[Congressional Record (Bound Edition), Volume 147 (2001), Part 10]
[House]
[Pages 14266-14267]
[From the U.S. Government Publishing Office, www.gpo.gov]



                   THE REAL PATIENTS' BILL OF RIGHTS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2001, the gentleman from New Jersey (Mr. Pallone) is 
recognized during morning hour debates for 5 minutes.
  Mr. PALLONE. Mr. Speaker, let me say this morning as I did last 
evening that I am very hopeful that the Republican leadership will 
bring up HMO reform this week. We are hearing this perhaps Thursday or 
maybe Friday.
  My greatest fear is that the true HMO reform, the real Patients' Bill 
of Rights, the Dingell-Ganske-Norwood bill, will not have an 
opportunity for a clean vote.
  What we are hearing is that the President is coming back from Europe 
today. He is going to make one final effort to try to convince my 
Republican colleagues who voted for the Dingell-Norwood-Ganske bill in 
the last session to come off that bill and to vote for what I consider 
a very weak alternative sponsored by the gentleman from Kentucky (Mr. 
Fletcher), one of my Republican colleagues.
  Let me stress again that there is a real difference between the 
Patients' Bill of Rights that almost all Democrats and a significant 
number of Republicans support that we voted on 2 years ago and would 
make the real reforms that are necessary to correct the problems and 
the abuses of HMOs, as opposed to this alternative bill that the 
Republican leadership is putting up sponsored by the gentleman from 
Kentucky (Mr. Fletcher), which is a lot weaker and does not really 
achieve HMO reform.
  Let me explain that a little bit. The two main focuses of HMO reform, 
one is to make sure that decisions about what kind of care you get, 
what kind of medical care you get, whether you are able to have a 
particular medical procedure, whether or not you are able to stay in 
the hospital for a certain length of time, these kinds of medical 
decisions should be made by the physician and the patient, not by the 
HMO, not by the insurance company. We need to switch that around.

[[Page 14267]]

  Right now, unfortunately, many Americans are denied the care that 
they really need that is medically necessary because the HMO is not 
willing to pay or denies the care.
  The second point that we are trying to achieve with true HMO reform 
is to make sure that if your care has been denied, if your doctor says 
that you need an operation and the HMO says we are not going to pay for 
it, that you have a way to redress that grievance, which is that you 
can go to an external review board quickly that can overturn that 
decision that can make sure that you get the procedure or operation; 
or, ultimately, if that does not work, that you can go to court.
  The problem is that the Fletcher bill, the bill that the Republican 
leadership wants to bring up and supports, really does not guarantee 
those two points, does not achieve what is necessary for HMO reform in 
those two major areas. Let me explain why.
  The decision about what is medically necessary, about whether or not 
you are going to be able to get a particular type of treatment, well, 
unfortunately, the standard of review for what is medically necessary 
in the Fletcher bill is a lot weaker. It allows for the HMO to use all 
the kinds of bureaucratic tricks to make sure that they still control 
the process or the standard as to what kind of care that you get.
  The Dingell-Ganske-Norwood bill, the real Patients' Bill of Rights, 
guarantees that that standard of review is one that is the normal 
practice by medical practitioners, by doctors in your community, and 
also with regard to specialty care.
  For example, if you need a cardiological procedure, if it is a child 
and a pediatrician has to come into play, that that specialty care, the 
standard of review of what is medically necessary is made by the 
physicians by the standard in the medical community, by the standard in 
that specialty care community. You do not have that guarantee under the 
Fletcher bill.
  On the second point, which is that if you are denied the care that 
you have the ability quickly to overturn that decision. Once again, the 
Fletcher bill falls short. It does not have the guarantee that we have 
in the real Patients' Bill of Rights that says that you have to be able 
to act quickly. That if you need an operation and you are being denied 
or you are in an emergency room and you are being denied something, 
that you can quickly go to an outside review board and have that 
overturned.
  There are so many procedural roadblocks to your ability to overturn 
the decision in the Fletcher bill that you really do not have the 
ability to effectively address your grievances and to overturn that 
denial of care.
  Mr. Speaker, I do not want anybody to be confused about what is going 
on here. What is going on here is that, once again, the Republican 
leadership is trying to deny the majority, most Democrats and enough 
Republicans that make up the majority for the real Patients' Bill of 
Rights, the opportunity to have a vote, a clean vote on that bill. That 
is what we want. That is what we demand. That is what we hope the 
Committee on Rules will achieve when we vote on this bill later this 
week. My greatest fear is we will not have this that clean vote, and I 
would ask that that be accomplished.

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