[Congressional Record (Bound Edition), Volume 147 (2001), Part 9]
[House]
[Pages 12285-12289]
[From the U.S. Government Publishing Office, www.gpo.gov]



                               HMO REFORM

  The SPEAKER pro tempore (Mr. LaHood). Under the Speaker's announced 
policy of January 3, 2001, the gentleman from Iowa (Mr. Ganske) is 
recognized for 60 minutes as the designee of the majority leader.
  Mr. GANSKE. Mr. Speaker, I especially want to thank you for the time 
that you are spending in the Chair tonight, as you have many evenings 
with your spare time. The Members of this House of Representatives who 
come to the floor to give Special Orders are especially appreciative 
as, over the years, other Members have volunteered their time to sit in 
the Chair so that we could do our Special Orders.
  This is the beginning of our July 4th recess, and I will try to be 
somewhat briefer than the hour time that I am allotted for this.
  Well, we have had, Mr. Speaker, a great debate going on in the Senate 
this week on the Patients' Bill of Rights; and I have been watching 
this with great interest, because for the past 5 years I have been 
working on this issue, and I have been coming to the floor frequently, 
just about every week, in order to give a Special Order talk on the 
status of legislation to help protect patients from abuses by HMOs.
  I am looking forward to the day when we pass a strong Patients' Bill 
of Rights piece of legislation on this floor to go along with what I 
think will be a strong Patients' Bill of Rights coming out of the 
Senate, that we marry those two bills together, that we add some 
important access provisions, such as an expansion of medical savings 
accounts, tax deductibility for the self-employed, and we move that 
down to the President's desk.
  I strongly encourage the President to sign that, because there have 
been some significant compromises over the past few years on this 
legislation that I believe meet the President's principles, and yet 
retains principles that he enunciated during the Presidential campaign, 
such as allowing for important State laws on patient protection to 
continue to function, laws like those in Texas, which appear to be 
working pretty well.
  Mr. Speaker, why are we continuing to talk about this? Well, we have 
had gridlock here in Washington for several years on this; and it has 
been a shame, because every day the HMOs make millions and millions of 
decisions that can significantly affect the well being of the patients 
they are supposed to be serving.
  Remember a few years ago, there was a movie, ``As Good as It Gets.'' 
It had Helen Hunt, who had a child with asthma, talking to a friend, 
Jack Nicholson, in the movie; and her little boy was being denied 
needed treatment for his asthma, which prompted Ms. Hunt to run a 
string of expletives together about that HMO. And I saw something I 
never saw happen before in a movie theater or seen since: I saw people 
stand up and clap in agreement with Ms. Hunt on that.
  Then we saw a few years ago a large number of jokes and cartoons 
about HMOs. You do not see it so much any more because, you know what? 
Everybody knows that this is a problem. In order for something to be 
humorous, there needs to be some element of surprise. But it is not 
surprising anymore

[[Page 12286]]

that people have problems. You talk to your friends, family members, 
colleagues, and practically everyone can come up with a story about how 
an HMO has inappropriately denied treatment to a patient.
  Remember the problem that we had a few years ago when one of the HMOs 
said, well, you know what? We do not think you need to stay in the 
hospital if you deliver a baby. Our plan guidelines say outpatient 
deliveries.
  So you had this type of cartoon. The maternity hospital, drive-
through window: ``Now only 6-minute stays for new moms.'' The person at 
the window saying, ``Congratulations. Would you like fries with that,'' 
as the mom holds a crying baby, and she looks more than a little 
frazzled.
  Well, it was not so funny when you started to see headlines on major 
newspapers around the country, like this one from the New York Post 
which said ``What his parents didn't know about HMOs may have killed 
this baby.'' Or this headline from the New York Post that says ``HMO's 
cruel rules leave her dying for the doc she needs.''
  Some of these cartoons were pretty hard hitting, and I would say the 
humor was black humor at a minimum. Here was a cartoon about HMOs that 
appeared a couple of years ago: ``Cuddly-care HMO. How can I help 
you?'' This is an operator at the end of one of those 1-800 numbers. 
She is repeating what she is hearing on the telephone, and she says, 
``Oh, you are at the emergency room and your husband needs approval for 
treatment.''
  Then she repeats what the person is saying. ``He is gasping, 
writhing, eyes rolled back in his head? That doesn't sound all that 
serious to me.''
  Over on there it says, ``Clutching his throat, turning purple? Um-
hum.''
  Then she says, ``Well, do you have an inhaler?''
  Then she says, ``He is dead?''
  And then she says, ``Well, then he certainly doesn't need emergency 
treatment, does he?''
  And finally the HMO reviewer says, ``Gee, people are always trying to 
rip us off.''
  Well, that was not too funny to this young lady. She fell off a 40-
foot cliff about 60 miles west of Washington, D.C. She broke her 
pelvis, her arm and had a concussion; nearly was dead. Fortunately, her 
boyfriend had a cellular phone. He phoned in the helicopter. They 
loaded her up, got her to the hospital, she was admitted through the 
emergency room, in the ICU on intravenous narcotics, and she got 
better.
  But then do you know what the HMO did? They would not pay her bill. 
They said that she had not phoned ahead for prior authorization.
  Does that strike you as a little funny? How was she supposed to know 
she was going to fall off a cliff and break her leg and have a 
concussion? Was she supposed to be able to read the tea leaves?
  Oh, and this was an issue. This was one of the first issues we talked 
about on HMOs. Back in 1995 I had a bill called the Patient Right to 
Know Act, because it became known that HMOs were requiring doctors to 
phone them in order to get permission to tell the patient about all of 
their medical treatments that might be possible. So you would have a 
situation, for instance, where a woman comes in to see a doctor; she 
has a lump in her breast. Before the doctor tells her her three 
options, he says, ``Oh, excuse me,'' goes out in the hallway, gets on 
the phone and says, ``HMO, can I tell this lady all about her treatment 
options?''
  So here we have a doctor saying, ``Your best option is cremation; 
$359, fully covered.'' And the patient is saying, ``This is one of 
those HMO gag rules, right?''
  That HMO gag rule was not so funny to this woman. Her HMO tried to 
gag the doctors treating her. She needed treatment for breast cancer. 
She did not get it, and she died. And, do you know what? Under the 
current Federal law, if you receive your insurance from your employer 
and the HMO makes a decision like that, under Federal law, current 
Federal law, they are liable for nothing except the cost of care 
denied. And if the patient is dead, then they are not responsible for 
anything. Now this little girl and boy and the woman's husband, they do 
not have their mom, because of what that HMO did.
  Here is another cartoon. The doctor is taking care of a patient on 
the operating table. The doctor says ``scalpel.'' The HMO bean counter 
says ``pocket knife.'' The doctor says ``suture.'' The HMO bean counter 
says ``band-aid.'' The doctor says, ``Let's get him to intensive 
care.'' The HMO bean counter says, ``Call a cab.''
  Let me tell you about a real case that was sort of a call-a-cab 
response. Down in Texas, after they passed the patient protection bill 
down in Texas, there was a fellow named Mr. Palosika. He was suicidal. 
He was in the hospital. His doctor thought he needed to stay in the 
hospital because, if he left, he might commit suicide. But the HMO 
said, no, we do not think he needs to stay in the hospital, and we are 
not going to pay for it. If he wants to stay, fine. The family can pay 
for it themselves.
  Well, when an HMO says that to most families, they do not have the 
money to pay for it up front themselves, so they just took him home.

                              {time}  1945

  That night, Mr. Palosika drank half a gallon of antifreeze and 
committed suicide.
  Now, under Federal law, that HMO was supposed to, if they disagreed 
with the treating doctor's advice, they were supposed to go to an 
expedited, independent review panel, but they did not do that, they 
just ignored the law. And that is why it is very important when we are 
dealing with patient protection legislation that we have a strong 
enforcement mechanism; not to create new lawsuits, but to prevent those 
lawsuits by making sure that the HMOs know that they will be 
responsible at the end of the day so they do not make decisions or so 
that they do not follow the rules, or, I should say, in order to ensure 
that they do follow the rules.
  Here is another one of those cartoons. This is the HMO claims 
department. The claims reviewer is saying, ``No, we don't authorize 
that specialist; no, we don't cover that operation; no, we don't pay 
for that medication,'' and then apparently somebody says something to 
the operator, and she says, ``No, we don't consider this assisted 
suicide.''
  Mr. Speaker, I hope I do not have to talk about this case much 
longer. I hope we really do pass a strong Patients' Bill of Rights 
soon, the Ganske-Dingell bill, on this floor. This is a little boy that 
I know. He is now about 8 years old, but when he was 6 months old, he 
had a fever of about 104, and he was sick one night, and his mom phoned 
the HMO, a 1-800 number, probably thousands of miles away, and said, my 
baby is sick, we need to go to the emergency room. And the medical 
reviewer said, well, under our contract, I will only authorize you to 
take little James to this one emergency room. That is all we have a 
contract with. Mom and Dad lived way on the outside of Atlanta, 
Georgia. Mom said, well, where is it? This voice over the phone said, I 
don't know, find a map. Made a medical decision, medical judgment, that 
reviewer did, that he was healthy enough to withstand a very long drive 
through Atlanta and bypass three hospitals with emergency rooms.
  So Mom and Dad wrap him up. It is the middle of the night. They start 
their trek, they pass those emergency rooms where they could have 
stopped if they had authorization, but they were not health care 
professionals, they did not know how sick little James was, but he then 
suffered a cardiac arrest. Fortunately, they were able to keep him 
going until they pulled into the emergency room. Mom leaped out of the 
car screaming, save my baby, save my baby. A nurse ran out. She started 
an IV, they started mouth-to-mouth resuscitation, they gave him 
medicines, they saved his life, but they did not save all of this 
little boy. Because of that cardiac arrest, he ended up with gangrene 
in both hands and both feet, and, consequently, both hands and both 
feet had to be amputated.
  Under current Federal law, an employer health plan that makes that 
kind of medical judgment that results in that kind of injury to this 
patient is

[[Page 12287]]

liable for nothing except the cost of his amputations.
  I will tell my colleagues something. Once in a while I read an 
article, an editorial in a newspaper, and I hear opponents to our 
legislation saying, oh, those are just anecdotes. Those are just 
anecdotes. That girl that fell off the cliff, that was just an 
anecdote. The young mother who died because she did not get the care 
from the HMO, that is just an anecdote. A little boy who loses both 
hands and both feet, that is just an anecdote.
  Mr. Speaker, do you know what I say to those people? I say, you know 
what? If this little anecdote had a finger, and if you pricked it, it 
would bleed. I say, this anecdote has to pull his leg prostheses with 
his arm stumps every day. This anecdote needs help putting on both 
bilateral prostheses. This anecdote will never be able to touch the 
face of the woman that he loves with his hand. He will never be able to 
play basketball. Now, he is a pretty well-adjusted kid, considering 
everything. He is a great kid. But I tell my colleagues, I want those 
people who write those op-ed pieces to meet this little anecdote and 
look him in the eye and tell him that we do not need a Patients' Bill 
of Rights.
  I will tell my colleagues this: There are not just a few anecdotes 
around the country. I get phone calls and letters from people all over 
the country. Just recently in Des Moines, Iowa, a woman came up to me 
and she said, I tell you what. I am fed up with our HMO. I have breast 
cancer. I have been battling this for a while. The treatments have made 
me worn out. But my doctor told me that I needed a test to see if the 
cancer had come back, and the HMO would not authorize it. Other doctors 
said the same thing, that I needed the test. It did not matter. The HMO 
would not authorize it. Finally, after a long fight, they authorized 
it, and then the day I was supposed to get it, they said no.
  And she said, Congressman, I went to my husband and I said to him, 
you know, Bill, I am going to ask you to do something I have never 
asked you to do for me before. That HMO has worn me out. I cannot fight 
them anymore. You are going to have to carry this for me. You are going 
to have to fight that HMO.
  Mr. Speaker, there is a real need to pass this. People pay a lot of 
money and their employers contribute a lot of money for their health 
care. They work a lot of hours to earn that health care. When they 
finally get sick, it ought to mean something. They ought to be treated 
with justice and human compassion and not by green eyeshades looking at 
the bottom line and coming up with some arbitrary definition of medical 
necessity.
  Mr. Speaker, under this Federal law I am talking about that passed 25 
years ago, an employer health plan can define medical necessity as 
anything they want to. Some health plans have defined medical necessity 
as the cheapest, least expensive care, quote/unquote. Well, before 
coming to Congress, I was a reconstructive surgeon. I took care of 
children with cleft lips and palates. More than 50 percent of the 
surgeons in this country that do that kind of work in the last several 
years have had cases denied for kids with cleft lips and palates by the 
HMO saying, oh, that is not medically necessary. And under Federal law, 
they can define it any way they want.
  That is why they had a big debate on this yesterday in the Senate, 
and they have managed to preserve language that says, if there is a 
dispute, an independent panel will make that decision and not be bound 
by the plan's arbitrary and unfair guidelines, so that if there is a 
denial of care, you get an honest-to-God chance that you will get the 
treatment you need.
  I commend the Senators who voted to preserve that very, very 
important issue of letting an independent panel determine medical 
necessity and not be bound by a plan's guidelines. That does not mean 
that our law says, our bill says that employers cannot set up their own 
benefits package. We are very clear on that. We do not change that for 
ERISA at all. If an employer wants to purchase a plan where the plan 
says explicitly in the contract language, we do not provide heart-lung 
transplants, that is fine. It is not what I would recommend, but they 
can do that, and we do not change that. If a patient came along and 
needed that, then they would have to come up with that financing 
themselves because it has been made explicitly clear. But if it has not 
been made clear that that is an explicit exclusion, and if the patient 
does need that and believe that they would get that under that type of 
agreement, then they should, they should.
  We say in our bill, the Ganske-Dingell bill, the Bipartisan Patient 
Protection Act of 2001, we say that businesses are protected from 
liability. We have a standard in our bill that says, businesses will 
not be liable unless they enter into direct participation in the HMO's 
decision that would result in injury. That is a standard that many of 
my Republican colleagues agreed with 2 years ago, and we adopted it.
  I had a good friend who is a businessman from Des Moines, Iowa, phone 
me today, and he wanted to know whether he would be liable under our 
bill, and I said, how do you provide your health insurance for your 
employees? He said, well, we hire BlueCross BlueShield. We take one of 
their plans or another plan. I said, do you ever get involved in 
BlueCross BlueShield's decisions? He said, oh, no. Oh, no. That is a 
matter of personal privacy for our employees. We do not want to know 
what is happening to their personal lives, and, quite frankly, they do 
not want us to know what is going on, and we do not want to know, if 
only for the reason that maybe we would have an employee at some time 
that is not performing up to par, and we might have to let that 
employee go, and we do not want that employee coming in and saying, 
well, you are just letting me go because you found out that I have 
diabetes or that I had to see a psychiatrist.
  Under our bill, the Ganske-Dingell bill, employers are protected from 
liability, unless, unless they directly participate. Furthermore, there 
has been additional protective language now adopted on the Senate side 
on this issue, and we think that that is a positive. We just want to 
make sure, not that there will be a lawsuit at the end of the day, but 
that if there is a dispute on care where the HMO says no, but the 
patient's doctors say yes, that there is a mechanism for resolving that 
dispute before anyone is injured, if necessary, going to an independent 
panel whose decision would be binding on the health plan, an 
independent panel where the decision would be binding on the health 
plan.
  In that circumstance, in the Ganske-Dingell bill, you know what? We 
give total punitive damages relief to the health plan. We say, if this 
dispute goes to an independent panel, and a health plan follows the 
decision, then they cannot be held liable at all for punitive damages. 
That has been one of the major concerns, large punitive damage awards 
by the business community.
  Some people attack our bill by saying, oh, it is going to increase 
the costs for health insurance premiums. We hear that a lot in the 
debate that has been going on in the Senate. My answer to that is that 
the Congressional Budget Office has looked at our bill, the McCain-
Edwards bill is the companion bill that is being debated in the Senate, 
they have looked at our bill and they say that the total cost would be 
4 percent increase in premiums over 5 years, so less than 1 percent per 
year. The alternative, Frist-Breaux bill, the GOP bill in the Senate, 
would increase premiums by about 3 percent over the same period of 
time. But the provision on the liability would result in a total 
increase in premiums of only .8 percent over 5 years. That is less than 
two-tenths of a percent. The analysis of that would show in practical 
terms that the cost of our bill would be about the cost of a Big Mac 
meal per month per employee.
  Mr. Speaker, the surveys around the country show that people think 
that that would be well worth it to know that they would be treated 
fairly.
  Now, just this week there has been a big roll-out of an opposition 
bill to the Ganske-Dingell bill. It is called the Fletcher bill, the 
Fletcher-Thomas bill.

[[Page 12288]]



                              {time}  2000

  It is called the Fletcher bill, the Fletcher-Thomas bill. As a 
doctor, I know that you do not do a complete physical exam without 
examining the body under the clothing. So there were a lot of good 
words said by the opponents to our bill about the Fletcher bill, but I 
have looked at the body of that Fletcher bill.
  I will tell my colleagues something, it is not pretty, except to the 
HMOs. When the Fletcher bill is stripped of its spin, the bones, and 
the sinews look like the old HMO protection bills that the opponents to 
real patient protection have tried to confuse the public with for 
several years.
  For example, in the Fletcher bill, there are significant constraints 
on the independence of the medical reviewer. The standards of review 
would actually codify negligent health plan practices. It would make 
them unreviewable.
  The Fletcher bill's designated decisionmaker language could be gamed 
by the HMO. They are working on designated decisionmaker language on 
the Senate side right now. Senator Snowe is working on that, and there 
is a way to write that language that is fine, it adds language that is 
protective for employers, but at the same time prevents that language 
from being used to deny patients the care they need.
  Mr. Speaker, I am very pleased to see progress being made on that on 
the Senate side. The Fletcher bill, despite the plan's sponsor's 
contentions, reverses State law. It effectively federalizes State law 
by saying that the only allowance for State court is if an HMO does not 
comply with the review panel, which under the Fletcher bill, the HMO is 
able to stack in its own favor. Those are just a few of the diseases on 
the Fletcher bill.
  I advise my fellow Republican House Members to become aware of being 
infected with the Fletcher bill. The real cure is the Ganske-Dingell 
bill.
  Here are some statements from my great colleague, the gentleman from 
Georgia (Mr. Norwood), who has worked with me and the gentleman from 
Michigan (Mr. Dingell) hand in hand on this for years.
  Here is what the gentleman from Georgia (Mr. Norwood), a very 
conservative Republican, says about the Fletcher bill. He says a 
patient could suffer injury or death from improperly denied care and 
still be blocked from a just court remedy with the Fletcher bill.
  Here is what the gentleman from Georgia (Mr. Norwood) says about the 
Fletcher bill. The design of this latest imposter bill is identical to 
previous attempts to derail patients' rights, create a technical right 
to sue an HMO with conditions that will disqualify the majority of 
cases quote unquote.
  The gentleman from Georgia goes on to say the HMO chooses the 
external appeals panel, which then determines whether the patient can 
go to court and the patient has no right of appeal.
  This alone is an insurmountable hurdle. It is just the tip of the 
iceberg. This bill, speaking about the Fletcher bill, imposes the 
responsibility of allowing a choice of the doctor on the employer 
instead of the HMO, and then it disqualifies the majority of employees 
from having the right to begin with. It contains nothing on adding 
prescription drug reform.
  The list goes on and on so far, in fact, that patients would be 
better off with no bill than with the Fletcher bill, quote, unquote.
  Mr. Speaker, my friend, the gentleman from Georgia, goes on in his 
press release and says the Fletcher bill further proposes that all 
suits over improperly denied care be removed to Federal court, with the 
exception of cases in which HMOs violate Federal law by refusing to 
comply with legally binding decisions of medical review panels.
  If the injury or death of a patient occurred prior to the ruling or 
through the delay imposed by the ruling, the patient loses their legal 
rights under the Fletcher bill, even their current limited right to sue 
under State law gained through the recent fifth court decision, 
upholding a portion of the liability provisions in the Texas patient 
protection act.
  The gentleman from Georgia continues in his press release, the new 
bill would accordingly preempt, preempt patient laws in Texas, Georgia, 
Arizona, California, Louisiana, Maine, Missouri, New Mexico, Oklahoma, 
Oregon, Washington, and West Virginia. Let me repeat that. My friend, 
the gentleman from Georgia, says the Fletcher bill would preempt 
patient protection laws in Texas, Georgia, Arizona, California, 
Louisiana, Maine, Missouri, New Mexico, Oklahoma, Oregon, Washington, 
and West Virginia.
  Let us talk a little bit about the comparison of the Fletcher bill to 
the Ganske-Dingell-Norwood bill. Fletcher claims the plans face 
unlimited punitive damages in State court and $5 million punitive 
damages in Federal court, regardless of compliance with review process 
under the Ganske-Dingell bill.
  Here is the fact. Under my bill, State level punitive damages awards 
are prohibited entirely if the plan follows the external appeals 
process. In addition, 33 States currently cap punitive and noneconomic 
damages. The law that would be in effect would be the law in those 
States.
  Punitive damages are banned entirely in Federal court cases while $5 
million in civil penalties are available in Federal court if the plan 
is proven by clear and convincing evidence to have acted in bad faith 
with flagrant disregard for the rights of the patients. That is what is 
in the Ganske-Dingell-Norwood bill.
  Mr. Speaker, the opponents to our bill, the gentleman from Kentucky 
(Mr. Fletcher) here, claims that our bill allows lawsuits, not only 
under ERISA, but also COBRA or HIPPA while the original Norwood-Dingell 
bill we debated a few years ago allowed ERISA cases only.
  Here is the fact. The Ganske bill removes contractual disputes to 
Federal court. Why do we do that?
  Number one, the Supreme Court has already said that is what should be 
done. We do it to preserve the ability of the Employee Retirement 
Income Security Acts uniform contract benefits. Our inclusion does not 
produce any additional causes of action under Ganske-Dingell. It does 
protect the ability of plans and employers to offer uniform health 
benefit plans Nationwide.
  Let me repeat that. Our bill is not a bill that would prevent an 
employer who works in many States from devising his own uniform 
benefits health plan. That is the fact. Fletcher claims that the 
Ganske-Dingell-Norwood bill would allow patients to sue in both Federal 
and State courts for the same injury; that is not correct. Our bill, 
the Ganske-Dingell bill, assigns contract disputes to Federal court, 
medical disputes to State court, patients must specify the grounds of 
the dispute when they file. Under standard court procedure, suits 
cannot be filed in both courts over the same grounds.
  Here is what the gentleman from Georgia (Mr. Norwood) said. The 
Fletcher bill appears designed for one goal, the confusion of the 
public and of Republican Members who want to vote for real patient 
protections.
  The gentleman from Georgia (Mr. Norwood) goes on and says any Member 
who supports this package, i.e., the Fletcher bill, does so for the 
exclusive benefit of the HMO lobby, quote, unquote.
  Let me give you five quick comparisons between the Ganske-Dingell 
bill and the Fletcher bill. Number one, the Ganske-Dingell bill enables 
every American to choose their own doctor. The Fletcher bill does not 
give Americans the right to choose the doctor and puts the requirement 
that employees get an option to choose their own doctor on the 
employer.
  Number two, the Ganske-Dingell bill ensures a fair review process. 
The Fletcher bill allows health plans to choose the reviewer at 
external review.
  Number three, the Fletcher bill forces the patient to get approval 
from an external reviewer before they can seek damages for injury in 
court. The Ganske-Dingell bill says that a reviewer's decision must be 
considered as evidence, but does not create an absolute bar from 
damages.
  Number four, the Fletcher bill will preempt 12 State laws that have 
been passed that allows HMOs to be held liable in State courts. The 
Ganske-Dingell bill protects those State laws, and

[[Page 12289]]

that is exactly one of the principles that President Bush said was 
essential on HMO reform during the campaign.
  Number five, the Ganske-Dingell bill allows cases regarding medical 
decisions to be heard in State courts. The Fletcher bill allows 
patients to go to State court when a plan does not follow external 
review and erroneously causes a medical decision. We call that breaking 
the law.
  Further, the Fletcher bill allows the patient to forum shop, the 
Fletcher bill allows the patient to forum shop between Federal and 
State court, not the Ganske-Dingell bill.
  These are some of the important differences that we are talking about 
between the Ganske-Dingell bill and the Fletcher bill.
  That is why over 500 health groups, consumer groups, professional 
groups have endorsed the Ganske-Dingell bill and very few have said 
much about the Fletcher bill, other than that in some cases, in some 
parts of the language, maybe it is okay. But if you look at the overall 
bill, the real patient protection bill is the Ganske-Dingell bill.
  Mr. Speaker, I believe, we will see this in large part passed with 
the McCain-Edwards-Kennedy bill, which is the companion bill to our 
bill. I think in large part, it will pass in the Senate. I think with a 
pretty big vote.
  Mr. Speaker, I applaud the hard work of the Senators who have worked 
on that and have shown a real concern for patient protections. I 
believe that will give us a big boost as we move into debate here on 
the House floor.
  I am appreciative of the work that Senators like Mike DeWine and 
Olympia Snowe, Lincoln Chafee, and others, who have put into this 
bipartisan bill as the Senate debate has moved forward. Those changes, 
as far as I have seen so far, look very acceptable to the gentleman 
from Georgia (Mr. Norwood) and myself and the gentleman from Michigan 
(Mr. Dingell).
  In the Senate, it would have been nice if they had added the 
expansion of medical savings accounts and the 100 percent deductibility 
for the self-insured. That is in our House bill, but under the rules in 
the Constitution, those types of provisions have to originate in the 
House so they did not debate those or pass those; but I believe they 
have wide bipartisan support.
  Mr. Speaker, I think it showed that the Democrats were willing to 
move to a compromise on this bill. It is no secret, a lot of Democratic 
Members are not real keen on medical savings accounts, but under the 
Ganske-Dingell bill we expand those medical savings accounts. That is 
part of the compromised process. That is how you get things done here 
in Washington.
  I will tell you what, a purely partisan vote in this House will not 
pass. The Fletcher bill is a partisan bill. There is one Democrat that 
supports it, maybe two, but what we have is a real core of Republicans 
who have been stalwarts for patient protection, who have withstood the 
blows of the $150 million campaign by the HMOs in this country trying 
to beat them down.

                              {time}  2015

  They have shown independence and courage, and I salute them. I look 
forward to this debate when it comes to the House floor after the July 
4th recess.
  I know that the gentleman from Georgia (Mr. Norwood) is going to go 
off his diet and will eat a little bit of red meat steak before we hit 
the floor. I am looking forward to working with the gentleman from 
Michigan (Mr. Dingell) as we work on this bill here on the floor.
  I am convinced that, if the Members will truly look at the bills, 
look at the bones and the sinews and the muscles, not just the clothing 
and the nice words, they will see that there is a significant 
difference. They should listen to the American Medical Association, and 
they should look at all the other groups that have looked at these 
bills and have said in very strong words the real patient protection 
bill, the bill that will help prevent situations like happened to this 
poor little boy is the Ganske-Dingell bill.
  I ask my colleagues over the July 4th recess to examine their 
consciences, to talk to some of the patients and the health care 
advocates and the health care professionals that have to deal with HMOs 
that make those types of arbitrary decisions that result in problems 
for patients.
  Talk to them over the July 4th recess. Listen to them. They represent 
an awful lot of people in my colleagues' districts. I believe that if 
my colleagues do, they will come to the conclusion that it is time to 
get this off the congressional calendar. It is time to join the Senate, 
to pass a bipartisan and a bicameral bill.
  Do not let it get hung up in committee, in a conference committee. 
Send it to the President's desk. I would love nothing better than for 
the President to look at the changes that we have done in the Senate 
debate and come to the conclusion that this bill, as I truly think it 
does, meets his principles and that he will sign it. That would be a 
very bright day for millions and millions of Americans.

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