Mr. Conyers) on the introduction of a necessity whose time 
has come, that is, the Quality Health-Care Coalition Act.
  I also want to thank the Committee on Rules for making my amendment 
in order. The amendment that I offer today enhances the underlying bill 
by expressing a sense of Congress relative to decisions regarding 
medical care and treatment. This amendment simply states that it is the 
sense of this body that decisions regarding medical care and treatment 
should be made primarily by the physician or health care professional 
in consultation with the patient.
  In my congressional district I have 22 hospitals and a vast a array 
of other health and medical research institutions and many residents 
with serious health and medical needs. Oftentimes health providers and 
patients will agree on a course of action, a course of treatment, that 
they consider best.
  However, the HMO or insurer will have, in some cases, drafted 
guidelines and rules that will not allow payment for the suggested 
treatment prescribed by the doctor.
  That leads to a situation where the doctor may have to forego his or 
her prescribed recommendation in order to get the patient's bill paid. 
In some instances, this has led to tragic consequences for patients. 
Quality health care is not only found in providing access. It is also 
found in the ability of doctors and other health providers to find 
remedies that may be outside the box. In other words, clinicians 
working for HMOs who draw guidelines to suggest that one size fits all, 
limit medical potential and the use of modern medical technology and 
does not allow for unique individual differences that patients may 
have.
  The power of insurers to determine coverage potentially gives them 
the power to dictate professional standards of care for all but the 
wealthiest of patients. That is not appropriate. It is not good care, 
and it is not right.
  Too many patients are suffering because HMOs have put profits ahead 
of patient care. This House cannot stand silently by while insurance 
company decisions are superseding the recommendations of health experts 
and doctors.
  It is time that we strengthen the doctor-patient relationship. 
Therefore, I would urge support for this important amendment and urge 
its passage. I would also suggest that on the eve of July 4, I believe 
that it is time that we pass a declaration of independence for this 
Nation's doctors, nurses and other health care providers who along with 
their patients ought to be able to determine the best and most 
appropriate course of action.
  Mr. Chairman, I reserve the balance of my time.


                         Parliamentary Inquiry

  Mr. OSE. Mr. Chairman, parliamentary inquiry.
  The CHAIRMAN. The gentleman will state his parliamentary inquiry.
  Mr. OSE. Mr. Chairman, wishing to speak in favor of the gentleman's 
amendment, how would I go about requesting time?
  The CHAIRMAN. The gentleman would proceed by asking unanimous consent 
for additional time, which would be granted on both sides.
  Mr. OSE. Mr. Chairman, I ask unanimous consent to address the House 
for 2 minutes in favor of the amendment.
  The CHAIRMAN. Is there objection to the request of the gentleman from 
California? Objection is heard.
  Is any Member in the Chamber seeking to control time in opposition?
  Mr. DAVIS of Illinois. Mr. Chairman, could I inquire of the Chair how 
much time I have left?
  The CHAIRMAN. The gentleman from Illinois (Mr. Davis) has 1 minute 
remaining.
  Mr. DAVIS of Illinois. Mr. Chairman, then I would be pleased to yield 
the 1 minute that I have remaining to the gentleman from California 
(Mr. Ose).
  Mr. OSE. Mr. Chairman, I thank the gentleman from Illinois (Mr. 
Davis) for his very cordial provision of time.
  Mr. Chairman, I rise in support of the gentleman's amendment, and I 
just wish to relate the impact in my district of the lack of available 
physician or health care professional assistance within the Medicare 
HMO sector of the health care market. The consequence that I am 
referring to is HCFA's interpretive nature on reimbursement rates that 
are allowed to Medicare HMOs and the like, and the consequence on 
doctors for providing service.
  I saw a study today that estimates that HCFA has exacted over $50 
billion over congressional intent by virtue of BBA-97. To the extent 
that we can return control of these decisions to a doctor and the 
patient, this is a step in the right direction, and I heartily endorse 
it.
  The CHAIRMAN. Is there any Member seeking time in opposition?

[[Page 13271]]


  Mr. THOMAS. Mr. Chairman, I seek the time in opposition.
  The CHAIRMAN. The gentleman from California (Mr. Thomas) is 
recognized for 5 minutes.
  Mr. THOMAS. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I do so to enter into a colloquy with my colleague, the 
gentleman from Illinois (Mr. Davis), only for clarification purposes.
  I do believe that the sense of this resolution is to make sure that 
medical decisions are made by the medical professionals, but I do have 
some concern about the wording because it says that it is the sense of 
Congress that decisions regarding medical care and treatment should be 
made by the physician or, and here is my concern, health care 
professional. We had heard some discussion earlier on another amendment 
that this legislation was not just about physicians; that it was about 
other health care professionals as well.

                              {time}  0050

  I am concerned about the class that would be covered by the term 
health care professional, because it is possible that some of those 
categories may, in fact, be jobs that we would not want to have the 
decision making and treatment recommendation in their hands. So was the 
intent of the gentleman from Illinois (Mr. Davis) in terms of expanding 
beyond physicians the decision-making capability regarding medical care 
and treatment?
  Mr. DAVIS of Illinois. Mr. Chairman, will the gentleman yield?
  Mr. THOMAS. I yield to the gentleman from Illinois.
  Mr. DAVIS of Illinois. Mr. Chairman, the intent is oftentimes medical 
providers work as a team. The physician is generally the lead person on 
the team, and so the language is not restricted to a physician in a 
situation where only he or she is working alone, but also as they work 
as members of a team who might be working on a particular problem.
  Mr. THOMAS. Reclaiming my time, I thank the gentleman for the 
clarification. I still have difficulty with the language, because the 
word between physician and health care professional is not ``and,'' it 
is ``or.'' So that it could be the physician or the health care 
professional, and the health care professional, depending on the way we 
define it, could be the candy striper in the hospital, and the candy 
striper in the hospital is the health care professional, and they make 
decisions regarding medical care and treatment.
  Does Congress want to go on record that it is the sense of Congress 
that the orderly, that the cook, that the person who is doing menial 
tasks but is classified as the health care professional is going to 
make decisions regarding medical care and treatment. Is that what we 
are doing it?
  Mr. DAVIS of Illinois. If the gentleman would continue to yield, the 
definition of health care professional reads in the bill: The term 
health care professional means an individual who provides health care 
items or services, treatment, assistance with activities of daily 
living or medications to patients and who to the extent required by 
State or Federal law possesses specialized training that confers 
expertise in the provision of such items or services, treatment, 
assistance, or medications.
  Mr. THOMAS. Reclaiming my time, Mr. Chairman, that means that 
somebody who is trained in giving someone a bath, because they are 
incapable of doing that is one of the activities of daily living that 
would be classified as the health care professional and, therefore, 
Congress believes that they should make medical care and treatment 
decisions; that is what the sense of Congress says.
  I think it is fairly early in the morning, and we are getting a 
little carried away in terms of what we want to do. If we want to say 
as a Congress, people who give people baths ought to be able to make 
medical decisions about their care and treatment, vote yes on this 
sense of Congress.
  Mr. GANSKE. Mr. Chairman, will the gentleman yield?
  Mr. THOMAS. I yield to the gentleman from Iowa.
  Mr. GANSKE. I say to the gentleman from California (Mr. Thomas) maybe 
one way to resolve this at this late hour is simply that it sounds as 
if basically these people, health professionals, this is covered within 
the extent of the duties that are described generally within their job.
  Mr. THOMAS. Reclaiming my time, Mr. Chairman, I think the gentleman 
from Iowa (Mr. Ganske) will find that is about the all-inclusive 
description of health care professionals I have heard, including people 
who give people baths.
  Mr. GANSKE. If the gentleman will continue to yield. Again, I would 
not have a problem with a person whose job it is to give a patient a 
bath, if that is the only thing we are talking about.
  Mr. THOMAS. I understand that, but this says the sense of Congress is 
that decisions regarding medical care and treatment, it does not say 
how we take a bath.
  The CHAIRMAN. All time has expired.
  The question is on the amendment offered by the gentleman from 
Illinois (Mr. Davis).
  The amendment was agreed to.
  Mr. THOMAS. No, no, I was on my feet.
  The CHAIRMAN. The gentleman will suspend.
  Mr. THOMAS. I was on my feet.
  The CHAIRMAN. The gentleman from California (Mr. Thomas) did not call 
for a recorded vote. The Chair moved the further proceedings.


          Sequential Votes Postponed in Committee Of the Whole

  The CHAIRMAN. Pursuant to House Resolution 542, proceedings will now 
resume on those amendments on which further proceedings were postponed 
in the following order:
  Amendment No. 1 by Mr. Ballenger of North Carolina;
  Amendment No. 2 by Mr. Stearns of Florida;
  Amendment No. 3 by Mr. Cox of California;
  Amendment No. 4 by Mr. Terry of Nebraska; and,
  Amendment No. 5 by Mr. Coburn of Oklahoma.
  The Chair will reduce to 5 minutes the time for any electronic vote 
after the first vote in this series.


                Amendment No. 1 Offered by Mr. Ballenger

  The CHAIRMAN. The pending business is the demand for a recorded vote 
on Amendment No. 1 offered by the gentleman from North Carolina (Mr. 
Ballenger) on which further proceedings were postponed and on which the 
noes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The CHAIRMAN. A recorded vote has been demanded.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 71, 
noes 345, not voting 19, as follows:

                             [Roll No. 367]

                                AYES--71

     Armey
     Ballenger
     Bartlett
     Barton
     Bass
     Bateman
     Bereuter
     Biggert
     Bliley
     Blunt
     Boehner
     Bonilla
     Bono
     Burton
     Buyer
     Cannon
     Castle
     Chabot
     Coble
     Coburn
     Combest
     Cunningham
     DeLay
     DeMint
     Dreier
     Dunn
     Ewing
     Gekas
     Goodling
     Goss
     Gutknecht
     Hastert
     Hayworth
     Hoekstra
     Hostettler
     Houghton
     Hulshof
     Johnson (CT)
     Kingston
     Knollenberg
     Kolbe
     LaHood
     Largent
     Lewis (KY)
     Linder
     McCrery
     McKeon
     Miller, Gary
     Myrick
     Nussle
     Packard
     Pease
     Pitts
     Pomeroy
     Pryce (OH)
     Radanovich
     Ramstad
     Rogers
     Ryan (WI)
     Ryun (KS)
     Sanford
     Schaffer
     Sensenbrenner
     Shadegg
     Stump
     Sununu
     Terry
     Thomas
     Tiahrt
     Watkins
     Watt (NC)

                               NOES--345

     Abercrombie
     Ackerman
     Aderholt
     Allen
     Andrews
     Baca
     Bachus
     Baird
     Baker
     Baldacci
     Baldwin
     Barcia
     Barr
     Barrett (NE)
     Barrett (WI)
     Becerra
     Bentsen
     Berkley
     Berman
     Berry
     Bilbray
     Bilirakis
     Bishop
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brady (TX)
     Brown (FL)
     Brown (OH)
     Bryant
     Burr
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Capps
     Capuano
     Cardin
     Carson
     Chambliss
     Chenoweth-Hage

[[Page 13272]]


     Clayton
     Clement
     Clyburn
     Collins
     Condit
     Conyers
     Cooksey
     Costello
     Cox
     Coyne
     Cramer
     Crane
     Crowley
     Cubin
     Cummings
     Danner
     Davis (FL)
     Davis (IL)
     Davis (VA)
     Deal
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Diaz-Balart
     Dickey
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doolittle
     Doyle
     Duncan
     Edwards
     Ehlers
     Ehrlich
     Emerson
     Engel
     English
     Eshoo
     Etheridge
     Evans
     Everett
     Farr
     Fattah
     Fletcher
     Foley
     Forbes
     Ford
     Fossella
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Frost
     Gallegly
     Ganske
     Gejdenson
     Gephardt
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gonzalez
     Goode
     Goodlatte
     Gordon
     Graham
     Granger
     Green (TX)
     Green (WI)
     Greenwood
     Gutierrez
     Hall (OH)
     Hall (TX)
     Hansen
     Hastings (FL)
     Hayes
     Hefley
     Herger
     Hill (IN)
     Hill (MT)
     Hilleary
     Hilliard
     Hinchey
     Hinojosa
     Hobson
     Hoeffel
     Holden
     Holt
     Hooley
     Horn
     Hoyer
     Hunter
     Hutchinson
     Hyde
     Inslee
     Isakson
     Istook
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Jenkins
     John
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kasich
     Kelly
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     King (NY)
     Kleczka
     Kucinich
     Kuykendall
     LaFalce
     Lampson
     Lantos
     Larson
     Latham
     LaTourette
     Lazio
     Leach
     Lee
     Levin
     Lewis (CA)
     Lewis (GA)
     Lipinski
     LoBiondo
     Lofgren
     Lowey
     Lucas (KY)
     Lucas (OK)
     Luther
     Maloney (CT)
     Maloney (NY)
     Manzullo
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McHugh
     McInnis
     McIntyre
     McKinney
     Meehan
     Menendez
     Metcalf
     Mica
     Millender-McDonald
     Miller (FL)
     Miller, George
     Minge
     Mink
     Moakley
     Mollohan
     Moore
     Moran (KS)
     Moran (VA)
     Morella
     Murtha
     Nadler
     Napolitano
     Neal
     Nethercutt
     Ney
     Northup
     Norwood
     Oberstar
     Obey
     Olver
     Ortiz
     Ose
     Owens
     Oxley
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pickett
     Pombo
     Porter
     Portman
     Price (NC)
     Quinn
     Rahall
     Rangel
     Regula
     Reyes
     Reynolds
     Riley
     Rivers
     Rodriguez
     Roemer
     Rogan
     Rohrabacher
     Ros-Lehtinen
     Rothman
     Roukema
     Roybal-Allard
     Royce
     Rush
     Sabo
     Salmon
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Saxton
     Scarborough
     Schakowsky
     Scott
     Serrano
     Sessions
     Shaw
     Shays
     Sherman
     Sherwood
     Shimkus
     Shows
     Simpson
     Sisisky
     Skeen
     Skelton
     Slaughter
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Snyder
     Souder
     Spence
     Spratt
     Stabenow
     Stearns
     Stenholm
     Strickland
     Stupak
     Sweeney
     Talent
     Tancredo
     Tanner
     Tauscher
     Tauzin
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Thune
     Thurman
     Tierney
     Toomey
     Towns
     Traficant
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Velazquez
     Visclosky
     Vitter
     Walden
     Walsh
     Wamp
     Waters
     Watts (OK)
     Waxman
     Weiner
     Weldon (FL)
     Weldon (PA)
     Weller
     Wexler
     Weygand
     Whitfield
     Wicker
     Wilson
     Wise
     Wolf
     Woolsey
     Wu
     Wynn
     Young (AK)

                             NOT VOTING--19

     Archer
     Clay
     Cook
     Filner
     Fowler
     Hastings (WA)
     Johnson, Sam
     Klink
     Markey
     Martinez
     McIntosh
     McNulty
     Meek (FL)
     Meeks (NY)
     Shuster
     Stark
     Taylor (NC)
     Vento
     Young (FL)

                              {time}  0113

  Messrs. LARSEN, BARCIA, GOODLATTE, GREEN of Wisconsin, LATHAM, and 
SHAYS changed their vote from ``aye'' to ``no.''
  Mr. HOEKSTRA and Mr. LINDER changed their vote from ``no'' to 
``aye.''
  So the amendment was rejected.
  The result of the vote was announced as above recorded.


                      Announcement by the Chairman

  The CHAIRMAN. Pursuant to House Resolution 542, the Chair announces 
that he will reduce to a minimum of 5 minutes the period of time within 
which a vote by electronic device will be taken on each amendment on 
which the Chair has postponed further proceedings.


                 Amendment No. 2 Offered by Mr. Stearns

  The CHAIRMAN. The pending business is the demand for a recorded vote 
on amendment No. 2 offered by the gentleman from Florida (Mr. Stearns) 
on which further proceedings were postponed and on which the noes 
prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The CHAIRMAN. A recorded vote has been demanded.
  A recorded vote was ordered.
  The CHAIRMAN. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 94, 
noes 320, not voting 21, as follows:

                             [Roll No. 368]

                                AYES--94

     Armey
     Ballenger
     Barton
     Bass
     Bereuter
     Biggert
     Bilirakis
     Bliley
     Blunt
     Boehner
     Bonilla
     Bono
     Brady (TX)
     Burton
     Buyer
     Cannon
     Castle
     Chabot
     Coble
     Coburn
     Combest
     Crane
     Cunningham
     Davis (FL)
     DeLay
     DeMint
     Dooley
     Dreier
     Ehlers
     Ehrlich
     Gekas
     Goodlatte
     Goodling
     Goss
     Green (WI)
     Hansen
     Hastert
     Hayworth
     Hefley
     Herger
     Hill (IN)
     Hoekstra
     Hostettler
     Hulshof
     Hutchinson
     Johnson (CT)
     Kingston
     Knollenberg
     Kolbe
     Largent
     Larson
     Latham
     Lewis (KY)
     Lucas (OK)
     Luther
     McCrery
     McInnis
     McKeon
     Mica
     Miller, Gary
     Mink
     Moran (KS)
     Myrick
     Northup
     Nussle
     Oxley
     Packard
     Pease
     Pitts
     Pombo
     Pomeroy
     Portman
     Pryce (OH)
     Radanovich
     Ramstad
     Ryan (WI)
     Ryun (KS)
     Salmon
     Sanford
     Sensenbrenner
     Shadegg
     Shays
     Souder
     Spence
     Stearns
     Stump
     Sununu
     Terry
     Thomas
     Tiahrt
     Toomey
     Watkins
     Wicker
     Young (AK)

                               NOES--320

     Abercrombie
     Ackerman
     Aderholt
     Allen
     Andrews
     Baca
     Bachus
     Baird
     Baker
     Baldacci
     Baldwin
     Barcia
     Barr
     Barrett (NE)
     Barrett (WI)
     Bartlett
     Bateman
     Becerra
     Bentsen
     Berkley
     Berman
     Berry
     Bilbray
     Bishop
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brown (FL)
     Brown (OH)
     Bryant
     Burr
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Capps
     Capuano
     Cardin
     Carson
     Chambliss
     Chenoweth-Hage
     Clayton
     Clement
     Clyburn
     Collins
     Condit
     Conyers
     Cooksey
     Costello
     Cox
     Coyne
     Cramer
     Crowley
     Cubin
     Cummings
     Danner
     Davis (IL)
     Davis (VA)
     Deal
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Diaz-Balart
     Dickey
     Dicks
     Dingell
     Dixon
     Doggett
     Doolittle
     Doyle
     Duncan
     Dunn
     Edwards
     Emerson
     Engel
     English
     Eshoo
     Etheridge
     Evans
     Everett
     Ewing
     Farr
     Fattah
     Fletcher
     Foley
     Forbes
     Ford
     Fossella
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Frost
     Gallegly
     Ganske
     Gejdenson
     Gephardt
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gonzalez
     Goode
     Gordon
     Graham
     Granger
     Green (TX)
     Greenwood
     Gutierrez
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hastings (FL)
     Hayes
     Hill (MT)
     Hilleary
     Hilliard
     Hinchey
     Hinojosa
     Hobson
     Hoeffel
     Holden
     Holt
     Hooley
     Horn
     Hoyer
     Hunter
     Hyde
     Inslee
     Isakson
     Istook
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Jenkins
     John
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kasich
     Kelly
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     King (NY)
     Kleczka
     Kucinich
     Kuykendall
     LaFalce
     LaHood
     Lampson
     Lantos
     LaTourette
     Lazio
     Leach
     Levin
     Lewis (CA)
     Lewis (GA)
     Linder
     Lipinski
     LoBiondo
     Lofgren
     Lowey
     Lucas (KY)
     Maloney (CT)
     Maloney (NY)
     Manzullo
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McHugh
     McIntyre
     McKinney
     Meehan
     Meeks (NY)
     Menendez
     Metcalf
     Millender-McDonald
     Miller (FL)
     Miller, George
     Minge
     Moakley
     Mollohan
     Moore
     Moran (VA)
     Morella
     Murtha
     Nadler
     Napolitano
     Neal
     Nethercutt
     Ney
     Norwood
     Oberstar
     Obey
     Olver
     Ortiz
     Ose
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pickett
     Porter
     Price (NC)
     Quinn
     Rahall
     Rangel
     Regula
     Reyes
     Reynolds
     Riley
     Rivers
     Rodriguez
     Roemer
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Rothman
     Roukema
     Roybal-Allard
     Royce
     Rush
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Saxton
     Schaffer
     Schakowsky
     Scott
     Serrano
     Sessions
     Shaw

[[Page 13273]]


     Sherman
     Sherwood
     Shimkus
     Shows
     Simpson
     Sisisky
     Skeen
     Skelton
     Slaughter
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Snyder
     Spratt
     Stabenow
     Stenholm
     Strickland
     Stupak
     Sweeney
     Talent
     Tancredo
     Tanner
     Tauscher
     Tauzin
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Thune
     Thurman
     Tierney
     Towns
     Traficant
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Velazquez
     Visclosky
     Vitter
     Walden
     Walsh
     Wamp
     Waters
     Watt (NC)
     Watts (OK)
     Waxman
     Weiner
     Weldon (FL)
     Weldon (PA)
     Weller
     Wexler
     Weygand
     Whitfield
     Wilson
     Wise
     Wolf
     Woolsey
     Wu
     Wynn

                             NOT VOTING--21

     Archer
     Clay
     Cook
     Filner
     Fowler
     Hastings (WA)
     Houghton
     Johnson, Sam
     Klink
     Lee
     Markey
     Martinez
     McIntosh
     McNulty
     Meek (FL)
     Scarborough
     Shuster
     Stark
     Taylor (NC)
     Vento
     Young (FL)

                              {time}  0120

  Mr. ROGAN changed his vote from ``aye'' to ``no.''
  So the amendment was rejected.
  The result of the vote was announced as above recorded.


                   Amendment No. 3 Offered by Mr. Cox

  The CHAIRMAN. The pending business is the demand for a recorded vote 
on the amendment offered by the gentleman from California (Mr. Cox) on 
which further proceedings were postponed and on which the ayes 
prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The CHAIRMAN. A recorded vote has been demanded.
  A recorded vote was ordered.
  The CHAIRMAN. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 201, 
noes 214, not voting 20, as follows:

                             [Roll No. 369]

                               AYES--201

     Aderholt
     Armey
     Bachus
     Baker
     Ballenger
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bass
     Bateman
     Bereuter
     Biggert
     Bilbray
     Bilirakis
     Bliley
     Blunt
     Boehner
     Bonilla
     Bono
     Boyd
     Brady (TX)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Cannon
     Castle
     Chabot
     Chambliss
     Chenoweth-Hage
     Clement
     Coble
     Coburn
     Collins
     Combest
     Cooksey
     Cox
     Crane
     Cubin
     Cunningham
     Davis (VA)
     Deal
     DeLay
     DeMint
     Dickey
     Doolittle
     Dreier
     Duncan
     Dunn
     Edwards
     Ehlers
     Ehrlich
     Etheridge
     Everett
     Ewing
     Fletcher
     Foley
     Fossella
     Frelinghuysen
     Gallegly
     Ganske
     Gekas
     Gibbons
     Gilchrest
     Gillmor
     Goode
     Goodlatte
     Goodling
     Goss
     Graham
     Granger
     Greenwood
     Gutknecht
     Hall (TX)
     Hansen
     Hastert
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (MT)
     Hilleary
     Hobson
     Hoekstra
     Hostettler
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Isakson
     Istook
     Jenkins
     John
     Johnson (CT)
     Jones (NC)
     Kasich
     Kingston
     Knollenberg
     Kolbe
     Kuykendall
     LaHood
     Largent
     Latham
     Lazio
     Leach
     Lewis (CA)
     Lewis (KY)
     Lucas (OK)
     Manzullo
     McCollum
     McCrery
     McInnis
     McKeon
     Metcalf
     Mica
     Miller (FL)
     Miller, Gary
     Moore
     Moran (KS)
     Moran (VA)
     Myrick
     Nethercutt
     Northup
     Norwood
     Nussle
     Ose
     Oxley
     Packard
     Pease
     Peterson (PA)
     Petri
     Pickering
     Pickett
     Pitts
     Pombo
     Porter
     Portman
     Price (NC)
     Pryce (OH)
     Radanovich
     Ramstad
     Reynolds
     Riley
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Roukema
     Royce
     Ryan (WI)
     Ryun (KS)
     Salmon
     Sanford
     Scarborough
     Schaffer
     Sensenbrenner
     Sessions
     Shadegg
     Shaw
     Shimkus
     Simpson
     Sisisky
     Skeen
     Smith (MI)
     Smith (TX)
     Souder
     Spence
     Spratt
     Stearns
     Stenholm
     Stump
     Sununu
     Talent
     Tancredo
     Tanner
     Tauzin
     Taylor (MS)
     Terry
     Thomas
     Thornberry
     Thune
     Tiahrt
     Toomey
     Upton
     Vitter
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)

                               NOES--214

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baca
     Baird
     Baldacci
     Baldwin
     Barcia
     Barrett (WI)
     Becerra
     Bentsen
     Berkley
     Berman
     Berry
     Bishop
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Borski
     Boswell
     Boucher
     Brady (PA)
     Brown (FL)
     Brown (OH)
     Capps
     Capuano
     Cardin
     Carson
     Clayton
     Clyburn
     Condit
     Conyers
     Costello
     Coyne
     Cramer
     Crowley
     Cummings
     Danner
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Diaz-Balart
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doyle
     Emerson
     Engel
     English
     Eshoo
     Evans
     Farr
     Fattah
     Forbes
     Ford
     Frank (MA)
     Franks (NJ)
     Frost
     Gejdenson
     Gephardt
     Gilman
     Gonzalez
     Gordon
     Green (TX)
     Green (WI)
     Gutierrez
     Hall (OH)
     Hastings (FL)
     Hill (IN)
     Hilliard
     Hinchey
     Hinojosa
     Hoeffel
     Holden
     Holt
     Hooley
     Horn
     Houghton
     Hoyer
     Inslee
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson, E. B.
     Jones (OH)
     Kanjorski
     Kaptur
     Kelly
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     King (NY)
     Kleczka
     Kucinich
     LaFalce
     Lampson
     Lantos
     Larson
     LaTourette
     Lee
     Levin
     Lewis (GA)
     Lipinski
     LoBiondo
     Lofgren
     Lowey
     Lucas (KY)
     Luther
     Maloney (CT)
     Maloney (NY)
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McHugh
     McIntyre
     McKinney
     Meehan
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller, George
     Minge
     Mink
     Moakley
     Mollohan
     Morella
     Murtha
     Nadler
     Napolitano
     Neal
     Ney
     Oberstar
     Obey
     Olver
     Ortiz
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Peterson (MN)
     Phelps
     Pomeroy
     Quinn
     Rahall
     Rangel
     Regula
     Reyes
     Rivers
     Rodriguez
     Roemer
     Rothman
     Roybal-Allard
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Saxton
     Schakowsky
     Scott
     Serrano
     Shays
     Sherman
     Sherwood
     Shows
     Skelton
     Slaughter
     Smith (NJ)
     Smith (WA)
     Snyder
     Stabenow
     Strickland
     Stupak
     Sweeney
     Tauscher
     Thompson (CA)
     Thompson (MS)
     Thurman
     Tierney
     Towns
     Traficant
     Turner
     Udall (CO)
     Udall (NM)
     Velazquez
     Visclosky
     Walden
     Waters
     Watt (NC)
     Waxman
     Weiner
     Weldon (PA)
     Weller
     Wexler
     Weygand
     Wise
     Woolsey
     Wu
     Wynn

                             NOT VOTING--20

     Archer
     Clay
     Cook
     Filner
     Fowler
     Hastings (WA)
     Johnson, Sam
     Klink
     Linder
     Markey
     Martinez
     McIntosh
     McNulty
     Meek (FL)
     Rush
     Shuster
     Stark
     Taylor (NC)
     Vento
     Young (FL)

                              {time}  0126

  Mr. TANNER and Mr. MORAN of Virginia changed their vote from ``no'' 
to ``aye.''
  So the amendment was rejected.
  The result of the vote was announced as above recorded.


                  Amendment No. 4 Offered by Mr. Terry

  The CHAIRMAN. The pending business is the demand for a recorded vote 
on amendment No. 4 offered by the gentleman from Nebraska (Mr. Terry) 
on which further proceedings were postponed and on which the noes 
prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The CHAIRMAN. A recorded vote has been demanded.
  A recorded vote was ordered.
  The CHAIRMAN. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 78, 
noes 338, not voting 19, as follows:

                             [Roll No. 370]

                                AYES--78

     Armey
     Ballenger
     Barrett (NE)
     Barrett (WI)
     Bartlett
     Barton
     Bass
     Bereuter
     Biggert
     Bilirakis
     Bliley
     Blunt
     Boehner
     Bonilla
     Bono
     Burton
     Buyer
     Cannon
     Castle
     Chabot
     Coble
     Coburn
     Combest
     Cox
     Crane
     DeLay
     DeMint
     Dreier
     Dunn
     Ewing
     Gekas
     Goodlatte
     Goodling
     Goss
     Green (WI)
     Hastert
     Hayworth
     Hoekstra
     Hostettler
     Hulshof
     Johnson (CT)
     Kingston
     Knollenberg
     Kolbe
     Largent
     Latham
     Lewis (KY)
     McCrery
     McKeon
     Miller, Gary
     Myrick
     Nussle
     Oxley
     Packard
     Pease
     Pitts
     Pomeroy
     Pryce (OH)
     Radanovich
     Ramstad
     Rogers
     Ryan (WI)
     Ryun (KS)
     Sanford
     Schaffer
     Sensenbrenner
     Shadegg
     Skeen
     Souder
     Stump
     Sununu
     Tancredo

[[Page 13274]]


     Terry
     Thomas
     Tiahrt
     Toomey
     Walden
     Watkins

                               NOES--338

     Abercrombie
     Ackerman
     Aderholt
     Allen
     Andrews
     Baca
     Bachus
     Baird
     Baker
     Baldacci
     Baldwin
     Barcia
     Barr
     Bateman
     Becerra
     Bentsen
     Berkley
     Berman
     Berry
     Bilbray
     Bishop
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brady (TX)
     Brown (FL)
     Brown (OH)
     Bryant
     Burr
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Capps
     Capuano
     Cardin
     Carson
     Chambliss
     Chenoweth-Hage
     Clayton
     Clement
     Clyburn
     Collins
     Condit
     Conyers
     Cooksey
     Costello
     Coyne
     Cramer
     Crowley
     Cubin
     Cummings
     Cunningham
     Danner
     Davis (FL)
     Davis (IL)
     Davis (VA)
     Deal
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Diaz-Balart
     Dickey
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Doolittle
     Doyle
     Duncan
     Edwards
     Ehlers
     Ehrlich
     Emerson
     Engel
     English
     Eshoo
     Etheridge
     Evans
     Everett
     Farr
     Fattah
     Fletcher
     Foley
     Forbes
     Ford
     Fossella
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Frost
     Gallegly
     Ganske
     Gejdenson
     Gephardt
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gonzalez
     Goode
     Gordon
     Graham
     Granger
     Green (TX)
     Greenwood
     Gutierrez
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hansen
     Hastings (FL)
     Hayes
     Hefley
     Herger
     Hill (IN)
     Hill (MT)
     Hilleary
     Hilliard
     Hinchey
     Hinojosa
     Hobson
     Hoeffel
     Holden
     Holt
     Hooley
     Horn
     Houghton
     Hoyer
     Hunter
     Hutchinson
     Hyde
     Inslee
     Isakson
     Istook
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Jenkins
     John
     Johnson, E. B.
     Jones (NC)
     Jones (OH)
     Kanjorski
     Kaptur
     Kasich
     Kelly
     Kennedy
     Kildee
     Kilpatrick
     Kind (WI)
     King (NY)
     Kleczka
     Kucinich
     Kuykendall
     LaFalce
     LaHood
     Lampson
     Lantos
     Larson
     LaTourette
     Lazio
     Leach
     Lee
     Levin
     Lewis (CA)
     Lewis (GA)
     Lipinski
     LoBiondo
     Lofgren
     Lowey
     Lucas (KY)
     Lucas (OK)
     Luther
     Maloney (CT)
     Maloney (NY)
     Manzullo
     Mascara
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McHugh
     McInnis
     McIntyre
     McKinney
     Meehan
     Meeks (NY)
     Menendez
     Metcalf
     Mica
     Millender-McDonald
     Miller (FL)
     Miller, George
     Minge
     Mink
     Moakley
     Mollohan
     Moore
     Moran (KS)
     Moran (VA)
     Morella
     Murtha
     Nadler
     Napolitano
     Neal
     Nethercutt
     Ney
     Northup
     Norwood
     Oberstar
     Obey
     Olver
     Ortiz
     Ose
     Owens
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Pelosi
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pickett
     Pombo
     Porter
     Portman
     Price (NC)
     Quinn
     Rahall
     Rangel
     Regula
     Reyes
     Reynolds
     Riley
     Rivers
     Rodriguez
     Roemer
     Rogan
     Rohrabacher
     Ros-Lehtinen
     Rothman
     Roukema
     Roybal-Allard
     Royce
     Rush
     Sabo
     Salmon
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Saxton
     Scarborough
     Schakowsky
     Scott
     Serrano
     Sessions
     Shaw
     Shays
     Sherman
     Sherwood
     Shimkus
     Shows
     Simpson
     Sisisky
     Skelton
     Slaughter
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Snyder
     Spence
     Spratt
     Stabenow
     Stearns
     Stenholm
     Strickland
     Stupak
     Sweeney
     Talent
     Tanner
     Tauscher
     Tauzin
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Thune
     Thurman
     Tierney
     Towns
     Traficant
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Velazquez
     Visclosky
     Vitter
     Walsh
     Wamp
     Waters
     Watt (NC)
     Watts (OK)
     Waxman
     Weiner
     Weldon (FL)
     Weldon (PA)
     Weller
     Wexler
     Weygand
     Whitfield
     Wicker
     Wilson
     Wise
     Wolf
     Woolsey
     Wu
     Wynn
     Young (AK)

                             NOT VOTING--19

     Archer
     Clay
     Cook
     Filner
     Fowler
     Hastings (WA)
     Johnson, Sam
     Klink
     Linder
     Markey
     Martinez
     McIntosh
     McNulty
     Meek (FL)
     Shuster
     Stark
     Taylor (NC)
     Vento
     Young (FL)

                              {time}  0133

  So the amendment was rejected.
  The result of the vote was announced as above recorded.


                 Amendment No. 5 Offered by Mr. Coburn

  The CHAIRMAN. The pending business is the demand for a recorded vote 
on amendment No. 5 offered by the gentleman from Oklahoma (Mr. Coburn) 
on which further proceedings were postponed and on which the noes 
prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The CHAIRMAN. A recorded vote has been demanded.
  A recorded vote was ordered.
  The CHAIRMAN. This will be a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 213, 
noes 202, answered ``present'' 1, not voting 19, as follows:

                             [Roll No. 371]

                               AYES--213

     Aderholt
     Armey
     Bachus
     Baker
     Ballenger
     Barcia
     Barr
     Barrett (NE)
     Bartlett
     Barton
     Bateman
     Bereuter
     Berry
     Bilirakis
     Bliley
     Blunt
     Boehner
     Bonilla
     Borski
     Brady (TX)
     Bryant
     Burr
     Burton
     Buyer
     Callahan
     Calvert
     Camp
     Canady
     Cannon
     Chabot
     Chambliss
     Chenoweth-Hage
     Coble
     Coburn
     Collins
     Combest
     Costello
     Cox
     Crane
     Cubin
     Cunningham
     Danner
     Davis (VA)
     Deal
     DeLay
     DeMint
     Diaz-Balart
     Dickey
     Doolittle
     Doyle
     Dreier
     Duncan
     Dunn
     Ehlers
     Ehrlich
     Emerson
     English
     Everett
     Ewing
     Fletcher
     Forbes
     Fossella
     Gallegly
     Gekas
     Gillmor
     Goode
     Goodlatte
     Goodling
     Goss
     Graham
     Green (WI)
     Gutknecht
     Hall (OH)
     Hall (TX)
     Hansen
     Hastert
     Hayes
     Hayworth
     Hefley
     Herger
     Hill (MT)
     Hilleary
     Hobson
     Hoekstra
     Holden
     Hostettler
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Isakson
     Istook
     Jenkins
     John
     Jones (NC)
     Kanjorski
     Kasich
     Kildee
     King (NY)
     Kingston
     Knollenberg
     Kucinich
     LaFalce
     LaHood
     Largent
     Latham
     LaTourette
     Leach
     Lewis (CA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lucas (KY)
     Lucas (OK)
     Manzullo
     Mascara
     McCollum
     McCrery
     McHugh
     McInnis
     McIntyre
     McKeon
     Metcalf
     Mica
     Miller, Gary
     Moakley
     Mollohan
     Moran (KS)
     Murtha
     Myrick
     Nethercutt
     Ney
     Northup
     Norwood
     Nussle
     Oberstar
     Ortiz
     Oxley
     Packard
     Pease
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pitts
     Pombo
     Portman
     Quinn
     Radanovich
     Rahall
     Regula
     Reynolds
     Riley
     Roemer
     Rogan
     Rogers
     Rohrabacher
     Ros-Lehtinen
     Royce
     Ryan (WI)
     Ryun (KS)
     Salmon
     Sanford
     Saxton
     Scarborough
     Schaffer
     Sensenbrenner
     Sessions
     Shadegg
     Sherwood
     Shimkus
     Shows
     Simpson
     Skeen
     Skelton
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Souder
     Spence
     Stearns
     Stenholm
     Stump
     Stupak
     Sununu
     Talent
     Tancredo
     Tauzin
     Taylor (MS)
     Terry
     Thomas
     Thornberry
     Thune
     Tiahrt
     Toomey
     Traficant
     Upton
     Vitter
     Walsh
     Wamp
     Watkins
     Watts (OK)
     Weldon (FL)
     Weldon (PA)
     Weller
     Weygand
     Whitfield
     Wicker
     Wilson
     Wolf
     Young (AK)

                               NOES--202

     Abercrombie
     Ackerman
     Allen
     Andrews
     Baca
     Baird
     Baldacci
     Baldwin
     Barrett (WI)
     Bass
     Becerra
     Bentsen
     Berkley
     Berman
     Biggert
     Bilbray
     Bishop
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Bono
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brown (FL)
     Brown (OH)
     Campbell
     Capps
     Capuano
     Cardin
     Carson
     Castle
     Clayton
     Clement
     Clyburn
     Condit
     Conyers
     Cooksey
     Coyne
     Cramer
     Crowley
     Cummings
     Davis (FL)
     Davis (IL)
     DeFazio
     DeGette
     Delahunt
     DeLauro
     Deutsch
     Dicks
     Dingell
     Dixon
     Doggett
     Dooley
     Edwards
     Engel
     Eshoo
     Etheridge
     Evans
     Farr
     Fattah
     Foley
     Ford
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Frost
     Gejdenson
     Gephardt
     Gibbons
     Gilchrest
     Gilman
     Gonzalez
     Gordon
     Granger
     Green (TX)
     Greenwood
     Gutierrez
     Hastings (FL)
     Hill (IN)
     Hilliard
     Hinchey
     Hinojosa
     Hoeffel
     Holt
     Hooley
     Horn
     Houghton
     Hoyer
     Inslee
     Jackson (IL)
     Jackson-Lee (TX)
     Jefferson
     Johnson (CT)
     Johnson, E.B.
     Jones (OH)
     Kaptur
     Kelly
     Kennedy
     Kilpatrick
     Kind (WI)
     Kleczka
     Kolbe
     Kuykendall
     Lampson
     Lantos
     Larson
     Lazio
     Lee
     Levin
     Lewis (GA)
     Lofgren
     Lowey
     Luther
     Maloney (CT)
     Maloney (NY)
     Matsui
     McCarthy (MO)
     McCarthy (NY)
     McDermott
     McGovern
     McKinney
     Meehan
     Meeks (NY)
     Menendez
     Millender-McDonald
     Miller (FL)
     Miller, George
     Minge
     Mink
     Moore
     Moran (VA)
     Morella
     Nadler
     Napolitano
     Neal

[[Page 13275]]


     Obey
     Olver
     Ose
     Owens
     Pallone
     Pascrell
     Pastor
     Payne
     Pelosi
     Pickett
     Pomeroy
     Porter
     Price (NC)
     Pryce (OH)
     Ramstad
     Rangel
     Reyes
     Rivers
     Rodriguez
     Rothman
     Roukema
     Roybal-Allard
     Rush
     Sabo
     Sanchez
     Sanders
     Sandlin
     Sawyer
     Schakowsky
     Scott
     Serrano
     Shaw
     Shays
     Sherman
     Sisisky
     Slaughter
     Smith (WA)
     Snyder
     Spratt
     Stabenow
     Strickland
     Sweeney
     Tanner
     Tauscher
     Thompson (CA)
     Thompson (MS)
     Thurman
     Tierney
     Towns
     Turner
     Udall (CO)
     Udall (NM)
     Velazquez
     Visclosky
     Walden
     Waters
     Watt (NC)
     Waxman
     Weiner
     Wexler
     Wise
     Woolsey
     Wu
     Wynn

                        ANSWERED ``PRESENT''--1

       
     Paul
       

                             NOT VOTING--19

     Archer
     Clay
     Cook
     Filner
     Fowler
     Ganske
     Hastings (WA)
     Johnson, Sam
     Klink
     Markey
     Martinez
     McIntosh
     McNulty
     Meek (FL)
     Shuster
     Stark
     Taylor (NC)
     Vento
     Young (FL)

                              {time}  0139

  So the amendment was agreed to.
  The result of the vote was announced as above recorded.
  Mr. CONYERS. Mr. Chairman, I will not offer a motion to recommit. As 
the lead cosponsor of the bill, I wish that the Coburn amendment had 
been defeated but notwithstanding its adoption I am asking everyone to 
vote aye on final passage.
  This vote is not being scored by the pro choice community.
  The CHAIRMAN. The question is on the committee amendment in the 
nature of a substitute, as amended.
  The committee amendment in the nature of a substitute, as amended, 
was agreed to.
  The CHAIRMAN. Under the rule, the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Pease) having assumed the chair, Mr. Shimkus, Chairman of the Committee 
of the Whole House on the State of the Union, reported that that 
Committee, having had under consideration the bill (H.R. 1304) to 
ensure and foster continued patient safety and quality of care by 
making the antitrust laws apply to negotiations between groups of 
health care professionals and health plans and health insurance issuers 
in the same manner as such laws apply to collective bargaining by labor 
organizations under the National Labor Relations Act, pursuant to House 
Resolution 542, he reported the bill back to the House with an 
amendment adopted by the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  Is a separate vote demanded on any amendment to the committee 
amendment in the nature of a substitute adopted by the Committee of the 
Whole? If not, the question is on the amendment.
  The amendment was agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. CONYERS. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 276, 
noes 136, answered ``present'' 2, not voting 20, as follows:

                             [Roll No. 372]

                               AYES--276

     Abercrombie
     Ackerman
     Aderholt
     Allen
     Andrews
     Baca
     Bachus
     Baker
     Baldacci
     Barcia
     Barr
     Bartlett
     Bentsen
     Berry
     Bilbray
     Bishop
     Blagojevich
     Blumenauer
     Boehlert
     Bonior
     Borski
     Boswell
     Boucher
     Boyd
     Brady (PA)
     Brown (FL)
     Brown (OH)
     Bryant
     Burr
     Callahan
     Calvert
     Camp
     Campbell
     Canady
     Capuano
     Cardin
     Carson
     Chambliss
     Chenoweth-Hage
     Clayton
     Clement
     Clyburn
     Collins
     Condit
     Conyers
     Cooksey
     Costello
     Coyne
     Cramer
     Crowley
     Cubin
     Cummings
     Danner
     Davis (FL)
     Davis (IL)
     Davis (VA)
     Deal
     DeFazio
     Delahunt
     DeLauro
     Diaz-Balart
     Dickey
     Dicks
     Dingell
     Doolittle
     Doyle
     Duncan
     Edwards
     Ehrlich
     Emerson
     Engel
     English
     Etheridge
     Evans
     Everett
     Farr
     Fattah
     Fletcher
     Foley
     Forbes
     Ford
     Fossella
     Frank (MA)
     Franks (NJ)
     Frelinghuysen
     Frost
     Gallegly
     Ganske
     Gejdenson
     Gephardt
     Gibbons
     Gilchrest
     Gillmor
     Gilman
     Gonzalez
     Goode
     Goodlatte
     Gordon
     Graham
     Granger
     Green (TX)
     Green (WI)
     Greenwood
     Hall (OH)
     Hall (TX)
     Hansen
     Hayes
     Hefley
     Hill (IN)
     Hill (MT)
     Hilleary
     Hilliard
     Hinchey
     Hinojosa
     Hoeffel
     Holden
     Hooley
     Horn
     Hoyer
     Hulshof
     Hunter
     Hutchinson
     Hyde
     Isakson
     Istook
     Jackson-Lee (TX)
     Jefferson
     Jenkins
     John
     Johnson, E. B.
     Jones (NC)
     Kanjorski
     Kaptur
     Kasich
     Kelly
     Kennedy
     Kildee
     Kind (WI)
     King (NY)
     Kleczka
     Kolbe
     Kucinich
     Kuykendall
     LaFalce
     Lampson
     Lantos
     LaTourette
     Lazio
     Leach
     Levin
     Lewis (CA)
     Lewis (KY)
     Linder
     Lipinski
     LoBiondo
     Lucas (KY)
     Lucas (OK)
     Maloney (CT)
     Maloney (NY)
     Manzullo
     Mascara
     Matsui
     McCarthy (NY)
     McCollum
     McDermott
     McGovern
     McIntyre
     McKinney
     Meehan
     Menendez
     Mica
     Miller (FL)
     Moakley
     Mollohan
     Moore
     Moran (KS)
     Moran (VA)
     Morella
     Murtha
     Nadler
     Napolitano
     Neal
     Nethercutt
     Ney
     Norwood
     Oberstar
     Obey
     Olver
     Ortiz
     Ose
     Pallone
     Pascrell
     Pastor
     Paul
     Payne
     Peterson (MN)
     Peterson (PA)
     Petri
     Phelps
     Pickering
     Pickett
     Pombo
     Porter
     Price (NC)
     Rahall
     Regula
     Reyes
     Reynolds
     Riley
     Rivers
     Rodriguez
     Roemer
     Rogan
     Rohrabacher
     Ros-Lehtinen
     Rothman
     Roukema
     Royce
     Rush
     Ryan (WI)
     Salmon
     Sanders
     Sandlin
     Sawyer
     Saxton
     Scarborough
     Scott
     Serrano
     Sessions
     Shaw
     Shimkus
     Shows
     Simpson
     Sisisky
     Skelton
     Slaughter
     Smith (MI)
     Smith (NJ)
     Smith (TX)
     Snyder
     Souder
     Spratt
     Stabenow
     Stenholm
     Strickland
     Stupak
     Sweeney
     Talent
     Tancredo
     Tanner
     Tauscher
     Tauzin
     Taylor (MS)
     Thompson (CA)
     Thompson (MS)
     Thornberry
     Thune
     Tierney
     Traficant
     Turner
     Udall (CO)
     Udall (NM)
     Upton
     Vitter
     Wamp
     Weiner
     Weldon (FL)
     Weller
     Weygand
     Whitfield
     Wicker
     Wilson
     Wise
     Wolf
     Wu
     Wynn

                               NOES--136

     Armey
     Baird
     Baldwin
     Ballenger
     Barrett (NE)
     Barrett (WI)
     Barton
     Bass
     Bateman
     Bereuter
     Berkley
     Berman
     Biggert
     Bilirakis
     Bliley
     Blunt
     Boehner
     Bonilla
     Bono
     Brady (TX)
     Burton
     Buyer
     Cannon
     Capps
     Castle
     Chabot
     Coble
     Coburn
     Combest
     Cox
     Crane
     Cunningham
     DeGette
     DeLay
     DeMint
     Deutsch
     Dixon
     Doggett
     Dooley
     Dreier
     Dunn
     Ehlers
     Eshoo
     Ewing
     Gekas
     Goodling
     Goss
     Gutierrez
     Gutknecht
     Hastings (FL)
     Hayworth
     Herger
     Hobson
     Hoekstra
     Holt
     Hostettler
     Houghton
     Inslee
     Jackson (IL)
     Johnson (CT)
     Jones (OH)
     Kilpatrick
     Kingston
     Knollenberg
     LaHood
     Largent
     Larson
     Latham
     Lee
     Lewis (GA)
     Lofgren
     Lowey
     Luther
     McCarthy (MO)
     McCrery
     McHugh
     McInnis
     McKeon
     Meeks (NY)
     Millender-McDonald
     Miller, Gary
     Miller, George
     Minge
     Mink
     Myrick
     Northup
     Nussle
     Oxley
     Packard
     Pease
     Pelosi
     Pitts
     Pomeroy
     Portman
     Pryce (OH)
     Quinn
     Radanovich
     Ramstad
     Rangel
     Rogers
     Roybal-Allard
     Ryun (KS)
     Sabo
     Sanchez
     Sanford
     Schaffer
     Schakowsky
     Sensenbrenner
     Shadegg
     Shays
     Sherman
     Sherwood
     Skeen
     Smith (WA)
     Stearns
     Stump
     Sununu
     Terry
     Thomas
     Thurman
     Tiahrt
     Toomey
     Towns
     Velazquez
     Visclosky
     Walden
     Walsh
     Waters
     Watkins
     Watt (NC)
     Watts (OK)
     Waxman
     Weldon (PA)
     Wexler
     Woolsey
     Young (AK)

                        ANSWERED ``PRESENT''--2

     Becerra
      Owens
       

                             NOT VOTING--20

     Archer
     Clay
     Cook
     Filner
     Fowler
     Hastings (WA)
     Johnson, Sam
     Klink
     Markey
     Martinez
     McIntosh
     McNulty
     Meek (FL)
     Metcalf
     Shuster
     Spence
     Stark
     Taylor (NC)
     Vento
     Young (FL)

                              {time}  0157

  Mr. THOMAS changed his vote from ``aye'' to ``no.''



  Mr. ROYCE and Mr. PORTER changed their vote from ``no'' to ``aye.''
  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________