[Congressional Record (Bound Edition), Volume 147 (2001), Part 9]
[House]
[Pages 12165-12171]
[From the U.S. Government Publishing Office, www.gpo.gov]



                               HMO REFORM

  The SPEAKER pro tempore (Mr. McInnis). Under the Speaker's announced 
policy of January 3, 2001, the gentlewoman from California (Mrs. Capps) 
is recognized for 60 minutes as the designee of the minority leader.
  Mrs. CAPPS. Mr. Speaker, I rise this evening to speak about the need 
for a strong and enforceable patient's bill of rights for the American 
people.
  I am one of three nurses currently serving in the House of 
Representatives, and there are other health professionals of all 
stripes among my colleagues, from doctors to public health specialists 
and microbiologist, from psychologists and social workers to 
psychiatrists. Together, in all of our experience and training, we know 
that we need to pass a real patient's bill of rights, a bill of rights 
that offers the American people real protection from the hard edges of 
managed care organizations or HMOs.
  Tonight we are going to share with our colleagues our firsthand 
experiences and make the case for the Ganske-Dingell bill. We have seen 
firsthand the damage caused by the excesses of the bean counters and 
the men in green eyeshades when they are too aggressive in containing 
costs. These bureaucrats have often done real harm to real people when 
they have taken on the role of medical professionals. Those of us here 
in Congress with medical backgrounds want to give our constituents the 
ability to fight back, and we think that the Ganske-Dingell bill is the 
best way to do this.
  This legislation guarantees access to high quality health care, 
including access to emergency or specialty care, to clinical trials, 
and direct access to pediatricians and OB-GYNs. It also holds health 
plans accountable when they interfere in the medical decisions of a 
trained medical professional. It provides for a strong external review 
process by medical professionals; and then, after that process, and if 
that process is exhausted, patients will have access to State courts.
  The HMOs have bitterly criticized this proposal on the grounds it 
will lead to frivolous lawsuits. The Ganske-Dingell bill is based on 
one now in practice in the State of Texas which has allowed patients to 
sue their HMOs and there have been only a handful of lawsuits of any 
kind. There is no evidence that this bill will lead to frivolous 
lawsuits, but it is an essential protection that our patients need 
because of the deterrent factor that it provides.
  Managed care organizations are operating in an environment designed 
to keep costs low, and we do need to control costs to keep health care 
affordable, but HMO administrators are under an incredible amount of 
pressure to cut corners. Often this pressure is excessive and leads to 
bad decisions and insensitive, inappropriate, and sometimes very 
damaging actions. Abuses of patients' rights to quality health care are 
very common, too common. There needs to be a counter force on the side 
of quality care, on the side of the patients, and that counter force 
has, at the bottom line, the threat of going to the courts.
  Access to the courts will help to restore the balance to the scales 
and will prevent the need for efficiency outweighing the need for 
quality care. It is what gives the patient's bill of rights its teeth. 
Without it, HMOs are free to continue their current practices without 
fear of the consequences. My constituents do not want to go to court to 
get the health care that they need, but HMOs do not always want to 
provide that care. And HMOs do not want to go to court either. The 
threat of appropriate litigation is how average Americans will keep the 
HMOs honest. We need to give patients that tool.
  Mr. Speaker, if the ceiling in this room were to collapse today 
because of a contractor doing shoddy work to save money, those of us 
who were injured would be able to sue that contractor in State court. 
This provides an important incentive for contractors to do their work 
well. The same should apply to managed care.
  And so I support this legislation, as do many of my colleagues with 
medical backgrounds. We know our patients. We know the HMOs. We know 
this issue and its importance. We know the challenges we face and we 
know how to overcome them. We know this bill is the right thing to do. 
So we are here this evening, Mr. Speaker, to help our colleagues see 
this example as well. We have an obligation to our constituents to do 
our duty and to pass this legislation.
  I want to now introduce and invite to the podium a colleague of mine, 
the gentlewoman from New York (Ms. Slaughter). She is going to present 
her viewpoint as a microbiologist with a master's degree in public 
health. She is particularly respected for her efforts on genetic 
nondiscrimination and women's health.
  Ms. SLAUGHTER. Mr. Speaker, I thank the gentlewoman from California 
for taking time this evening and for yielding to me.
  In my judgment, one of the most important aspects of the patient's 
bill of rights gets the least attention, and it is the potential impact 
on public health. Now, although most people think of this initiative as 
one involving individual patients and their access to care, there are 
major public health implications as well.
  In our Nation, public health has become something of a forgotten 
stepchild of the health care system. In

[[Page 12166]]

other industrialized nations, public health goes hand-in-hand with 
individual health care: Communicable diseases are reported in a 
standardized fashion, all children receive vaccinations during their 
regular checkups, and public health professionals can track the 
incidence of disorders like cancer based on geography.
  None of that is true in the United States. In this country, we have 
created an artificial division between individual health care and 
public health. Children are supposed to receive immunizations on a 
certain schedule, but many fail to receive some or all of their shots 
because they move, switch insurance plans, or lose coverage. Different 
States track and report different disorders in different ways, and the 
health of the individual is examined in total isolation from the health 
of the community.
  The patient's bill of rights has the potential to address some of 
these problems. For example, the Ganske-Dingell bill contains a solid 
proposal giving women direct access to an OB-GYN. This provision can 
help us attack rates of sexually transmitted diseases by allowing women 
to go directly to the right doctor without having to waste the time, 
the effort, and the money of passing through a gatekeeper physician. If 
we can help women get treatment for sexually transmitted diseases 
quickly and effectively, we can reduce the rates of transmission.
  Similarly, the Ganske-Dingell bill has provisions regarding direct 
access to pediatricians for children. Parents need to be able to get 
their children to the right doctors as quickly as possible, especially 
in the cases of communicable diseases, which often can be mistaken for 
other sicknesses in their early stages and spread like wildfire in 
settings like day care and schools. If we can prevent the transmission 
of diseases like these and many others when the patients can get timely 
care under their insurance plan, we benefit the whole community. Sick 
people create sick communities. When we delay care, we place numerous 
other individuals at the risk of illness. A patient's bill of rights 
would help patients directly to get the care they need.
  I would like to note that State, local, and Federal governments have 
a major financial stake in the patient's bill of rights as well. When 
patients cannot receive timely care under their insurance plan, they 
often seek care in other places, such as clinics and emergency rooms. 
And in many cases the cost of their care must be absorbed by the 
facility, the State assistance plans, and Medicaid. The Federal 
Government spends tens of millions of dollars each year to fund the so-
called disproportionate share hospitals, which treat high numbers of 
patients lacking coverage. If we could reduce the amount of 
unreimbursed care in this Nation by even a small fraction, it would 
make a tremendous difference to many struggling hospitals and 
facilities, and that in turn would allow those facilities to dedicate 
more resources to public health goals, like indigent care and outreach.
  Finally, as a public health professional, I find it deeply troubling 
that Congress would consider allowing insurance companies to continue 
practicing medicine without a license. Insurance company bureaucrats 
have no business inserting themselves into the doctor-patient 
relationship. Middle managers should not second-guess M.D.'s. If 
insurers want to practice medicine, then they must be responsible for 
the consequences when things go wrong, and that means being held liable 
for medical decisions.
  I am pleased that our colleagues in the other body are debating a 
strong, responsible patient's bill of rights. The House majority 
leadership bill, H.R. 2315, does not pass muster, and I hope that all 
of my colleagues will pass up this anemic version in favor of a real 
patient's bill of rights, H.R. 522, the Ganske-Dingell Patients' Bill 
of Rights.
  Mrs. CAPPS. Mr. Speaker, I want to thank my colleague, the 
gentlewoman from New York (Ms. Slaughter), and particularly for her 
perspective from a public health point of view.
  I know many of us, when we saw the managed care plans coming on the 
horizon as a cost containment method applauded the program for its 
preventive care aspects, and some HMOs still do offer these, and they 
are to be commended. But many, in their cost cutting methods, have 
curtailed the prevention aspect and the guidance and some of the extra 
programs that are offered through counseling and health education, 
advice for families, and the periodic checkups that are part of a good 
developmental program for children in favor of cost containment. So I 
think we should go back and accentuate.
  We need to point out that this patient's bill of rights is not an 
attempt to do away with managed care, but to reform it and to bring it 
back into the arena of the responsibility of health professionals for 
the care of their patients and the ability of patients to get the kind 
of care that will be in their best interest in health care.
  I wish now to give time to my colleague, the gentleman from Ohio (Mr. 
Strickland). He is a psychologist and now is my colleague on the 
Subcommittee on Health of the Committee on Commerce. He has been a 
leader for a long time on the patient's bill of rights and comes to 
Congress with his perspective, coming right out of his work in 
psychology in his Congressional District. I am happy to yield to him.
  Mr. STRICKLAND. I thank the gentlewoman for yielding to me.
  Before coming to this House, I practiced psychology in a maximum 
security prison, working with mentally ill inmates; I worked in a 
community mental health center; I worked in a large psychiatric 
hospital; and I have worked with emotionally disturbed children. The 
fact is that we do need a strong patient's bill of rights. And it is 
puzzling to me, it is truly puzzling to me that today in America 
patients can be abused by managed care organizations and have no legal 
recourse.
  I would like to share with my colleagues tonight a story of one of my 
constituents. Every one of us here in the Congress, whether we are 
Democrats or Republicans, regardless of what part of the country we are 
from, have constituents who come to us with their problems, and I would 
like to talk this evening about a young woman who is 31 years of age. 
She lives in a small town in Highland County, Ohio. Her name is Patsy 
Haines.
  Patsy's husband called my office several weeks ago and he asked if we 
could be helpful. He told us that his wife suffered from chronic 
leukemia and that she had worked for 5 years at this company until she 
became too ill to work. She was diagnosed with this life-threatening 
illness. Her doctor told her that she needed a bone marrow transplant. 
Patsy has a brother who is willing to participate, who is willing to 
help her, and he is a perfect match for such a transplant surgery.

                              {time}  2030

  The problem is that Patsy cannot get her insurance company to agree 
to pay for this surgery.
  I went to the James Cancer Hospital in Columbus, Ohio, possibly one 
of the premier cancer facilities in this Nation. I spent half a day 
there, and I talked with the doctor who is over the entire transplant 
program at the center, and I spent a couple of hours with a young 
doctor, a very inspiring doctor, who is a specialist when it comes to 
bone marrow transplant surgery. This young doctor was incredibly 
sympathetic to Patsy Haines' condition, and agreed to talk with her and 
her physician.
  After his consultation, he agreed that this young woman needs this 
surgery. He told me that if she receives this surgery, she has a very 
good possibility of recovery, of living a long life, of being a mother 
to her child, a wife to her husband. But the sad fact is if Patsy 
Haines does not receive this surgery, she very likely will lose her 
life.
  This past Saturday I went to a high school in Hillsboro, Ohio. 
Community members had brought together items to auction off for Patsy. 
Patsy was there in a wheelchair because her illness has progressed to 
the point where her legs are badly swollen and she needs a wheelchair 
in order to get around. People sat on those high school

[[Page 12167]]

bleachers, and they bought items which had been offered for auction. 
Patsy Haines is an incredibly inspiring young woman.
  I do not know if she is watching tonight or if her family or 
community members are watching tonight, but she inspires me. I said 
something at that auction that I truly believe, that none of us are 
islands. None of us in this world stand alone. As Members of Congress, 
we should have the attitude that each constituent's joy is joy to us, 
and each constituent's grief is our own.
  I feel grief for Patsy Haines tonight. It is shameful in the United 
States of America in the year 2001 that we have car washes and sell 
cupcakes and auction off small household items to get the resources 
necessary to help a young woman get the medical attention that she so 
desperately needs. The American people do not want us to be in this set 
of circumstances. The American people are with us on this issue. Poll 
after poll shows that the American people believe if an HMO or an 
insurance company makes a medical decision and deprives a person of 
necessary and needed medical treatment, that they ought to be held 
responsible in a court of law.
  As the gentlewoman said, the State of Texas has such a law, the State 
from whence our President came and where he was governor. During the 
last Presidential campaign I remember the President talking about the 
Texas Patients' Bill of Rights, and he displayed some pride in the fact 
that Texas had done this.
  What we are trying to do in this Congress with the Ganske-Dingell 
bill and on the Senate side with the McCain-Kennedy-Edwards bill is to 
do basically what they have done in Texas. The gentlewoman is right, in 
Texas this law has been in effect for 2 years, and there have been 
literally half a dozen lawsuits. The reason for that is, I believe, 
once this law is in place and the insurance companies know they are 
subject to going to court and having to face the consequences of that, 
it makes them much less likely that they will deny necessary treatment.
  So tonight we are talking about something really important. I hope 
the American people are watching. I believe the American people of 
every persuasion, conservative to liberal, Republican, Democrat, 
Independent, strongly believe that citizens of this country should be 
protected from this kind of awful, terrible, treatment.
  I hope as a result of what we are trying to do here Patsy Haines and 
her family, and Americans like her, will no longer be subject to this 
kind of mistreatment. What we are doing in the next 2 or 3 weeks here 
in Washington is as important as anything that this Congress has done 
in perhaps decades because we are taking the necessary step to see that 
American citizens, regular moms and dads and kids, get the kind of care 
they need.
  I will close by saying this. A couple of days ago a colleague of mine 
held a press conference in Columbus, Ohio, and came out in opposition 
to the Patients' Bill of Rights because of the ability to bring suit 
that is given to the patient in this legislation.
  There was a business executive there that had suffered a serious 
illness and was there to talk about the fact that he had been taken 
care of by his company. But not all of us are business executives. Some 
of us are just ordinary citizens like Patsy Haines. Our responsibility 
here in this Congress is to make sure that ordinary citizens are 
protected.
  I thank the gentlewoman for this special order and giving me the 
chance to talk about my constituent. I believe that the American people 
are watching, and as a result of the fact that they are watching us, I 
believe we have a very, very good chance of actually getting this 
legislation passed and signed into law.
  Mrs. CAPPS. Mr. Speaker, I thank my colleague from Ohio for sharing 
such a moving story. It is remarkable in this land of ours we have some 
of the best possibilities for health care in the world, and some of 
that is due to funding for research which has been promoted and 
supported from this House, this very body. We stand behind the great 
advances in our medical technology and our skills and opportunity. Yet 
at the same time we have such a gap between our ability to give health 
care and those who are actually able to get it.
  Mr. Speaker, one of the barriers are those without access to any 
health insurance. That is the subject for another conversation here on 
the floor, but there are barriers even to those who have health 
insurance and how tragic it is to have an employer-sponsored plan and 
go to one's doctor, and sometimes it is a matter, as with the 
gentleman's young friend Patsy, of a life-and-death matter. To have 
that doctor's recommended plan denied by an HMO, to me that is 
practicing medicine; and particularly now with the legislation like we 
are supporting and proposing which would involve strong external review 
so it would not just be the view of one doctor, actually we need to 
protect against frivolous medical decisions, but a panel of one's 
peers, and to have that still set aside by an HMO, that to me calls for 
some kind of last resort that can only be handled in a court of law. We 
do not want any more stories like the one that the gentleman from Ohio 
(Mr. Strickland) shared with us about his friend, Patsy Haines.
  Mr. Speaker, I yield to the gentlewoman from the Virgin Islands (Mrs. 
Christensen). She is the first woman physician ever elected to 
Congress. She is the Chair of the Congressional Black Caucus Brain 
Trust, and is always willing to speak and share her information in our 
efforts to pass this national Patients' Bill of Rights.
  Mrs. CHRISTENSEN. Mr. Speaker, it is a pleasure and honor to join the 
gentlewoman from California, and I thank her for yielding to me to 
speak on this issue.
  I am a family physician. I have almost 25 years of experience 
providing health care, mostly in the United States Virgin Islands, and 
knowing the importance of early access to quality health care to the 
overall health of this Nation, I never thought that 4 years after we 
began efforts to pass a strong Patients' Bill of Rights we would still 
have to take to the floor to plead for its passage.
  This is another instance, as the gentleman from Ohio said, the people 
of this country know best. Americans have lost confidence in the 
current managed care system. They are calling upon us to fix it and to 
place the medical decisionmaking back in the hands of those trained to 
make those decisions, the physicians, and the hands who have most at 
stake, the patients. As late as today patients traveled from New Jersey 
to meet with Members of Congress, to meet with the Health Care Task 
Force to once again make the case for the need for the full provisions 
of the Dingell-Norwood-Ganske bill.
  They talk about health care delayed and denied and lives lost or 
destroyed. Two of them told us of having to fight for needed health 
care while also having to fight at the same time the physically and 
emotionally devastating disease of cancer. All of their energy and 
attention was needed at that time and should have been directed to 
fight the illness and not an insensitive health care system.
  We also talk about the plight of those who accepted their denials 
because they felt powerless to fight the large systems. I would say as 
a physician who has been involved in public health, I know that 
prevention is worth a pound of cure, but it does not take an M.D. 
degree to know that. Our grandparents told us that over and over again.
  If we are ever to rein in the high cost of medicine, we can only do 
it by ensuring that everyone in this country, regardless of income 
level or ethnicity, has access to good primary care, secondary care and 
tertiary care when they need it. To do this the bipartisan Patient 
Protection Action of 2001, the Patients' Bill of Rights that we are 
discussing this evening sponsored by the gentleman from Iowa (Mr. 
Ganske), the gentleman from Michigan (Mr. Dingell) and the gentleman 
from Georgia (Mr. Norwood) and Senators McCain, Kennedy and Edwards is 
an important step, long overdue, but better late than never, and a step 
that we must take now.

[[Page 12168]]

  Even after the Patients' Bill of Rights becomes law, we will still 
have to provide health care coverage to the 43 to 45 million Americans 
who do not have health care coverage. We have to close the gap of color 
and those who live in rural areas. We have to make sure that our young 
people of color have access to health care careers, and can go back and 
serve their underserved communities.
  A lot of debate is being focused on the liability causes that my 
colleagues referred to, and I think it is important to make it clear 
that this is not about lawsuits and large awards, it is about putting 
the necessary teeth in the legislation to make sure that the HMOs and 
insurance plans put the patient and his or her medical needs in front 
of their profits. Money cannot buy back the ability to walk to the 
paraplegic who lost mobility because of delayed health care, or bring 
back a loved one because they did not receive the diagnostic treatment 
that they needed.
  The bill that we support does not, nor has it ever held employers who 
do not participate in making medical decisions to be liable. Employers 
if they do not intervene in making those decisions have never been held 
liable by the Patients' Bill of Rights that was introduced even in the 
last Congress by the gentleman from Iowa (Mr. Ganske) and the gentleman 
from Michigan (Mr. Dingell).
  On the other hand if a managed care organization makes a decision 
about health care, they should be held liable. Providers have been 
liable for years, and managed care organizations or insurance plans who 
make decisions about medical care should be liable as well.

                              {time}  2045

  There is so much wrong with the managed care system that needs to be 
corrected, I know we could probably go on for longer than an hour. But 
we in this body do have the opportunity to put it back on the right 
track by passing H.R. 526, the Ganske-Dingell-Norwood bill which is 
also called the Bipartisan Patient Protection Act of 2001. We are here 
this evening to join you to say, let's do it.
  Mrs. CAPPS. I thank the gentlewoman from the Virgin Islands (Mrs. 
Christensen) for sharing her story. She brought up something that I 
want to accent, because I think it is such a sadness to see what I call 
revictimization that so often occurs with people and their bureaucratic 
paperwork that they need to do. Often facing terrible diagnoses with 
sometimes horrendous outcomes and strenuous treatment regimes that they 
must go through and then on top of that, to need to struggle with the 
insurance company to provide the coverage. It is like doing battle on 
every front. It must feel to the patient and also to their family like 
being kicked when you are down, when you have such a battle and such a 
struggle with your health care itself, and trying to save your life or 
trying to get back on track again with your health and then to be 
constantly nit-picked or told no, not this, and so many hoops to go 
through, I really feel like we need to get it back into the priority 
and to streamline many of the approval processes and to make it so that 
we are treating people with the dignity really that all of us know as 
American citizens that we want to have. For this to be so completely, 
not always, but so frequently gone down a different path, that is a 
most humiliating experience for someone who has to go through it. That 
is certainly part of what we want to correct in this Ganske-Dingell 
patients' bill of rights.
  Now it is a pleasure for me to yield time to one of my fellow nurses 
here in Congress the gentlewoman from New York (Mrs. McCarthy). She 
represents one extreme end of the country and I am out there in the 
other end but we are both nurses. That means we are joined at the 
heart. We have worked together to make sure that the patients' bill of 
rights, for example, includes whistleblower protection for nurses and 
other important pieces. It is no surprise to either the gentlewoman 
from New York or I that the American Nurses Association and so many of 
the other nurse groups around the country are strongly in support of 
this particular patients' bill of rights.
  Mrs. McCARTHY of New York. I thank my colleague from California and 
my fellow nursing partner and certainly our friends that are 
physicians.
  You have heard stories tonight from us. You have heard us tell 
stories about our constituents. But I think if you hear and have 
listened to us, why are we so passionate about this? Why are we backing 
the patients' bill of rights? I am going to tell you a story, also, but 
this story is very personal. Even before I ever came to Congress, I had 
spent over 32 years, my life, as a nurse. All of us, we went into 
health care because we care about taking care of people. And we see our 
doctors today, they still care about their patients. They are fighting 
for their patients on a daily basis.
  But I want to tell you a personal story on why this bill is personal 
to me. Going back several years ago, something happened in our family. 
My son ended up being in the hospital. I have to say when he was in the 
hospital and he was in the intensive care unit, he got the best care 
you could possibly ever see. Because he was in the hospital, everything 
was approved. Then Kevin had to spend a long time in rehab. They told 
me he was actually going to spend a year in rehab. My son was only 26 
years old at that time. He went through the sessions in the morning. I 
would be there with him 18 hours a day. By lunchtime, I am saying to 
myself, ``Well, he's not tired, let's do rehab again.''
  Of course, I went to the head of the unit and I said, ``Let's do the 
whole session all over again.''
  ``Well, we can't.''
  I said, ``What do you mean you can't?''
  ``Well, the insurance companies will never pay for a double 
session.''
  I kind of sat down and I thought about it for a while and I said, 
well, I can do a lot of this stuff on my own with him, I had the 
training for it, I knew what I was doing. But then I went back to the 
director and I said, Wait a minute. My son is 26 years old. He can do 
more. And if we actually look at it, if he has double sessions, that 
means he is going to get his therapy, twice as much in one day and he 
is going to be out of here twice as fast. As I said to you, they had 
told me he would be in rehab for a full year.
  Well, we won that battle. I got him the double sessions because the 
hospital decided even if the HMO at that time would not pick up the 
cost, they would. So Kevin started with double sessions. We were out of 
rehab in 3 months. Obviously he had to go to rehab for a good several 
more months as an outpatient but that was only the beginning of our 
battle. Because every single thing that we had to have done for Kevin 
as far as rehab and everything else, we had to fight for those 
services. But here is where the kicker came in as far as I am 
concerned. Kevin had to have a procedure done. He had to go back in the 
hospital. Five doctors, five of their doctors, their doctors, said 
Kevin had to go in the hospital for a surgery. We were turned down. 
Each doctor went to bat, said, wait a minute, he has to go in the 
hospital and he has to have this surgery done. And he was turned down, 
he was turned down, turned down. All the way up to the point where I 
finally talked to the medical director of the HMO and I said, ``Why are 
you denying him this operation?''
  ``We do not feel he needs it.''
  I said, ``Who are you to make that decision when five of your 
doctors, a neurosurgeon, a neurologist, the surgeon himself, the 
cardiologist and the vascular man said he had to be in the hospital for 
this operation?''
  I said, ``Do you know what my son's medical history is?''
  He said, ``Well, actually I have it.'' By the way, his medical 
history was a little bit larger than the Manhattan telephone book. He 
did not understand it. He could not understand it.
  Now, we were kind of lucky. The company that Kevin worked for 
happened to own the HMO that Kevin was covered under. Well, I found out 
who the CEO was of that company and I called him up. I said, this is 
ridiculous. And he agreed with me and he called

[[Page 12169]]

and Kevin was in the hospital in a couple of days.
  My point is, why did we have to go through this? Why did I have to 
spend that time trying to get the care for my son that he needed? If 
anyone even thinks that Kevin wanted to go back in the hospital or I 
wanted him back in a hospital, believe me, that is not the place we 
wanted to be. We would have been happy if we had never seen another 
hospital the rest of our lives. Now I am in Congress and on a daily 
basis we have to fight for my constituents to get the care, number one, 
that they deserve. They deserve. Because the decisions are made by our 
doctors. And unfortunately when we talk about the patients' bill of 
rights, people out there do not even realize the consequences that are 
going on in the health care system today because of the rights that 
doctors do not have anymore. Doctors are not encouraging their children 
to become doctors and we are seeing that falling over to where nursing 
is falling off short because nurses are not going to go into the health 
care system because they see what is going on. There has been a 
trickle-down effect for the last several years.
  We have all worked with our health care providers. We have all worked 
with everyone that comes in to see us because they know we are in a 
health care position. By the way, we might be in Congress, but our 
first job still is to provide the health care system to all of our 
constituents across this Nation. That will always be my first priority, 
because that is an oath that we have all taken, to provide care for 
those. Now our jobs are just bigger.
  You took care of all your patients back on the island. You certainly 
took care of all the children in the schools. I certainly took care of 
my floor full of patients. Now all of us have hundreds and thousands of 
more patients to take care of. That is why we are backing the real 
patients' bill of rights. That is why we are involved in this so 
passionately. We want our doctors to be able to make the decisions. We 
want our nurses to be able to give the care that they need without 
ramifications, that if they report something, they are not going to be 
fired or they are not going to be, what we call rotated around to 
floors that we did not want to be on. These are important protections.
  All you are unfortunately hearing about in the newspapers is the 
suing thing. Again, let us go back to our President and his State of 
Texas. They have a patients' bill of rights, and they have not been 
sued. The amount of lawsuits in Texas since it was implemented is so 
tiny it is not even worth talking about. I will be very honest with 
you, if the correct care is given to all of our patients, no one is 
going to sue.
  If you have the time and certainly my colleague from California, I 
would love to have a colloquy, because I happen to think we, is it not 
amazing it is three women, but we really have firsthand experience on 
how this real patients' bill of rights is going to help the American 
people.
  Let me say one other thing. Many people think their HMOs are 
terrific, and there are some good ones out there. We are not slamming 
all of them. What we are saying is, though, until you come up with a 
situation where it might be chronic health care or maybe a life and 
death situation, or maybe it is a bone marrow transplant which they 
still consider experimental, but if you fight it long enough, you are 
going to get it, it is just that they want you to fight for it, and 
that is wrong. All of us have seen families going through so much. They 
should not have to worry, can I do this, can I raise the money to have 
it done. America is better than that. We know America is better than 
that.
  Mrs. CAPPS. I want to thank my colleague from New York for sharing 
her personal story of her son and remark that she fought hard, she had 
to make a lot of phone calls. Some folks do not have that facility. 
Maybe there are language barriers. Maybe there are other barriers or 
they give up. That is compromised health care. That is health care that 
goes unmet, health needs that go unmet. Her son happened to work for 
the HMO, the president or whatever the situation, so that she had a 
personal connection. How about the thousands and thousands of families 
that do not have that privilege and have that opportunity? We need to 
speak for them. We need to have this be legislation that really does 
address the issues so that situations can be relieved just as a matter 
of course, not as a matter of exception.
  But I want to bring up and am happy to have the gentlewoman from the 
Virgin Islands join us as well, but I do not want to leave another 
topic that the gentlewoman from New York brought up in her time as a 
nurse, and, that is, the important measure in this bill, the 
whistleblower protection. Let me make a couple of statements about it 
and ask our colleague who is a family physician to respond as well from 
the hospital perspective.
  I am concerned now as many in this House and many across the country 
are about the shortage of nurses. We have a crisis. We have 126,000 
positions going vacant today in our hospitals and health care 
facilities across this land. We have many things we need to do to 
address this. But one of the issues that is of real concern to those 
who work at the front line and in the health care settings is the 
demoralization that occurs when a person with professional standards 
has been trained and goes to work in a setting and sees and observes 
something which is not to that standard and has no recourse. It is the 
most awful experience to go through and think, this is wrong, and 
sometimes you are there and you have to participate, and, for fear of 
your job, you cannot go to someone in higher authority or to an outside 
agency and a place without fear of retaliation. So this whistleblower 
protection which has been included in the Ganske-Dingell patient 
protection bill is vital. I know from my own personal experience in 
public health out in the community to have this accountability so that 
the confidence that you have when you go through training, which is 
hard enough, and then go out to work, which is also challenging. This 
kind of work that we are talking about that nurses and doctors and 
health care professionals provide is not the easiest in the world. It 
has its tremendous rewards. But when you feel that barricade, that you 
see something and you cannot report it because your livelihood will be 
on the line, well, that demands correction. That piece in this bill I 
believe we need to stand up for. Maybe either of my colleagues would 
like to comment.
  Mrs. CHRISTENSEN. Let me just say that the nurses from the Virgin 
Islands are up this week as well and this is something they are very 
concerned about. I wholeheartedly agree with everything the gentlewoman 
said about needing to keep that in the patients' bill of rights, the 
fact that it is included only in the Ganske-Norwood-Dingell bill. But I 
wanted to say something about something else that our colleague said. 
She said that when her son was in rehab, if I heard her correctly, the 
rehab facility decided that even if they were not going to get 
reimbursed they would provide the service and soak up the cost.

                              {time}  2100

  We find that happening more and more where either the provider or the 
facility is saying, well, we know this is necessary.
  So we are going to take the chance. We are going to provide it to the 
patient even if we do not get reimbursed. Well, hospitals cannot afford 
not to be reimbursed and still be able to provide quality service to 
the patients that come to them, and providers on the other hand, they 
are also taking the risk and saying well, I know my patient needs this, 
I am going to go ahead and do it, make the referral or order the 
diagnostic test but when they come up for review later on they run some 
risks as well.
  We find that more and more providers, whether it is a hospital or a 
physician or another health provider, they are making those decisions 
to provide the care and take the risks but it also puts the patient 
under some stress that again they do not need to know, well, am I going 
to have this paid for. I am really glad we are here tonight supporting 
the Ganske-Dingell-Norwood bill because this bill provides for

[[Page 12170]]

access to specialists. The decision is going to be what is medically 
necessary, access to emergency room services, just using your prudent 
layperson's judgment so that people can get care and get it early and 
that our facilities and our providers can be reimbursed for the 
services they provide.
  Mrs. CAPPS. It is really common sense legislation. Those of us who 
have been doing health care work, I have spent 2 decades in my school 
community in the public schools of my community on the front lines 
every day with families that were seeking medical care and doing battle 
with their HMOs. This is not to do away with them. We are not trying to 
give insurance a bad name. We need it.
  There are good plans, but when excesses occur and when people step 
over the line, companies do and providers do, then they have to be held 
accountable because the bottom line is a matter of basic common sense 
and what is right for families, for individuals, for this country 
really in terms of access to health care and good quality health care. 
I appreciate the comments of the gentlewoman on that.
  I want to also make sure that we include in this discussion another 
very important piece of the Patients' Bill of Rights which includes the 
opportunity to have clinical trials be continued and be able to 
continue your insurance.
  I have some personal experience myself, so many families do, with 
members of family who are confronted with the most awful diagnosis, one 
of the most awful of all, which is the word cancer, and to know that 
many of the treatments that work for cancer are so recent in their 
discovery that they have not yet been fully implemented or approved 
under the Food and Drug Administration and, therefore, they are still 
under the clinical trial phase but if your doctor tells you that 
without treatment and without this particular kind of treatment, as our 
colleagues stated earlier in this hour, that there is no chance really 
for life to even continue, you might have a few months at best but you 
could try this clinical trial, you could embark on that course, I know 
personally, with my own family, that you do not hesitate for a minute; 
give me that chance; give me that straw to hang onto, particularly if 
it is one that has gone through several phases but it is still not 
approved yet and yet it has offered hope to others and treatment and 
good results to others; oh, you cling to that with your life. You do 
anything to get that treatment for your loved one, and in yet that very 
dark hour in your life, so many of insurance companies give you this 
ultimatum: You go down that path and you seek that medical treatment 
and we are cutting your insurance; you are losing all of your 
insurance.
  That is like a death sentence. That is an amazing position to be put 
into as a person, or with your loved one sitting there beside you 
having to make those terrible choices. We should not be forcing our 
patients to make this kind of choice. So that is why this Ganske-
Dingell bill will require that insurance companies continue their basic 
coverage of patients when they elect to participate in clinical trials.
  Now that makes sense. That is a good thing to do. That is what we 
should be doing for those with the awful diagnoses that many are 
facing. We want to make sure that new and different treatments are 
available to all patients without having them lose their ability to 
have coverage for regular treatments. This is a good measure within 
this Ganske-Dingell bill. So I offer it as one of the reasons I am 
supporting it and perhaps either the gentlewomen with me tonight would 
like to comment on that or any of the other topics that we have left 
out.
  Mrs. McCARTHY of New York. One of the things I would like to comment 
on, and I support the words that the gentlewoman has just said, again 
we as health care providers know a lot of times that when our patients 
are certainly looking for something to hang onto, and God knows we have 
seen our patients fight for every breath that they take and they want 
to try something to continue to be with their loved ones, but it is the 
loved ones that unfortunately are faced with this fighting most of the 
time; a lot of the patients do not. We have become their advocates. We 
are still taking our oath very seriously; the gentlewoman from the 
Virgin Islands (Mrs. Christensen) as a doctor, myself and the 
gentlewoman from California (Mrs. Capps) as nurses. We are there to 
protect our patients, as I said earlier, and we will continue to do 
that.
  I think again what I am seeing, which really starts to scare me 
because are we coming into a society for those that have really good 
insurance and those that have minimum insurance, those that have really 
good insurance will get the health care that they need; those that do 
not they are not going to get the health care. I spent, like I said, 32 
years in nursing. We did not know who was wealthy. We did not know who 
was poor. Everybody got the same kind of treatment in the hospital.
  Going back to earlier what we were saying about where the hospitals 
would pick up because they felt the treatment was needed, that is their 
obligation because, again the good hospitals, the good health care 
providers know their job is to take care of the patient.
  Mrs. CHRISTENSEN. Absolutely.
  Mrs. McCARTHY of New York. The majority of hospitals in this Nation 
do not make money. They are always in the red because every penny they 
get goes back into the infrastructure of the hospital.
  Now, I think the three of us, once we get this Patients' Bill of 
Rights through, we could come back and talk about all the other ills 
that we are seeing in the health care system, things that all of us are 
working on for future bills, because we have to start addressing them 
and we have to face them. We cannot hide our heads in the sand anymore.
  Five years ago, when the gentlewoman came in, we started talking 
about the whole collapse of our health care system; 5 years ago. Here 
we are now finally having a bill out there that can make a difference, 
but we have a long way to go. We have to bring the health care system 
back to the way it was. Certainly our hospitals have learned to cut 
down on costs. Certainly we have to make sure there is not fraud and 
abuse. We will do that, but we still can deliver a good health care 
system to our patients. The Patients' Bill of Rights will do that.
  This is the only true bill because it has the protections in there 
for our health care workers, our nurses, our doctors. It is certainly 
going to make our HMOs stand up and take their responsibility and if 
they do their job right they will be fine. It is a shame, it is a shame 
that we have had to come this far to do legislation in this great House 
that we work in but sometimes that is why we are here, to make them, 
whether it is the HMOs, whether it is the auto manufacturers, or 
different corporations, to do the right thing.
  The Patients' Bill of Rights does the right thing for the American 
people.
  Mrs. CHRISTENSEN. As I said earlier, too, this is something that the 
people of America have clearly said they want. All of the provisions 
that are included in the Ganske-Dingell-Norwood bill are direct 
responses to what the people of this country have said they want to see 
in their health care system. I agree that this is an important 
beginning, but it is a beginning because we do have to go out and 
provide insurance coverage because there are 43 or so million people 
that will not even be touched by what we do here.
  This is an important part of making sure that health care and quality 
health care is accessible to the people who are covered within this 
system and accessible when they need it. We do have other issues.
  Mrs. CAPPS. Yes.
  Mrs. CHRISTENSEN. When one talks about containing costs as the 
driving force or making profits on the other end, the driving factor 
for pursuing managed care, a lot of people are left out for whom it is 
very expensive to provide health care. They are largely the poor people 
who have not had access to health care for many years; people of color 
in this country who have not had access to health care; people in our 
rural areas. So we have to end this two-tiered system that our 
colleague just referred to of health care in this country and make sure

[[Page 12171]]

that that quality health care is equally accessible to all of our 
citizens and residents in this Nation.
  Mrs. CAPPS. I want to make sure, just as we draw this to a close, I 
have a pledge I want to make with my two colleagues, but I want to make 
sure that we leave on the record the answers to a couple of myths that 
are out there. One is on the part of employers that where there is this 
fear that if we do this Patients' Bill of Rights that the employer who 
provides the insurance will be liable, that the lawsuit will include 
them. We have been assured that they are in the business of providing 
insurance plans for their employees, who are also occasionally 
patients. Then if their employees choose that plan and they give them 
often that range of plans to choose from that, then they are not 
themselves liable when the insurance company itself makes decisions 
which are not in the patient's best interest.
  The insurance company is the one who must be held accountable, not 
the employer in that case.
  The other myth that is out there is, and I have heard it on the 
floor, I have heard it among some of our colleagues who say it is just 
going to drive up the cost of health care insurance, and there are so 
many particularly small businesses who are struggling now to provide 
it, they want to provide it but that is another topic that we are going 
to address another time about making health care available in a variety 
of ways, not just putting it on the backs of mostly small business 
providers.
  The cost of the premiums in Texas, in the plan that this Patients' 
Bill of Rights, this Dingell-Ganske plan is based on, that the premiums 
went up, I think they characterized it as a Big Mac a month, or 
actually just a very small amount of an increase in a premium that most 
constituents, most employees, would be happy to make if they knew that 
they had the benefits that we have been outlining as part of this 
Ganske-Dingell Patient Protection Act.
  So we want to make sure that it is clear that we do in this country 
hold people accountable when they make mistakes. Doctors, health care 
providers, all of us had insurance policies because we knew that we 
could make a mistake and we wanted our patients to have recourse, and 
health care providers are very knowledgeable about the need to have 
that.
  On the other hand, HMOs, and insurance companies like HMOs, are the 
only sector of our economy now that is not able to be touched by 
accountability. That is clearly out of focus for our country's pattern 
of holding accountability. This bill will correct that. It only holds 
those insurance companies liable when they practice medicine. If one 
practices medicine, they are held liable. If an insurance company 
chooses to practice medicine, they will be held liable as well. That is 
what this is all about.
  Within the Patients' Bill of Rights, access to emergency care, access 
to obgyn without having to go through a gateway, these are not 
debatable. These are understood as needed reforms within managed care 
today, and we need to embrace all of it as a package, which is really 
about common sense.
  Mrs. McCARTHY of New York. I would just like to follow up. When the 
gentlewoman was talking about our small businesses, I was on that 
committee for 4 years and we certainly all know how we have all fought 
to protect our small businesses. That is the engine that is driving 
this country, by the way. Our small businesses are doing well. The 
gentleman from Georgia (Mr. Norwood), certainly the gentleman from 
Michigan (Mr. Dingell), at that time even when I had concerns about is 
this going to hurt our small businesses, and that is why the language 
is in our bill. If they want to clarify it a little bit more, we can 
probably work that out. We are not out to hurt our small businesses 
because that is not going to help any of us.
  As the gentlewoman said, we have to make sure that our small 
businesses can open up and offer health care insurance to all their 
employees so let us take that myth out of there. The gentlewoman is 
absolutely right on that. The protection that is in the Patients' Bill 
of Rights, especially with the gentleman from Georgia (Mr. Norwood), if 
anybody knows the gentleman from Georgia (Mr. Norwood), believe me he 
is going to protect small businesses. So that is a myth.
  Unfortunately, there is too much politics dealing with this health 
care issue and we should take the politics out of this issue and 
certainly do the right thing for the American people. That is what has 
to be done.
  Mrs. CAPPS. I so appreciate my colleagues being here. I think we are 
almost out of time, but I will yield further to the gentlewoman from 
the Virgin Islands (Mrs. Christensen) for some comments.
  Mrs. CHRISTENSEN. I am glad that the gentlewoman made the 
clarification about the employers not being liable, the fact that the 
premiums and lawsuits do not rise, because we have that experience. It 
is also important to point out that this is a real bipartisan bill. 
There has been a lot of work and a lot of compromise to bring this bill 
forward that addresses issues and has addressed some of the concerns of 
people on both sides of the aisle. This is a bipartisan effort to 
address something that has been of great concern to the American 
people.
  Mrs. CAPPS. Mr. Speaker, we will now close and remind our colleagues 
that we did pass this very bill before in this House. So let us just do 
the right thing and pass it again. This is my pledge that I want to 
make to my dear colleagues who have joined us here this evening, the 
gentlewoman from New York (Mrs. McCarthy), and the gentlewoman from the 
Virgin Islands (Mrs. Christensen), let us pass the Patients' Bill of 
Rights and then let us gather on the floor to discuss some other needs 
in health care, such as the nurse and professional shortage, such as 
those without any access to health care because we still have a long 
way to go. We are willing and we are prepared, we are going to be here 
until we can address each of these issues. So I will join my colleagues 
again on the floor at a further time.

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